The Right Way to Collect a Urine Specimen from a Patients with an Indwelling Catheter

[thehipcrip]

As someone who uses an indwelling urethral catheter for bladder management, I'm exceedingly frustrated by how few nurses (and doctors who are not urologists, for that matter) know the proper procedure for collecting a urine specimen from someone with an indwelling catheter.

I've had five orders for a UA written during recent visits to the ED and an admission for abdominal surgery. Not one of the four nurses or the ED doctor who came to collect the specimen knew the correct procedure, and only one (a marvelous RN) listened to me when I explained why the way she planned to take the sample would not yield accurate results and what needed to be done to collect a valid specimen.

So I'm curious. As a nurse, were you ever specifically taught how to collect a urine sample from patients who rely on indwelling catheters? If so, what were you taught? Did this teaching occur as this part of your nursing school curriculum or did you learn on the job from another nurse, doctor, or (gasp!) a patient?

[flyingchange]

We were taught to draw off the foley port, using a sterile syringe, after alcohol swabbing it. In the words of my clinical instructor, "the fresher the better"; i.e. clear the tube as best you can, clamp it off below the port, and then draw when new urine has collected there.

[KayRN910]

I agree with the poster above. The fresher the better. I have even unhooked it and let it drain in a sterile cup before.

However, I do disagree with your *gasp!* about learning from the patient. In the ER, people come with all sorts of things we aren't used to seeing or dont know the exact way the patient was told it should be done, so I have no problem asking,"when you do this at your home/doctors office/other hospital, ect, how do you do it?" I think I can use my judgement to see if it's along the correct lines.

I had a patient who had an odd looking condom cath. Had some tape stuff that went around it. Me and two other nurses weren't exactly sure what was going on with it, so we asked. I learned something new. Better that than faking it!

[whichone'spink, BSN, RN]

I have been taught to aspirate from the port with a sterile syringe after scrubbing the port with an alcohol swab. What were the nurses doing?

[MunoRN, RN]

I was taught to take it from the port (clear the line, clamp below the port, draw your sample aseptically after some urine has accumulated above the clamp). Although in practice, I have found that some Docs and even ID Docs prefer to get the sample from the bag. Their rationale is that it's all the same open system between the bladder and the bag, so any bugs in the bag should still be treated regardless of where they originated; (if there aren't bugs in your bladder but they are in the bag, they'll probably be in your bladder soon so antibiotic coverage is beneficial.) The esterase and WBC levels will also give in an indication as to whether the colonization is internal or external.

[deemalt, BSN, RN]

It may become very obvious that you are doing it wrong (ie taking sample from the bag) because many foley bags are actually bactericidal!

[GM2RN]

However, I do disagree with your *gasp!* about learning from the patient. In the ER, people come with all sorts of things we aren't used to seeing or dont know the exact way the patient was told it should be done,

Yeah, definitely an overreaction on the part of the OP. There is way too much to know to learn it all in nursing school, so NS teaches the basics. Much of what a nurse learns about nursing is on the job, but even after many years in the profession there is no way nurses or doctors can know everything about everything.

[Sun0408, ASN, RN]

I agree with the above posters.. I do it the same way.

[Trekfan]

We were taught to draw off the foley port, using a sterile syringe, after alcohol swabbing it. In the words of my clinical instructor, "the fresher the better"; i.e. clear the tube as best you can, clamp it off below the port, and then draw when new urine has collected there.

Ok as some that has one I would like to toss is my Yes in the hospitals with a sealed system this would be fine BUT heres the thing that most people are missing my night bag with the port is always reused IE i unhook it in the morning the end of the tube always ends up on the floor and so so on , my catheter is worse is full of contamated setament and drops all over the place and I have ever found a way to clean it . so I NOT call it clean eather pluse someone with a catheter alway has a uti anyway ? so taking it from any part of the catheter I think would be a bad idea .

[xtxrn, ASN, RN]

My :two cents: Drain visible urine from the tubing into the bag- no old juice, please :). Coil tubing back on bed, and wait for 15-20 minutes. Wipe port of Foley with alcohol. Aspirate urine from said swabbed port. Place used needle in sharps box and cap end of syringe with a sterile cap. If the lab won't take a syringe, place urine in a sterile specimen cup- label specimen and send to lab.

[Trekfan]

My :two cents: Drain visible urine from the tubing into the bag- no old juice, please :). Coil tubing back on bed, and wait for 15-20 minutes. Wipe port of Foley with alcohol. Aspirate urine from said swabbed port. Place used needle in sharps box and cap end of syringe with a sterile cap. If the lab won't take a syringe, place urine in a sterile specimen cup- label specimen and send to lab.

I think you won but you will have to check with the OP you are the olney one who said to clear the tube frist ! ! the last person I had used the needle port but they where sucking day old urine and stuff from the tube .

[Trekfan]

Adding a question in here maybe the OP can help with this one ? Is there anyway to clean the sediment out of the inside of a foley other then flushing ? Also any ideas on how to get a foley to stay connected to a bag once it has streched out and gotten old other then tape or sleeping in a diaper with it opened ?