Urine sample from ileal conduit?

[gc13]

I work in an acute rehab and was taking care of a patient with an ileal conduit. When ambulating with the patient to the bathroom, she complained of feeling really tired, weak, and wasn't walking as well as she had a few days before when I last worked with her. But she was still able to walk and toilet with 1 assistance. When she finished on the toilet, I took her vitals. BP 70s/40s, HR 140, temp 99.something and SpO2 98. I immediately paged the MDs. They came to see her and ordered fluids, labs and urine and blood cultures. All orders were completed which meant obtaining urine cultures from the ileal conduit. The ileal conduit was in an ostomy bag that was connected to a longer urine collection bag for when the patient was in bed asleep so we wouldn't have to empty her ostomy bag as frequently. I collected the urine sample from the ostomy bag rather than the larger collection bag to reduce contamination. Labs came back and her WBCs since the two days that she last had labs collected went from 9 to 29. The doctors and I went into presumed sepsis mode and transferred the patient to the ICU. Thankfully, the ICU was able to get the patient back to us in the clear after a few days. Two weeks later, I get a call from infection control asking for details about how I collected the urine sample. I explained how I collected the sample and was told that I should have straight cath'ed the ileal conduit for the most accurate sample (I didn't even know that was possible). The call ended with them telling me that there will be some follow up encounters. My unit educator was on the call and told me not to worry, but I cant help but worry. What are potential outcomes of this scenario?

[NRSKarenRN, BSN, RN]

Good refresher for when catheter is available/ not available (eg. outpatient settings).....

Best Practice Guideline: Obtaining Urine Specimen from Ileal Conduit/Urostomy

Quote

• The most accurate method of collecting a urine sample for culture, according to limited sources, is the use of a double lumen sterile catheter inserted directly into the stoma.
• Specimens for culture should never be obtained directly from the urostomy pouch or bedside drainage bag.

[JKL33]

My guess is that they called simply gather information in order to arrange follow-up education.

It's important to keep in mind that while you did not use the correct procedure for obtaining urine from a urostomy, nothing you did caused the patient's vital signs to change/worsen and nothing you did caused the serum WBC to jump from 9K to 29K.

Here's the problem (just stuff to think about): There are several possible causes (including sepsis) for what you first noticed with your patient, and if we send a urine sample that is essentially contaminated, it doesn't help narrow down what is causing the change in condition and may lead to inappropriate treatments.

One thing you can do if faced with a situation that is clearly different than what you are used to (such as the need to obtain a sample from a urostomy) is see if your facility has a policy that addresses it. If they don't, use your resources: Check a nursing procedure reference (electronic), consult with your peers or supervisor on duty. Check with your lab personnel. You could even call a different department/floor or two, like one of the M/S floors or ED, etc. Worst case, google it.

You did a great job advocating for this patient right away, BTW! ???