Examination-of-body-fluids-urinalysis.pptx

Urine Specimen Collection Ms. Sneha Sehrawat

• Health is a state in which the individual has complete health in all dimensions including his physical, mental, social and spiritual. When a child or an individual is not healthy, the disease occurs and these diseases may present with certain clinical manifestations. In order for the diagnosis of a particular disease, the clinical manifestation of the disease does not give the complete picture.

We need to perform certain diagnostic measures for the confirmation. For these diagnostic measures, certain may require collection of specimen from our body. This specimen that is collected may be blood, sputum, stool or feces. In-order to make sure that the diagnostic measures are accurate, certain guidelines has to be followed, certain protection measures have to be taken. So the collection of urine specimen is dealt in detail in this.

COLLECTION OF URINE SPECIMEN Urine has a long rich history as a source for measuring health and well-being and remains an important tool for clinical diagnosis. The clinical information obtained from a urine specimen is influenced by the collection method, timing and handling.

Urine Collection Random Specimen : This is the specimen most commonly sent to the laboratory for analysis, primarily because it is the easiest to obtain and is readily available. This specimen is usually submitted for urinalysis and microscopic analysis.There are no specific guidelines for how the collection should be conducted; avoiding the introduction of contaminants into the specimen is recommended.

First Morning Specimen : This is the specimen of choice for urinalysis and microscopic analysis, since the urine is more concentrated. It is also called an 8-hour specimen. The first morning specimen is collected when the patient first wake up in the morning, having emptied the bladder before going to sleep. Proper collection practices and accurate recording of the collection time are important criteria or a first morning specimen.

Mid Stream clean catch specimen : This is the preferred type of specimen for culture and sensitivity testing because of the reduced incidence of cellular and microbial contamination. Patients are required to first cleanse the urethral area with a gentle soap toilette. The patient should then void the first portion of the urine stream into the toilet. The urine midstream is then collected into a clean container. Any excess urine should be voided into the toilet. This method of collection can be conducted at any time of the day or night.

Timed collection specimen: A timed specimen is collected to measure the concentration of these substances in the urine over a specified length of time, usually 8 or 24 hrs. In this method, the bladder is emptied prior to beginning the timed collection. Then, for the duration of the designated time period, all urine is collected and pooled into a collection container, with the final collection taking place at the very end of that period. The specimen should be refrigerated during the collection period. Accurate timing is critical.

Catheter collection specimens: This assisted procedure is conducted when a patient is bedridden or cannot urinate independently. The healthcare provider inserts a Foley catheter into the bladder through the urethra to collect the urine specimen. Specimens may be collected directly from a Foley into an evacuated tube or cup. This is not much practical as the chance of urethral trauma is more and more expertise is needed.

Urine Container • • • • •

Wide mouth (4 - 5 cm) Sufficient volume (50 ml preferred) Glass or plastic with no additives Leak-proof Sterile, if specimen is stored for a period of time before testing

Procedure • Assess the voiding status of client • Assess Client’s understanding of purpose of test and method of collection • Explain the procedure to client • Provide fluids to drink ½ hour before collection unless contraindicated • Provide privacy for client by closing door or bed curtain • Give client or family members soap, washcloth and towel to cleanse perineal area.

• perform hand hygiene and apply non sterile gloves and assist non ambulatory clients with perineal care. Assist female client onto bedpan • using sterile asepsis, open sterile kit ,apply sterile gloves after opening sterile specimen cup, placing cap with sterile inside surface up and do not touch inside of container or cap • pour antiseptic solution over cotton balls or gauze pads unless kit contains prepared gauze pads in antiseptic solution

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Assist or allow client to independently cleanse perineum and collect specimen A. Female • Spread labia with thumb and forefinger of non dominant hand • Cleanse area with cotton ball or gauze, moving from front to back • While continuing to hold labia apart, client should initiate stream and after stream is achieved ,pass container into stream and collect 30 to 60 ml

• B. Male • Hold penis with one hand and using circular motion and antiseptic swab, cleanse end of penis, moving from center to outside. In uncircumcised men, the foreskin should be retracted before cleansing • After client has initiated urine stream, pass specimen collection container into stream and collect 30 to 60 ml

Need of Urinalysis An indicator of health or disease, especially with metabolic and renal disorders. • At pre-employment medical examinations • Routinely at physician office and medical clinics • Annual medical examination

What are the potential changes in Unpreserved urine?

Potential Changes in Unpreserved Urine

Physical changes Colour- bilirubin - biliverdin hemoglobin - methemoglobin Clarity - Decreased due to bacterial proliferation,solute precipitation Odour - Increased due to bacterial proliferation and decomposition

Potential Changes in Unpreserved Urine

Chemical Changes pH - Increased or decreased Glucose - decreased Ketones - decreased Bilirubin - decreased Urobilinogen - decreased Nitrite - increased or decreased

Potential Changes in Unpreserved Urine

Microscopic Changes RBC, WBC, Casts *decreased due to disintegration especially in alkaline urine Bacteria *increased due to bacterial proliferation

Urine Examination

Preservatives Most preservatives prevent bacterial growth and loss of glucose (eg. formalin) No preservatives can prevent destruction of bilirubin, urobilinogen or occult blood.

Urine Examination No single urine preservative is available NCCLS recommends that it be analyzed within 2 hours. Refrigeration can induce precipitation of amorphous urates and phosphate crystals that can interfere substantially with microscopic examination

Urine Examination • Physical Examination • Chemical Examination • Microscopic Examination

Urine - Physical Examination • Colour - urochrome, urobilin, uroerythrin • Clarity Clear Slightly cloudy Cloudy Turbid

• Odour

Physical Tests • Color Normal color range from straw, pale yellow, to amber. Abnormal color: red - RBCs beer-brown - bilirubin orange, blue, green - drug, dye or food

Urine color changes with commonly used drugs • • • • • • •

Alcohol Desferal Paraflex (muscle relaxant) L-dopa (for parkinsonism) Flagyl Nitrofurantoin Riboflavin

• • • • • • •

Pale Red Red Red then brown Reddish brown Brown-yellow Bright yellow

Physical Tests • Turbidity Normal is essentially clear. Cloudy urine: amorphous salts - non pathologic bacteria, blood cells - pathologic

Chemical Examination

Urinalysis - Analysis technique Urinalysis Physical examinations Volume - average of 1.0 to 1.5L of urine excreted per day Amount excreted is an indicator for diuretic disorder Polyuria: More than 2000ml urine/day Oliguria: Less than 500ml urine/day Anuria : Less than 200ml urine/day Dysuria: No urinary excretion

Instrumentation

Dipstick - Care and Storage • • • • •

Store in original container Do not expose to light, heat and moisture If there is any colour change, discard Do not use pass expiration date. Store at manufacturer recommended temperatures

Dipstick – Testing Shortfall

• Aware of false-positive and false-negative!

Microscopic Examination

Sediment examination • Most common laboratory procedure utilized for the detection of renal and/or urinary tract disease • numerous morphologic entities – blood cells, epithelial cells, organisms

• correlate with the biochemical results – dipsticks – clinical condition of the patient

Procedure for Urine Microscopy

sample collection

centrifugation

decantation

Report slide preparation writing report

microscopy