Collecting urine

Two types of urine specimens collected

  • First-void urine
    • First 20mL of urine stream. Can be collected any time of day but best collected first thing in the morning or at least 4 hours after last urination
    • NAAT to test for gonorrhoea, chlamydia, and trichomonas
  • Mid-stream urine (MSU)
    • Urine collected after allowing first part of urine stream to pass into the toilet. Usually need about 20mL
    • Albumin creatinine ratio (ACR) — protein secreted into urine from kidneys
    • Microscopy, culture and sensitivity (MC&S) — shows bacteria in urine

If collecting urine for drug screening — follow same procedure as MC&S —doesn't have to be mid-stream

Attention

  • Store urine dipsticks at less than 30°C and low humidity. May need to be in air-conditioned room
  • If it takes 12 hours or more for urine sample to reach pathology — also use dip slide for MC&S
  • Do ACR when person well. Best in morning after fasting — less false positive results from protein meals, exercise, infection
  • For MC&S you need plain urine, may also need dip slide, stained sample
  • Won’t need all these tests every time — check which ones you need
  • Give person paper bag to carry urine containers through public areas in clinic

Collecting specimens from older children and adults

What you need

  • Private toilet area for person to pass urine
  • Clean gauze swabs/sterile saline wipes
  • Sterile water
  • Clean paper towel
  • 2 x yellow top sterile specimen jars labelled ‘1’ and ‘2’ — Figure 5.27

Figure 5.27  
  • Paper bag to carry collected specimen 
  • If delay of 12 hours or more before reaching pathology
    • Dip slide
    • 5mL plain sterile container
    • Formalin solution
    • Pipette

What you do

Ask person to

  • Wash genital area with gauze swabs or sterile saline wipes, rinse with sterile water, dry with clean paper towel
  • Catch first lot of urine in jar 1 (about 20mL)
  • Catch second lot of urine in jar 2 (about 20mL)

For NAAT to test for gonorrhoea, chlamydia, trichomonas (jar 1)

  • At least 8mL of urine in jar 1
  • Store and transport under refrigeration

For MC&S (jar 2)

  • Plain sample — at least 8mL of urine in jar 2
  • Dip slide (if needed) is POC Test agar plate, its purpose is avoiding misleading impressions produced by growth of organisms in urine sample between collection and arrival at laboratory
    • Pipette small amount of urine from jar 2 over dip slide, screw top on tightly
  • Stained sample (if needed) is a method to find cancer cells, renal (nephron/tubular) cells in the urine
    • Pipette 5mL urine from jar 2 into 5mL plain sterile container, add 3 drops of formalin, screw top on tightly
    • OR pipette urine into urine stain tube if available
  • Make sure all samples are correctly labelled
  • Store and transport jar 2 and the 5mL container under refrigeration
  • Store and transport dip slide at room temperature

Finger tap method for newborns and young babies

  • Safe and easy method of urine collection using bladder stimulation
  • Can use for babies up to 6 months old — depending on how heavy they are

Attention

  • Baby should have a good feed 15–20 minutes before trying this procedure
  • Babies often wee when genital area cleaned — be ready to catch some

What you need

  • 2 practitioners
  • Soap and water for washing genitals
  • Clean gauze swabs or cotton wool balls
  • Sterile water for rinsing
  • Clean paper towel
  • Sterile specimen jar
  • If delay of 12 hours or more before reaching pathology —
    • Dip slide
    • 5mL plain sterile container
    • Formalin solution
    • Pipette

What you do

  • Wash genital area well with soap and water using clean swabs or cotton wool balls
    • For boys — gently pull back foreskin (don’t force it)
    • For girls — clean gently around labial folds
  • Rinse well with sterile water, dry well with clean gauze swab or paper towel
  • First practitioner holds baby up by underarms, legs dangling
  • Second practitioner uses 1 or 2 fingers to gently tap the suprapubic area at a rate of 100 taps per minute for 30 seconds — Figure 5.28

Figure 5.28  
  • If baby doesn’t pass urine — gently rub lower back (lumbar area) in circular motion for 30 seconds — Figure 5.29
  • Alternative method is to gently rub the lower abdomen for a few minutes using a circular motion with a gauze soaked in cold water with specimen jar ready to catch urine
  • Repeat until mid-stream sample is caught — Figure 5.30. Usually within 5 minutes

Figure 5.29  

Figure 5.30  
  • If finger tap method doesn't work —
    • Give baby another feed and try again