31. CCA Study Notes: Collecting Urine Specimens

The Big Picture

Urine samples are collected so they can be tested. The results help physicians identify a health problem or see how treatment is working.

Different urine samples require different collection methods. You need to know which urine to collect, when to collect it, and how to keep unwanted material out of the sample.

Correct labelling, storage, client privacy, safety, observation, reporting, and recording are also important parts of specimen collection.

Look for Nova Scotia CCA Notes throughout this page for current provincial guidance.

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Course Notes: Key Ideas You Need to Know

Why Urine Specimens Are Collected

Urine specimens are samples of urine collected for testing. Physicians use urine test results to make a diagnosis or evaluate treatment.

Several collection methods are used. The method depends on the type of specimen required.

Four Important Collection Methods

Specimen	Key Idea
Random urine specimen	Collected at any time with no special measures
Midstream specimen	Urine is collected from the middle part of voiding after cleaning the perineal area
24-hour urine specimen	All urine during a 24-hour collection period is saved after the first voiding is discarded
Infant or child specimen	A collection bag is used for an infant or child who is not toilet trained

Random Urine Specimen

A random urine specimen is collected for a urinalysis. No special measures are needed, and the specimen can be collected at any time.

Many clients can collect the specimen themselves. A client who is weak or very ill will need assistance.

Specimen collection may be difficult with very old clients, very young children, or people who cannot follow instructions. This can include clients with dementia or a severe mental health disorder.

Ask your supervisor for suggestions when you need help obtaining the specimen. Continue to protect the client’s dignity and privacy.

Midstream Specimen

A midstream specimen is also called a clean-voided specimen or clean-catch specimen.

The perineal area is cleaned before voiding. This reduces the number of microbes around the urethral area.

The client begins to urinate into the toilet, bedpan, urinal, or commode. The first urine is not collected. The client stops the urine flow, the sterile ⓘ specimen container is positioned, and the client begins urinating again into the container.

Stopping and restarting the urine stream can be difficult for some people. The CCA may need to hold the container in position to collect the specimen.

24-Hour Urine Specimen

A 24-hour urine specimen includes all urine voided during a 24-hour collection period.

The client’s first voiding on the day collection begins is discarded. After that, all urine voided during the next 24 hours is collected.

Keep the collected urine chilled on ice or refrigerated during the collection period. This helps prevent the growth of microbes.

Some tests require a preservative in the collection container. Nearly all 24-hour collection bottles contain a preservative. Do not pour the preservative out.

The client and staff need to understand the procedure and the collection period.

In home care, the client and primary caregiver will need to collect some of the specimen on their own. Make sure they understand what they need to do. Contact your supervisor if they are unsure.

Collecting Urine From an Infant or Child

For an infant or child who is not toilet trained, a collection bag is placed over the urethral area.

A parent or staff member will assist with applying the bag if the child is agitated ⓘ.

This collection method may also be adapted for clients who use wheelchairs or who are incontinent.

General Rules for Collecting Urine Specimens

These rules apply when collecting urine specimens:

• Explain the procedure thoroughly and obtain the client’s cooperation.
• Follow medical asepsis and Standard Practices.
• Wear gloves when collecting specimens.
• Use a clean container for each specimen.
• Use the correct container for the specimen being collected.
• Label the container accurately.
• Do not touch the inside of the container or lid.
• Collect the specimen at the specified time.
• Do not allow feces or toilet tissue to enter the specimen.
• Put the lid on the specimen container after collection.
• Place the container in a plastic bag for transportation.

Labelling the Specimen

The specimen container should include:

• the client’s full name
• the client’s address or room and bed number
• the date
• the time the specimen was collected

If preprinted labels are used, place the correct label on the container.

Correct labelling reduces the risk of the specimen being misplaced or confused with another client’s specimen.

Keep Feces and Toilet Tissue Out of the Specimen

Ask the client not to defecate during specimen collection. The urine specimen must not contain feces.

Used toilet tissue should go into the toilet or another place directed by the procedure. It must not contaminate the urine specimen.

Storage and Transportation

In a facility, take the specimen and requisition slip to the laboratory or storage area as directed.

In community settings, follow your supervisor’s instructions for storing the specimen. Tell the client or family where the specimen is stored. Follow your supervisor’s instructions for sending it to the laboratory.

Number to remember: Urine specimens must be kept cool and should be tested within 2 to 4 hours, unless a preservative has been added.

Nearly all 24-hour collection bottles contain a preservative. Do not pour it out.

What to Report and Record

Report and record required observations, including:

• difficulty obtaining the specimen
• urine colour
• urine clarity
• urine odour
• particles in the urine
• client complaints of pain, burning, urgency, dysuria, or other difficulties

Dysuria means painful or difficult urination.

Urinary urgency means needing to void immediately.

Urination means emptying urine from the bladder. It is also called micturition or voiding.

Promoting the Client’s Quality of Life

During specimen collection, promote:

• dignity
• independence
• individualized care
• preferences
• privacy
• safety

These principles apply throughout the random, midstream, and infant or child collection procedures.

Collecting a Random Urine Specimen

Pre-Procedure

1. Identify the client according to employer policy.
2. Explain the procedure to the client.
3. Practise proper hand hygiene.
4. Gather the required equipment:
   • bedpan and cover, urinal, or specimen pan
   • specimen container and lid
   • label
   • gloves
   • plastic bag

Identifying the client correctly prevents one client from being mistaken for another. Gathering the equipment before starting also prevents unnecessary trips away from the client.

Procedure

5. Label the specimen container.
6. Put the container and lid in the bathroom.
7. Provide privacy.
8. Put on gloves.
9. Ask the client to urinate into the bedpan, urinal, or specimen pan. Remind the client not to put toilet tissue into the urine collection receptacle.
10. Take the receptacle to the bathroom.
11. Measure the urine if I&O is ordered.
12. Pour about 120 mL (4 oz.) of urine into the specimen container. Dispose of extra urine in the toilet.
13. Put the lid on the specimen container. Place the container in a plastic bag.
14. Clean the receptacle and return it to the proper place.
15. Help the client with handwashing.
16. Remove your gloves and practise proper hand hygiene.

The plastic bag reduces the risk of splashing and pathogen transfer.

Post-Procedure

17. Provide for the client’s safety and comfort.
18. Place the call bell within reach when this applies.
19. Follow the care plan for bed rail use when this applies.
20. Remove privacy measures.
21. Practise proper hand hygiene.
22. Follow your agency’s policy or your supervisor’s instructions for storing and transporting the specimen.

The call bell and bed rail steps may not apply in community settings.

Keep the specimen cool. It should be tested within 2 to 4 hours unless a preservative has been added.

Report and record your actions, observations, and basic assessments according to employer policy. Recording and reporting this information serves legal purposes and keeps the rest of the health care team informed.

Collecting a Midstream Specimen

Pre-Procedure

1. Identify the client according to employer policy.
2. Explain the procedure.
3. Practise proper hand hygiene.
4. Gather:
   • a clean-voided specimen kit with antiseptic solution
   • a label
   • disposable gloves
   • sterile gloves if they are not included in the kit
   • a bedpan, urinal, or commode if needed
   • a plastic bag
   • an antiseptic wipe according to facility policy
   • supplies for perineal care

Preparing the Client and Sterile Equipment

5. Provide privacy.
6. Label the specimen container.
7. Put on gloves and provide perineal care. Remove the gloves and practise proper hand hygiene.
8. Open the sterile kit and use sterile technique.
9. Put on sterile gloves.
10. Pour the antiseptic solution over the cloth intended for perineal care.
11. Open the sterile specimen container. Do not touch the inside of the container or lid. Place the lid down with the inside facing upward.

Touching the inside of the container or lid can contaminate the specimen.

Cleaning for a Client With Female Genitalia

12. Clean the perineal area:
    1. Spread the labia with the thumb and index finger of your nondominant hand ⓘ.
    2. Treat that hand as contaminated. Do not use it to touch sterile items.
    3. Clean the urethral area from front to back.
    4. Use a clean corner of the cloth for every stroke.
    5. Keep the labia separated while collecting the specimen.

Using a clean area of the cloth for each stroke reduces the risk of contaminating the area with pathogens.

Cleaning for a Client With Male Genitalia

13. Clean the penis:
    1. Hold the penis with your nondominant hand.
    2. Begin cleaning at the urethral opening.
    3. Clean in a circular motion with the cloth intended for perineal care.
    4. Continue holding the penis until the specimen has been collected.

Treat the hand holding the penis as contaminated. It must not touch sterile items.

Collecting the Midstream Urine

14. Ask the client to begin voiding into the toilet, bedpan, commode container, or urinal. The beginning urine is discarded.
15. Ask the client to stop the urine flow.
16. Position the sterile specimen container. For a client with female genitalia, continue keeping the labia separated when possible.
17. Ask the client to begin voiding again and collect about 30 to 60 mL (1 to 2 oz.) of urine.
18. Remove the specimen container.
19. Release the labia or penis.
20. Allow the client to finish voiding into the toilet, bedpan, commode container, or urinal.
21. Put the lid on the specimen container. Touch only the outside of the container and lid.

The first urine is discarded because it may contain normal flora and other pathogens from the urethral area. Urine collected after the beginning stream is considered sterile.

Finishing the Procedure

22. Wipe the outside of the container with an antiseptic wipe according to facility policy.
23. Place the container in a plastic bag.
24. Give the client toilet tissue after the client finishes voiding.
25. Remove and empty the bedpan, commode container, or urinal when one was used.
26. Clean the equipment and return it to its proper place.
27. Remove gloves and practise proper hand hygiene.
28. Help the client with handwashing.
29. Practise proper hand hygiene again.

After a Midstream Collection

After collection:

• provide for safety and comfort
• place the call bell within reach when applicable
• follow the care plan for bed rail use when applicable
• remove privacy measures
• practise proper hand hygiene
• follow agency policy or supervisor instructions for storage and transportation

Report and record your actions, observations, and basic assessments according to employer policy.

Collecting a Urine Specimen From an Infant or Child

Pre-Procedure

1. Identify the child according to employer policy.
2. Explain the procedure to the child and the parents.
3. Practise proper hand hygiene.
4. Gather:
   • collection bag
   • wash basin
   • cloth intended for perineal care
   • bath towel
   • two diapers, including one with a 2.5-cm (1-in.) hole over the area of the urethra
   • specimen container
   • gloves
   • plastic bag
   • scissors

Gathering the equipment first keeps you from having to leave the child to retrieve missing items.

Applying the Collection Bag

5. Provide privacy.
6. Remove and dispose of the worn diaper. Treat it as contaminated.
7. Clean the perineal area. Use a new corner of the cloth for each stroke. Rinse and dry the area.
8. Practise proper hand hygiene.
9. Position the child on their back. Flex the child’s knees and separate the legs.

This is the best position for applying the urine collection bag.

10. Remove the adhesive backing from the collection bag.
11. Apply the collection bag to the perineum. Do not cover the anus.
12. Put a new diaper on the child.
13. Pull the collection bag through the 2.5-cm (1-in.) hole in the bottom of the diaper.
14. Practise proper hand hygiene.
15. Raise the head of the crib if allowed. This helps urine collect in the bottom of the bag.
16. Raise the crib rail.
17. Check the bag periodically to see whether the child has voided. Wear gloves and provide privacy when checking.

The bag should not cover the anus because the anal area is considered contaminated. Urine left on the child’s skin can irritate delicate skin tissue.

After the Child Voids

Collect the specimen as soon as possible after the child voids.

18. Provide privacy.
19. Put on gloves.
20. Lower the crib rail.
21. Remove the diaper.
22. Gently remove the collection bag.
23. Press the adhesive surfaces of the bag together, or transfer the urine to the specimen container through the drainage tab.
24. Clean the perineal area. Rinse and dry it well.
25. Put a new diaper on the child.
26. Remove gloves and practise proper hand hygiene.

Cleaning the skin removes old urine that could irritate the child’s delicate skin.

Post-Procedure for an Infant or Child

27. Provide for safety and comfort. Raise the crib rail.
28. Remove privacy measures.
29. Write the requested information on the specimen container. Place the container in the plastic bag.
30. Clean and return reusable equipment to its proper place. Discard disposable items. Wear gloves for this step.
31. Practise proper hand hygiene.
32. Follow your supervisor’s instructions for storing and transporting the specimen.

Report and record your actions, observations, and basic assessments according to employer policy.