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
• 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 • Pale
• Desferal • Red
• Paraflex (muscle relaxant) • Red
• L-dopa (for parkinsonism) • Red then brown
• Flagyl • Reddish brown
• Nitrofurantoin • Brown-yellow
• Riboflavin • 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 centrifugation decantation

collection

Report

slide preparation
writing report microscopy