How to collect a urine sample for analysis from a patient with a long-term urinary catheter (indwelling catheter) and hypospadias who has discharge around the catheter site after a recent catheter change?

From the Guidelines

To collect a urine sample for analysis from a patient with hypospadias who has a long-term catheter with discharge around it, the best approach is to obtain a fresh specimen directly from the catheter after allowing for urine accumulation while plugging the catheter, as recommended by the AUA/SUFU guideline 1. When collecting the urine sample, it is essential to follow proper techniques to minimize contamination.

• Clamp the drainage tube for 15-30 minutes to allow urine to collect in the bladder.
• Clean the sampling port on the catheter with an alcohol swab.
• Use a sterile needle and syringe to withdraw 5-10 mL of urine from the port.
• Transfer this urine immediately to a sterile specimen container. It is crucial not to collect urine from the extension tubing or collection bag, as stated in the guideline 1, to avoid contamination. If the catheter has no sampling port, briefly disconnect the catheter from the drainage tube (after cleaning the connection point with alcohol), collect the urine in a sterile container, and reconnect immediately. The presence of discharge around the catheter suggests possible infection, so collecting a clean sample is crucial for accurate results. The sample should be sent to the laboratory within 30 minutes or refrigerated if there will be a delay. This method avoids contamination from the discharge around the catheter insertion site, which could affect test results. In residents with long-term indwelling urethral catheters and suspected urosepsis, it is recommended to change the catheter prior to specimen collection and institution of antibiotic therapy 1. However, in this case, the catheter was changed one day ago, so it is not necessary to change it again before collecting the urine sample. The guideline from the Infectious Diseases Society of America 1 provides additional recommendations for the evaluation of fever and infection in older adult residents of long-term care facilities, but the AUA/SUFU guideline 1 is more relevant to this specific situation.

From the Research

Collecting Urea Sample for Analysis

To collect a urea sample for analysis from a patient with a long-term catheter and hypospadias, it is essential to follow proper procedures to avoid contamination and ensure accurate results.

• The patient's catheter was changed one day ago, which is a crucial factor to consider when collecting the sample.
• According to the study 2, nurses should not collect urine samples by draining directly from the drainage bag, as this can lead to contamination.
• Instead, the sample should be collected using a sterile technique, such as inserting a needle into the catheter tubing or using a urine collection device specifically designed for catheterized patients 3.
• It is also important to consider the type of catheter used, as some materials may be more prone to causing urinary tract infections (UTIs) than others 4.
• The study 5 highlights the importance of using appropriate urine collection methods to diagnose UTIs in patients with hypospadias.

Considerations for Patients with Hypospadias

Patients with hypospadias are at a higher risk of developing UTIs, especially after urethroplasty 5.

• The study 6 discusses the long-term complications of hypospadias repair, including urinary tract symptoms and sexual and cosmetic issues.
• When collecting a urea sample from a patient with hypospadias, it is essential to be aware of these potential complications and take steps to minimize the risk of UTIs.
• The use of latex catheters may be safe for short-term urinary catheterization in patients without latex hypersensitivity 4.

Best Practices for Urine Collection

Best practices for urine collection include using a sterile technique, avoiding contamination, and following evidence-based guidelines 2, 3.

• Nurses play a crucial role in collecting urine samples and should receive education and training on proper techniques to minimize the risk of UTIs and ensure accurate results 2.
• The study 3 provides an overview of the current indications, complications, and management of indwelling urinary catheters, highlighting the importance of proper care and maintenance to prevent complications.