To understand the indications for performing urinalysis
To perform urinalysis without contamination
Understand how to instruct a patient on obtaining a mid-stream sample
To be able to accurately record findings
Theory_and_background Theory and Background Indications for performing urinalysis It can be used as: Urinalysis may be routine as part of health check, well woman / well man clinic OR because it is indicated by patient history and presentation. There are a large range of sticks available, some are very specific eg. testing for glycosuria (the excretion of glucose into the urine). Many have multiple tests on each strip please check the test strips selected have the specific tests on that you require. What can you test for? Glucose is not normally present in the urine. Presence may be due to elevated blood glucose levels or reduced renal threshold. Protein (Albumin) albumin and globulin is normally in too low a concentration to give a positive reaction. False positive results occur in strongly alkaline urine. Abnormal proteinuria (the presence of an excess of serum proteins in the urine) is usually due to glomerular disease, which may be caused by a variety of conditions, including diabetes mellitus and hypertension. Blood suggests urological disease and/or urinary tract infection (UTI). Results may be false positive if the container is contaminated with menstruation, bleach, perianal skin, stale urine or povidone iodine. pH Value is usually slightly acidic within pH 5-6 (range 4.8 to 8.5). Lowest after overnight fast, highest after meals. Can be helpful when screening for renal disease, respiratory disease, certain metabolic disorders and specific therapeutic regimens, such as, sodium bicarbonate. Nitrites are not normally present; produced by gram negative bacteria converting nitrates to nitrites. Ideally specimen should be obtained about 4 hours after last passing urine (voiding). Indicates a UTI and if the patient is symptomatic should be sent for further testing. Ketones are abnormal urinary constituents, being breakdown products of fatty acid metabolism. Bilirubin indicates hepatic or biliary disease. Urobilinogen is normally present in urine, elevated levels may indicate liver abnormalities or excessive destruction of red blood cells. Urobilinogen tests should be considered with the bilirubin result to provide a differential diagnosis. A false negative result may be obtained from a stale sample. Leucocytes – A positive result suggests pyuria (pus in the urine) associated with a UTI. Isolated results may not be significant. Repeated positives should not be ignored – but be aware of possible sources of contamination or other factors which may limit sensitivity to this test. Specific Gravity (SG) sometimes called ‘density’. It is a laboratory test that measures the concentration of all chemical particles in the urine. Normal ranges given do vary between 1.001 -1.035 – so do check your product instructions carefully. Increased SG is seen in conditions causing dehydration, glycosuria, renal or heart failure or inappropriate antidiuretic hormone secretion or proteinuria. Decreased SG may be seen in excessive fluid intake or renal failure or pyelonephritis. Tests can be falsely positive or falsely negative so remember to be aware of other factors… Consider whether – The sample could have been contaminated? The patient’s medication could have affected the results or the sensitivity of the test? The patient’s condition could have affected the results or sensitivity of the test? Urine_collection There are different methods and ways of collecting urine, some are listed below; Routine sample of urine MSSU – mid stream sample of urine First Pass Urine– first few drops of urine, eg; in Chlamydia screening CSU – catheter specimen of urine EMU – early morning urine 24 hour urine Some methods of collection; Catheterised patients– (using needle free collection port) Images above supplied and permission granted by B. Braun Medical Ltd The collection process MSU is the recommended routine collection method. Periurethral cleaning is only recommended if the sample is to go for analysis (water is considered sufficient). The first part of voided urine is discarded and, without interrupting the flow, approximately 10mL is collected into a CE marked leak proof container, or a sterile pot and transferred to a sample bottle. The remaining urine is discarded. (Standards unit, PHE June 2017, pg 24) National guidance on this is below; https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/618126/B_41i8.2.pdf Urine dipstick analysis Before using CHECK Patient safety Procedure Check container Consider – Tests required? How to read the strip? Urine dipstick analysis You must put on a pair of gloves and a plastic apron prior to opening the sample container and wash your hands when you finish. Take a moment to consider the colour and turbidity (cloudiness of the urine) as these may be significant – and be linked to pathology or dietary and drug causes. Remove strip & close container Open the test strip container and remove a strip. Replace the top immediately Exposed strips absorb atmospheric moisture and renders the test zones inaccurate. Do not contaminate the strips by placing them on a table, use a clean surface or clean blue roll. Placing the dip stick in the urine sample Briefly (no longer than one second) dip the test strip into the urine to wet all the test zones. Compare analysis stick against colour scale Place the strip on a piece of clean blue roll. Compare test zones with the colour scale on the side of the strip container at the time indicated by the manufacturer. The colours are stable for at least another minute allowing plenty of time for reading. NOTE your results. Documenting_results There are different methods for documenting the results, for example; Legal Considerations All medical notes are written in BLACK pen (as are all legal documents) if not recorded electronically. All the following points should be documented: IF it isn’t recorded IT wasn’t DONE References_and_other_useful_resources Glossary MSSU – mid stream sample of urine First Pass Urine– first few drops of urine, eg; in Chlamydia screening CSU – catheter specimen of urine EMU – early morning urine http://www.whnt.nhs.uk/document_uploads/PatientInfo_Urology/mssurv.pdf
There are also many further types of devices that can be fitted to urine bottles to aid collection or urine can be collected in a sterile pot before transfer to a specimen bottle
Documenting results
DO…
Don’t …
References and useful resources
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