Urinary Sample Collection Methods in Ileal Conduit Urinary Diversion Patients: A Randomized Control Trial.

PURPOSE: The purpose of this study was to compare bacteriological urinalysis findings using 3 urinary sample collection methods (clean stoma catheterization, urine dripping from the stoma, urine collected from the clean urostomy pouch) in ileal conduit urinary diversion patients. DESIGN: Randomized controlled trial. SAMPLE AND SETTING: Twenty-seven patients with ileal conduit urinary diversion from an outpatient urology clinic were enrolled; 9 patients were seen twice, for a total of 36 subjects and comparisons. METHODS: Data were collected during a clinic visit by a trained research nurse. Patients were randomized into 2 groups: group A had the first urine sample collected by clean stoma catheterization, followed by sample collection by urine dripping from the stoma; group B had the first urine sample collection by urine dripping from the stoma, followed by sample collected by clean stoma catheterization. All patients had a third urine sample collected from a factory-clean urostomy pouch. Bacteriological urinalysis findings were compared among methods. Descriptive analyses were summarized using mean, percentage, and frequency. The mean ages of the patients between the groups were compared with the t test. Other between-group comparisons were performed using the Fisher exact test. Urinary culture finding differences among the same patients were evaluated using the McNemar test. Sensitivity and specificity of the different urine sample collection methods were calculated assuming urine sample collection by catheterization as a reference method. RESULTS: Uropathogen bacteria were detected in urinary culture in 16 of 36 samples (44%) collected by clean stoma catheterization, 15 of 36 samples (42%) collected by urine dripping directly from the stoma, and 13 of 35 samples (37%) collected from the clean urostomy pouch. Significant differences among the urine collection methods were not detected. Assuming catheterization as the most reliable method of sample collection, the sensitivity and specificity of the urine dripping from stoma collection method were 81.3% and 90.0%, respectively. The sensitivity and specificity of the urostomy pouch collection method were 73.3% and 90.0%, respectively. Among the same patients, there were no significant differences in the incidence of uropathogen bacteria when clean stoma catheterization was compared with urine dripping from the stoma and urostomy pouch methods. CONCLUSION: This study provides clinically relevant information regarding urine collection methods in ileal conduit patients. Urinary sample collection by urine dripping directly from the stoma or collected from a clean urostomy pouch provided similar uropathogen bacteria findings compared with sample collection by clean stoma catheterization.

Uso de las tiras de orina / Using urinary strips

Introducción. El análisis de orina con tiras reactivas es una prueba muy usada en la clínica. Su uso más habitual es de confirmar o excluir la sospecha de infección de orina, pero también son útiles en la gestión de otras enfermedades. Desarrollo. Las tiras de orina más usadas disponen de 10 reactivos: leucocitos, nitritos, pH, glucosa, proteínas, cuerpos cetónicos, bilirrubina, urobilinógeno, densidad y sangre, para un análisis cualitativo y semicuantitativo de las muestras de orina. Se sumergirá en la muestra de orina y, tras esperar el tiempo indicado en el envase, se podrán interpretar los resultados, siempre teniendo en cuenta que hay un gran número de falsos positivos y negativos y que los resultados están influenciados por múltiples factores. Discusión. El uso más extendido de las tiras de orina es como ayuda diagnóstica ante la sospecha de infección, aunque la clínica nos oriente en gran medida. La probabilidad de tener infección de orina si hay disuria, frecuencia y urgencia miccional, hematuria, dolor suprapúbico y sensibilidad en la pelvis es de un 90 %. Si hay únicamente disuria y urgencia o frecuencia miccional la probabilidad disminuye a un 70-80 %, y si solo hay disuria, a un 25 %. Conclusiones. Las tiras de orina son un método rápido, fácil y barato para el diagnóstico y seguimiento de enfermedades, pero sus resultados son muy heterogéneos y están influenciados por factores externos, por lo que deben interpretarse con cautela. La sensibilidad y especificidad de las tiras de orina es muy variable según los estudios (S 46 %-86 % y E 17 %-93 %). Aunque los mayores valores diagnósticos se producen en las consultas de Atención Primaria, donde se estudia a una población más variada y se hace un mayor uso de las tiras, también es donde se requiere un mayor trabajo de diagnóstico diferencial por los numerosos falsos positivos. Se precisan más estudios con mayores especificaciones de los criterios seguidos y de las poblaciones estudiadas para llegar a determinar la verdadera sensibilidad y especificidad de las tiras de orina (AU)

Introduction. Urinalysis using reactive strip is a commonly used in clinical practice. Although mainly indicated as first step test when a urine infection it suspected, it may also be a helpful tool in the management of a wide range of disorders. Development. Standard urine test strips may comprise of up to 10 different chemical pads or reagents (leukocytes, nitrites, pH, glucose, proteins, ketones, bilirubin, urobilinogen, density and blood) that allow a qualitative and semiquantitative analysis of a urine sample. The test method consists of immersing the strip completely in a well-mixed sample of urine and left to stand for the time necessary for the reactions to occur (which is variable depending on the manufacturer). Finally the colors that appear are compared against a specific chromatic scale provided. Several factors may influence the results causing a significant number of false positives and negatives. Such limitations should always be taken into account when reading the test. Discussion. Despite clinical features lead to the suspicion of an infection, urine test strips is a fast screening test that may reinforce the diagnosis. The combination of dysuria, frequency and emergency, hematuria, pain and sensibility in the pelvis reaches a positive predictive value to identified a urine infection of 90 %. When only dysuria and emergency or high frequency are present, the such probability diminishes to 70-80 %, and, when dysuria is the only symptom, it drops to 25 %. Conclusions. Despite urine test strips is a fast, easy and cheap method for the diagnosis and follow-up of several diseases, results are fairly heterogeneous and may be influenced by external factors. Therefore a cautious interpretation if advised. Sensibility and specificity of urine test strips is widely variable (S 46 %-8 6% and E 17 %-93 %). Although the highest diagnostic values are obtained at primary care centers, where such tests are routinely used in a diverse population, the number of false positives is still high. This issue should be taken into account and a proper differential diagnosis of a positive result is mandatory in all cases (AU)

How to perform a urinalysis.

RATIONALE AND KEY POINTS: This article aims to help nurses to undertake a urinalysis in a safe, timely, effective and patient-centred manner, ensuring privacy and dignity. Urinalysis is a common clinical procedure involving examination of urine to detect problems in the body. ▶ Urinalysis should be carried out by competent healthcare practitioners. ▶ Urinalysis is a simple, cost-effective tool which can be performed for screening, diagnosis and management of conditions, because urine might undergo several changes as an individual becomes unwell. ▶ Urinalysis is an essential component of the holistic and symptomatic assessment of any individual in poor health. ▶ The healthcare practitioner should explain the procedure to patients. ▶ The healthcare practitioner should document relevant findings. REFLECTIVE ACTIVITY: Clinical skills articles can help update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. How reading this article will change your practice. 2. The learning points you have identified, and how you can dissesminate these points to your colleagues. 3. Any further learning needs you have identified. Subscribers can upload their reflective accounts at: rcni.com/portfolio.

Recogida de urocultivo por sondaje vesical en niños: una observación sistemática / Coleta de urocultura por sonda vesical em criança: uma observação sistemática / Collect of uroculture by urinary catheter in child: a systematic observation

La infección urinaria se caracteriza por la invasión de microorganismos en el tracto urinario, siendo una de las patologías más frecuentes en todos los grupos de edad, especialmente en niños. El urocultivo se considera el método estándar-oro para el diagnóstico de laboratorio, ofreciendo un alto valor predictivo positivo, si se garantiza una técnica aséptica durante la recolección. El estudio de tipo evaluativo, prospectivo y cuantitativo, tiene por objeto comparar los resultados de los urocultivos por sondaje vesical recogidos por enfermeras del Ambulatorio y Enfermería de un Hospital Universitario Pediátrico teniendo en cuenta el material y la técnica utilizada en el procedimiento.La población de estudio consistió en 12 enfermeros, 4 residentes y los resultados de 300 muestras de cultivos de orina en el período junio-agosto de 2012. Los datos fueron recolectados a través de la observación sistemática y la documentación técnica. Los resultados mostraron una mayor contaminación del procedimiento en la enfermería (13,3%) que en el Ambulatorio (1,3%), donde se utilizó kit específico de urocultivo (AU)

A infecção urinária se caracteriza pela invasão de microrganismos no trato urinário, sendo uma das patologias mais frequentes em todas as faixas etárias, principalmente, em crianças. A urocultura é considerada o método padrão-ouro de diagnóstico laboratorial por oferecer alto valor preditivo positivo, se garantida uma técnica asséptica durante a coleta da urina. O estudo do tipo avaliativo, prospectivo e quantitativo objetivou comparar os resultados das uroculturas por sonda vesical coletada por enfermeiros do Ambulatório e Enfermaria de um Hospital Universitário Pediátrico, considerando o material e a técnica utilizada no procedimento. A população estudada foi composta por 12 enfermeiros, 4 residentes de enfermagem e pelos resultados das 300 amostras das uroculturas no período de junho a agosto de 2012. Os dados foram coletados mediante observação sistemática e técnica documental. Os resultados apontaram maior contaminação do procedimento na Enfermaria (13,3%) do que no Ambulatório (1,3%), onde se utilizou kit específico de urocultura

Urinary tract infection is characterized by invasion of microorganisms in the urinary tract, one of the most frequent pathologies in all age groups, especially in children. The uroculture is considered the gold standard method of diagnosis for offering high positive predictive value, if guaranteed aseptic technique during the urine collected. The assessment study, prospective and quantitative aimed to compare the results of urine cultures for catheter collected by nurses in the clinic and infirmary of a University Hospital Pediatric, considering the material and the technique used in the procedure. The study population consisted of 12 nurses and 4 nursing home residents and the results of 300 samples of uroculture in the period June-August 2012. Data were collected through systematic observation and technical documentation. Results showed higher contamination procedure Infirmary (13.3%) than in the Clinic (1.3%), which we used urine specific kit (AU)

Urinalysis: a review of methods and procedures.

There is much value in using urine as a diagnostic aid in the critical care setting. As a noninvasive source of data, urine reveals a wealth of information about the body's biochemical status. It is important for critical care nurses to understand the processes that occur in the renal system and to comprehend the depth of information that can be obtained through an analysis of urine. This discussion provides an overview of common urine tests and provides information for nurses about urine collection methods. The discussion will help the critical care nurse describe various urine test procedures, common urine collection methods, nursing interventions, and patient education important to each study.

Emergency department visual urinalysis versus laboratory urinalysis.

OBJECTIVE: The primary objective of this study was to compare the results of nurse-performed urinalysis (NPU) interpreted visually in the emergency department (ED) with laboratory performed urinalysis (LPU) interpreted by reflectance photometry. METHODS: This was a prospective observational study based on a convenience sample from my emergency practice. Emergency nurses, who were unaware of the study, performed usual dipstick analysis before sending the same urine sample to the laboratory for testing. RESULTS: Of 140 urinalyses performed during the study period, 124 were suitable for analysis. When compared with the reference standard LPU, the NPU had an overall sensitivity of 100% (95% confidence interval [CI] 95%-100%) and a specificity of 49% (95% CI 33%-65%) for the presence of any 1 of blood, leukocyte esterase, nitrites, protein, glucose or ketones in the urine. Of 20 falsely positive NPUs, 18 were a result of the nurse recording 1 or more components as "trace" positive. CONCLUSION: Although NPU does not yield identical results to LPU, a negative LPU is expected when the initial NPU in the ED is negative.

Urine collection in infants and children.

June Rogers and Caroline Saunders review current evidence and best practice regarding obtaining a urine specimen from children.

Comparison of sampling methods for urine cultures.

PURPOSE: To compare efficacy and cost of conventional and alternative sampling methods concerning urine cultures. DESIGN AND METHODS: An experimental study with two replications was carried out in a 900-bed university hospital in Ankara, Turkey. The sample was 160 hospitalized female patients, who were asked to give urine specimens, September 10,2000 and September 1,2001. They were patients on urology and obstetrics and gynaecology wards. The authors informed the patients about the study first and then obtained two samples from each patient under their observation. The number of specimens was 320. Statistical methods were descriptive. FINDINGS: The rates of contamination and significant growth, respectively, were 4.4% and 7.5% for the conventional method and 5.6% and 10% for the alternative method. The cost per culture was 2.588.257 TL (2.10 USD) for the conventional method and 57.021 TL (0.05 USD) for the alternative method. The cost difference was statistically significant. CONCLUSIONS: The two methods yielded similar results but the alternative method was less expensive.

Anatomy and physiology of urinary elimination. Part 1.

Elimination of urine is an essential bodily function, but independence in this activity may be affected by physical and mental disability. Part 1 of this article discusses the anatomy and physiology of the renal and urinary tract and the production of urine. Urinalysis is a vital nursing assessment and the collection of specimens and the range of tests undertaken are outlined. Assisting patients to use the toilet, commode or bedpan is an essential nursing skill. The importance of sensitivity, empathy and moving and handling risk assessment is discussed, and the assessment and management of urinary tract infection and urinary tract stones are addressed. The importance of prevention of cross infection for nurses and patients is highlighted throughout the article.

The management of in vitro diagnostic point-of-care testing.

In vitro diagnostic point-of-care testing (IVDPCT) can improve patient care but improvements can only be properly realised by adequate management in order to ensure high-quality test results. Nurses perform IVDPCT in all areas of clinical practice, from intensive care units to GP surgeries, using a wide variety of devices ranging from urinalysis strips to blood gas analysers.

Limitations of urinary pH monitoring in long-term catheter users.

Weekly measurement of urinary pH has become a standard part of long-term catheter management in many parts of the UK. The common problem of catheter encrustation is caused by urease-producing bacteria which also tend to produce alkaline urine. To determine if urinary pH changes in individual catheter users provided enough information for pH monitoring to aid in catheter management, an analysis of the literature was combined with a study of the urinary pH and catheter blockage patterns in 20 catheter users colonized with urease-producing bacteria. It was found that weekly pH measurement does not aid in the diagnosis or management of catheter encrustation. As such, this practice cannot be recommended.

Are true-negative nitrite results affected by a two-hour delay in dipstick/pad analysis of urine in incontinence pads?

OBJECTIVES: To determine if true-negative nitrite results of a urine dipstick pressed into an incontinence pad (dipstick/pad method) are affected by a 2-hour delay in analysis. DESIGN: A quantitative study. SETTING AND SUBJECTS: Clean-catch urine specimens from a convenience sample of clinic patients, staff, and long-term care facility residents. INSTRUMENT: Changes from negative to positive for each group of urine specimens were evaluated using percentages within the groups. METHODS: Urine specimens were collected and a portion was cultured. Urine specimens negative for a urinary tract infection were included in the study. A portion of the specimen was poured into an incontinence pad. Initial nitrite results were determined using a dipstick pressed into an incontinence pad. Pads with true-negative dipstick/pad nitrite results were tested 2 hours later in the same manner. Urine culture results determined groups: mixed colonies; 50,000 to 75,000 colony-forming units per milliliter of a single type of uropathogen; greater than or equal to 50,000 cfu/mL diphtheroids; no significant growth; and no growth. RESULTS: Of the 443 urine cultures negative for a urinary tract infection, 441 initial dipstick/pad nitrite results were negative. Two initial true-negative nitrite dipstick/pad results, or 0.5%, changed from negative to positive over the 2-hour period: 1 in the "mixed colonies" group (0.4%) and 1 in the "no growth" group (0.7%). CONCLUSIONS: Results of this study indicate that true-negative nitrite results of a dipstick pressed into urine in an incontinence pad do not appear to be affected by a 2-hour delay in analysis.

Use of a urine color chart to monitor hydration status in nursing home residents.

To determine whether urine color, as measured by a color chart, might be a valid indicator of hydration status in frail nursing home residents, this study tested the associations between urine color and urine specific gravity. This is a descriptive correlational study set in seven nursing homes in eastern Iowa. Ninety-eight nursing home residents > or =65 years of age participated. Exclusion criteria for the study included: unstable congestive heart failure or diabetes, documented renal disease, hyponatremia (serum sodium <135 meq/L), terminal illness, acutely confused/delirious or urinary tract infection at baseline, and gastrostomy-tube dependence. Weekly urine specimens were collected. Ucol was measured first, using a urine color chart. Usg was determined using the Chemstrip Mini UA Urine Analyzer. Week-by-week Spearman rank order correlations between urine color and specific gravity for the total sample (n=98) ranged from r(s) = 0.3 - 0.7, p < .01; the PROC mixed model was significant, p < .01. In subgroup analyses (n=78), all females (r(s) = 0.67, p = .01) and both males (r(s) = 0.53, p = .01) and females (r(s) = 0.72, p =.01) with adequate renal function (Cockcroft-Gault estimated creatinine clearance [CrCl] values of > or =50 ml/min) had significant associations between average urine color and average Usg. Females with mild renal impairment (CrCl between 30 and 50 ml/min) also had significant associations between Ucol and Usg (r(s) = .64, p < .01). Ucol averaged over several individual readings offers another tool in assessing hydration status in Caucasian nursing home residents with adequate renal function measures by estimated CrCl values.

Obtaining urine for culture from non-potty-trained children.

The accurate diagnosis of urinary tract infection (UTI) in young children is important for initial management and the prevention of long-term damage to the developing kidney. Various methods are used for urine collection from the non-potty-trained age group, including catheterisation, suprapubic aspiration, clean-catch sampling, adhesive bag sampling and urine collection pads. Research literature was examined to identify which method is most effective. The themes that evolved from the review were parents' and nurses' views on ease of use, reliability of sample obtained and cost-effectiveness. Although not the most convenient method, clean-catch gives more reliable results making it also the most cost effective approach. Change management strategies are required to overcome barriers to research implementation and to ensure best practice.

Urinalysis.

Urine analysis is an essential component of patient assessment, which is used for screening, diagnosis and planning care. This article discusses specimen collection and reagent strip testing.