Urine collection in Neonates

CHHS16/235

Canberra Hospital and Health Services

Clinical Procedure

Urine Collection in Neonates

Contents

Contents1

Purpose2

Alerts2

Scope2

Section 1 – Bladder Tap3

Section 2 – Bag Collection of Urine4

Section 3 – Collection of Urine using cotton wool balls4

Section 4 – Collection of urine via urethral catheterisation5

Implementation6

Related Policies, Procedures, Guidelines and Legislation6

References7

Definition of Terms7

Search Terms7

Purpose

The purpose of this procedure is to obtain a sterile or non sterile urine specimen for testing for:

Bladder tap is performed to obtain sterile urine for culture

Bag urine can be collected for culture and sensitivity, metabolic screening, amino acid testing

Clinitest strip testing of urine – Ph, glucose, ketones, protein, blood, leucocytes

Catheterisation is performed for urinary retention in the neonate. This occurs most commonly with a muscle relaxed baby or congenital abnormalities affecting the bladder and urethra emptying ability (neurogenic bladder )e.g. myelomeningocele

This Standard Operating Procedure (SOP) describes for staff the process to

Scope

Alerts

Hand Hygiene: healthcare workers will comply with ACT Health hand hygiene practices in order to support the reduction of infection caused by the transmission of harmful pathogens.

Patient Identification Pathology Specimen labelling: defines the correct process that Health Directorate staff must comply with when identifying a patient and accurately labelling Pathology specimens collected from that patient.

Specimens must be received in pathology within two hours of collection

Rare Complications include bladder wall haematoma, lacerated vessel on anterior bladder wall, perforation of hollow viscus and osteomyelitis of pubic bone or abdominal wall abscess

Do not insert extra tubing length when inserting a urethral urinary catheter this will increase the risk of trauma and knotting

Do not use a catheter with a balloon and/or a guidewire

Scope

This document pertains to infants and babies nursed in the Neonatal Intensive Care (NICU) and Special Care Nursery (SCN)

This document applies to:

Medical Officers

Nurses and Midwives who are working within their scope of practice (Refer to Scope of Practice for Nurses and Midwives Policy)

Student Nurses and Midwives under direct supervision

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Section 1 – Bladder Tap

Equipment

Alcohol based hand rub (ABHR)

Basic set

25 gauge needle

5ml or 10ml syringe

Skin preparation (non alcohol)

Sterile specimen container

Patient identification label and labelled pathology form

Bandaid spot

Sucrose

1ml syringe

Procedure

1. Attend hand hygiene before touching the patient by either hand washing or using ABHR

2. Palpate bladder for fullness of bladder

3. Collect and prepare equipment

4. Position baby supine on flat surface and remove nappy

5. Administer sucrose 2 minutes prior to procedure for pain relief according to policy for Sucrose for pain relief

6. Immobilise baby by gently holding ankles and arms. Firmly wrap upper body

7. Medical officer is to scrub hands and don sterile gloves

8. Medical officer to prepare pubic area which is swabbed 3 times

9. Medical officer - 25-gauge needle attached to a 3-ml syringe is directed perpendicular to the skin just superior (0.5 cm) to the symphysis in the midline and advanced to its hub

Fig 1. Technique for supra pubic bladder aspiration (2)

10. The needle is withdrawn, slowly, with slight pressure pulling back on the syringe

11. A minimal amount of haematuria may be seen after an attempt, but otherwise the risks are minimal

12. Ultrasound may be used to ascertain bladder fullness prior to bladder tap

13. Apply bandaid to puncture site

14. Place the urine in the specimen jar

15. Label specimen container and send to pathology with request form

16. Settle neonate comfortably

17. Record in progress notes and observation chart

18. Dispose of equipment according to OH&S standards

19. Document the procedure on the observation chart, problem sheet and in the progress notes

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Section 2 – Bag Collection of Urine

Equipment

Sterile specimen container

Basic set

5ml or 10ml syringe

Skin preparation (non alcohol)

Sterile urine bag

Procedure

1. Place infant in supine position and remove nappy

2. Clean and dry thoroughly genital area

3. Carefully open the sterile urine bag without contaminating the bag

4. Apply the bag by attaching the bottom of the bag to the peritoneum or scrotal area

5. Once the baby has voided remove the urine bag by using no sting barrier wipe

6. Drain the urine from the bag by removing blue tab and place in sterile container

7. Reapply nappy, wash hands and settle baby

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Section 3 – Collection of Urine using cotton wool balls

Equipment

sterile cotton wool ball

10 ml syringe

sterile specimen collection container

clinitest strip

Procedure

Collection of urine using cotton wool balls:

1. place clean cotton wall ball inside baby’s nappy closest to urethral opening for best absorption of urine into cotton wool ball

2. remove moist cotton wool ball from the baby’s nappy with the next cares

3. place cotton wool ball in to the hub of the syringe. Press syringe head into hub to squeeze out urine on to Clinitest strip

4. document findings of Clinitest urine test on patient flow chart care plan and in the patents clinical notes

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Section 4 – Collection of urine via urethral catheterisation

Equipment

Sterile dressing pack

Gauze squares - extra

Chlorhexidine 0.1% (warmed)

5fg feeding tube (always have a spare feeding tube)orappropriately sized indwelling catheter

Lubricant- sterile water or KY jelly

Sterile yellow top jar

Sterile scissors

Sterile gloves

Steri strips

Another staff member to assist with holding

Sucrose

Sterile fenestrated green drape

Procedure

1. Inform parents of the procedure

2. Sucrose for pain relief

3. Open all equipment using asceptic technique

4. Place baby in the supine position with legs abducted

5. Hand hygiene as per the ‘Asceptic Non Touch Technique’ policy

6. Don sterile gloves

7. For a male baby stabilise the shaft of the penis with non-dominant hand, perpendicular to the body. This hand is now considered contaminated.

· apply gentle pressure at the base of the penis to avoid reflex urination

· clean the penis with antiseptic solution starting at meatus and moving down the shaft of the penis. Allow the antiseptic to dry

· gently insert the catheter into the meatus until urine is seen in the catheter sterile lubricant to catheter tip. Never force the cather

· If the catheter is to remain indwelling, immediately connect the catheter to closed urinary collection system (yellow topped jar or urine bag)

· secure with Steri Strips to the baby’s inner thigh

8. Female catheterisation

· with the non-dominant hand separate the labia using sterile gauze

· using the free hand for the rest of the procedure, clean the area around the meatus with antiseptic solution using anterior-to-posterior strokes to prevent drawing faecal material in to the field. Allow the antiseptic to dry

· apply sterile lubricant or sterile water to catheter tip for easier inserton

· gently insert catheter until urine is visible in catheter tubing. Do not insert extra tubing

· if catheter is accidentally inserted into vagina, leave in place and insert new catheter anterior to the first catheter

· connect to closed urinary collection system and secure

9. Send urine sample for culture if required

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Implementation

Implementation via:

training for all staff in NICU and SCN during orientation

Access to SharePoint for information on Policies, Procedures and Guidelines

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Related Policies, Procedures, Guidelines and Legislation

Policies Healthcare Associated Infections ProceduresPatient Identification-pathology specimen labelling

Patient identification and procedure matching policy

Pathology requests and specimens

Urine specimen management procedure

Urine collection via bladder tap or sterile bag

Waste Management Policy

Asceptic Non Touch Technique

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References

1. Hoppert M. Microscopic techniques in biotechnology. Weinheim: Wiley-VCH; 2003.

2. Drummond PD. Triggers of motion sickness in migraine sufferers. Headache. 2005;45(6):653-6.

3. Meltzer PS, Kallioniemi A, Trent JM. Chromosome alterations in human solid tumors. In: Vogelstein B, Kinzler KW, editors. The genetic basis of human cancer. New York: McGraw-Hill; 2002. p. 93-113.

4. Reliability of Reagent Strips for Semi-quantitative Measurement of Glucosuria in a Neonatal Intensive Care Setting Jolita Bekhofa, Boudewijn J. Kollenb, Sjef van de Leurc, Joke H. Kokd,Irma H.L.M. van Straatena

5. Austin, BJ, Bollard C, Gunn T. Is urethral catheterization a successful alternative to suprapubic aspiration in neonates? Journal of Paediatrics and Child Health, Issue 1, Feb 1999,p 34-36

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Definition of Terms

Glycosuria – Urine testing positive for glucose on Clinitest urine testing

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Search Terms

Urine, urine collection, urine bag, bladder tap, Clinitest testing

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Disclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Service specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever

(to be completed by the HCID Policy Team)

Date Amended

Section Amended

Approved By

Eg: 17 August 2014

Section 1

ED/CHHSPC Chair

Doc Number

Version

Issued

Review Date

Area Responsible

Page

CHHS16/245

1

15/12/2016

01/07/2021

WY&C

1 of 7

Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register