CHHS16/235

Canberra Hospital and Health ServicesClinical Procedure Urine Collection in NeonatesContents

Contents....................................................................................................................................1

Purpose.....................................................................................................................................2

Alerts.........................................................................................................................................2

Scope........................................................................................................................................ 2

Section 1 – Bladder Tap............................................................................................................ 3

Section 2 – Bag Collection of Urine...........................................................................................4

Section 3 – Collection of Urine using cotton wool balls............................................................4

Section 4 – Collection of urine via urethral catheterisation......................................................5

Implementation........................................................................................................................ 6

Related Policies, Procedures, Guidelines and Legislation.........................................................6

References................................................................................................................................ 7

Definition of Terms...................................................................................................................7

Search Terms............................................................................................................................ 7

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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

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

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

CHHS16/235

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 ABHR2. Palpate bladder for fullness of bladder3. Collect and prepare equipment4. Position baby supine on flat surface and remove nappy5. Administer sucrose 2 minutes prior to procedure for pain relief according to policy for

Sucrose for pain relief6. Immobilise baby by gently holding ankles and arms. Firmly wrap upper body7. Medical officer is to scrub hands and don sterile gloves8. Medical officer to prepare pubic area which is swabbed 3 times9. 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)

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10. The needle is withdrawn, slowly, with slight pressure pulling back on the syringe11. A minimal amount of haematuria may be seen after an attempt, but otherwise the risks

are minimal12. Ultrasound may be used to ascertain bladder fullness prior to bladder tap13. Apply bandaid to puncture site14. Place the urine in the specimen jar15. Label specimen container and send to pathology with request form16. Settle neonate comfortably17. Record in progress notes and observation chart18. Dispose of equipment according to OH&S standards19. 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 nappy2. Clean and dry thoroughly genital area3. Carefully open the sterile urine bag without contaminating the bag4. Apply the bag by attaching the bottom of the bag to the peritoneum or scrotal area5. Once the baby has voided remove the urine bag by using no sting barrier wipe6. Drain the urine from the bag by removing blue tab and place in sterile container7. 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

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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 ball2. remove moist cotton wool ball from the baby’s nappy with the next cares3. place cotton wool ball in to the hub of the syringe. Press syringe head into hub to

squeeze out urine on to Clinitest strip4. 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 procedure2. Sucrose for pain relief3. Open all equipment using asceptic technique4. Place baby in the supine position with legs abducted 5. Hand hygiene as per the ‘Asceptic Non Touch Technique’ policy 6. Don sterile gloves7. 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

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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. Kollen b , Sjef van de Leur c , Joke H. Kok d ,Irma H.L.M. van Straaten a

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 ByEg: 17 August 2014 Section 1 ED/CHHSPC Chair

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