Urine collection in Neonates - | Health



Canberra Hospital and Health ServicesClinical Procedure Urine Collection in NeonatesContents TOC \h \z \t "Heading 1,1" Contents PAGEREF _Toc469566922 \h 1Purpose PAGEREF _Toc469566923 \h 2Alerts PAGEREF _Toc469566924 \h 2Scope PAGEREF _Toc469566925 \h 2Section 1 – Bladder Tap PAGEREF _Toc469566926 \h 3Section 2 – Bag Collection of Urine PAGEREF _Toc469566927 \h 4Section 3 – Collection of Urine using cotton wool balls PAGEREF _Toc469566928 \h 4Section 4 – Collection of urine via urethral catheterisation PAGEREF _Toc469566929 \h 5Implementation PAGEREF _Toc469566930 \h 6Related Policies, Procedures, Guidelines and Legislation PAGEREF _Toc469566931 \h 6References PAGEREF _Toc469566932 \h 7Definition of Terms PAGEREF _Toc469566933 \h 7Search Terms PAGEREF _Toc469566934 \h 7PurposeThe 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 cultureBag urine can be collected for culture and sensitivity, metabolic screening, amino acid testingClinitest strip testing of urine – Ph, glucose, ketones, protein, blood, leucocytesCatheterisation 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. myelomeningoceleThis Standard Operating Procedure (SOP) describes for staff the process to ScopeAlertsHand 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 collectionRare 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 knottingDo not use a catheter with a balloon and/or a guidewireScopeThis document pertains to infants and babies nursed in the Neonatal Intensive Care (NICU) and Special Care Nursery (SCN)This document applies to:Medical OfficersNurses 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 supervisionBack to Table of ContentsSection 1 – Bladder TapEquipmentAlcohol based hand rub (ABHR)Basic set25 gauge needle5ml or 10ml syringeSkin preparation (non alcohol)Sterile specimen containerPatient identification label and labelled pathology formBandaid spotSucrose1ml syringeProcedure Attend hand hygiene before touching the patient by either hand washing or using ABHRPalpate bladder for fullness of bladderCollect and prepare equipmentPosition baby supine on flat surface and remove nappyAdminister sucrose 2 minutes prior to procedure for pain relief according to policy for Sucrose for pain reliefImmobilise baby by gently holding ankles and arms. Firmly wrap upper bodyMedical officer is to scrub hands and don sterile glovesMedical officer to prepare pubic area which is swabbed 3 timesMedical 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 hubFig 1. Technique for supra pubic bladder aspiration (2)The needle is withdrawn, slowly, with slight pressure pulling back on the syringeA minimal amount of haematuria may be seen after an attempt, but otherwise the risks are minimalUltrasound may be used to ascertain bladder fullness prior to bladder tapApply bandaid to puncture sitePlace the urine in the specimen jarLabel specimen container and send to pathology with request formSettle neonate comfortablyRecord in progress notes and observation chartDispose of equipment according to OH&S standardsDocument the procedure on the observation chart, problem sheet and in the progress notesBack to Table of Contents Section 2 – Bag Collection of UrineEquipment Sterile specimen containerBasic set5ml or 10ml syringeSkin preparation (non alcohol)Sterile urine bagProcedure Place infant in supine position and remove nappyClean and dry thoroughly genital areaCarefully open the sterile urine bag without contaminating the bagApply the bag by attaching the bottom of the bag to the peritoneum or scrotal areaOnce the baby has voided remove the urine bag by using no sting barrier wipeDrain the urine from the bag by removing blue tab and place in sterile containerReapply nappy, wash hands and settle babyBack to Table of Contents Section 3 – Collection of Urine using cotton wool ballsEquipment sterile cotton wool ball10 ml syringesterile specimen collection containerclinitest stripProcedure Collection of urine using cotton wool balls:place clean cotton wall ball inside baby’s nappy closest to urethral opening for best absorption of urine into cotton wool ballremove moist cotton wool ball from the baby’s nappy with the next caresplace cotton wool ball in to the hub of the syringe. Press syringe head into hub to squeeze out urine on to Clinitest stripdocument findings of Clinitest urine test on patient flow chart care plan and in the patents clinical notesBack to Table of ContentsSection 4 – Collection of urine via urethral catheterisationEquipmentSterile dressing packGauze squares - extraChlorhexidine 0.1% (warmed)5fg feeding tube (always have a spare feeding tube)orappropriately sized indwelling catheterLubricant- sterile water or KY jellySterile yellow top jarSterile scissorsSterile glovesSteri stripsAnother staff member to assist with holding SucroseSterile fenestrated green drapeProcedure Inform parents of the procedureSucrose for pain reliefOpen all equipment using asceptic techniquePlace baby in the supine position with legs abducted Hand hygiene as per the ‘Asceptic Non Touch Technique’ policy Don sterile glovesFor 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 urinationclean the penis with antiseptic solution starting at meatus and moving down the shaft of the penis. Allow the antiseptic to drygently insert the catheter into the meatus until urine is seen in the catheter sterile lubricant to catheter tip. Never force the catherIf 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 thighFemale catheterisationwith the non-dominant hand separate the labia using sterile gauzeusing 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 dryapply sterile lubricant or sterile water to catheter tip for easier insertongently insert catheter until urine is visible in catheter tubing. Do not insert extra tubingif catheter is accidentally inserted into vagina, leave in place and insert new catheter anterior to the first catheterconnect to closed urinary collection system and secureSend urine sample for culture if requiredBack to Table of Contents Implementation Implementation via: training for all staff in NICU and SCN during orientationAccess to SharePoint for information on Policies, Procedures and GuidelinesBack to Table of ContentsRelated Policies, Procedures, Guidelines and LegislationPolicies 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 Back to Table of ContentsReferencesHoppert M. Microscopic techniques in biotechnology. Weinheim: Wiley-VCH; 2003.Drummond PD. Triggers of motion sickness in migraine sufferers. Headache. 2005;45(6):653-6.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.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 StraatenaAustin, 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 34-36Back to Table of ContentsDefinition of Terms Glycosuria – Urine testing positive for glucose on Clinitest urine testingBack to Table of ContentsSearch Terms Urine, urine collection, urine bag, bladder tap, Clinitest testingBack to Table of ContentsDisclaimer: 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 AmendedSection AmendedApproved ByEg: 17 August 2014Section 1ED/CHHSPC Chair ................
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