What is the proper method of sampling of urine from an indwelling catheter?

This article, the second in a four-part series, describes the procedure for collecting a catheter specimen of urine

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Use the checklist below to review the steps for completion of “Obtaining a Urine Specimen from a Foley Catheter.”

Video Review of Obtaining a Urine Specimen from a Foley Catheter:

Steps

Disclaimer: Always review and follow agency policy regarding this specific skill.

1. Gather supplies: peri-care supplies, nonsterile gloves, 30 – 60 mL Luer-lock syringe for sterile specimen, alcohol wipes/scrub hubs, two preprinted patient labels, clear biohazard bag for lab sample, urinary graduated cylinder, and 10-mL syringe.
2. Perform safety steps:
   • Perform hand hygiene.
   • Check the room for transmission-based precautions.
   • Introduce yourself, your role, the purpose of your visit, and an estimate of the time it will take.
   • Confirm patient ID using two patient identifiers (e.g., name and date of birth).
   • Explain the process to the patient.
   • Be organized and systematic.
   • Use appropriate listening and questioning skills.
   • Listen and attend to patient cues.
   • Ensure the patient’s privacy and dignity.
   • Assess ABCs.
3. Verify the order and assemble the supplies on a protective drape on the table: gloves, Luer-lock syringe, alcohol swabs, sterile container, two preprinted patient labels, and clear lab specimen biohazard bag for transport to lab.
4. Perform hand hygiene and put on nonsterile gloves.
5. Check for urine in the tubing and position the tubing on the bed.
6. If additional urine is needed, clamp the tubing below the port for 10-15 minutes or until urine appears.
7. Clean the sample port of the catheter with an alcohol swab.
8. Attach the Luer-lock syringe to the sample port of the catheter and withdraw 10-30 mL of urine; remove the syringe and unclamp the tubing.
9. Open the lid of the sterile container, inverting the lid on the drape and maintaining sterility. Transfer the urine to the sterile container, preventing touching the syringe to the container; place the syringe on the drape; close the lid tightly; clean the outside of the container with germicidal wipes.
10. Remove gloves and perform hand hygiene.
11. Add information to the preprinted label: date, time collected, and your initials. Apply gloves. Place the label on the specimen container and put the container inside the biohazard bag. Remove gloves and wash your hands. Place the second label outside of the bag. Transport to the lab immediately.
12. Assist the patient to a comfortable position, ask if they have any questions, and thank them for their time.
13. Ensure safety measures when leaving the room:
    • CALL LIGHT: Within reach
    • BED: Low and locked (in lowest position and brakes on)
    • SIDE RAILS: Secured
    • TABLE: Within reach
    • ROOM: Risk-free for falls (scan room and clear any obstacles)
14. Perform hand hygiene.
15. Document the procedure and related assessment findings. Report any concerns according to agency policy.

Culture - urine - catheterized specimen; Urine culture - catheterization; Catheterized urine specimen culture

How the Test is Performed

This test requires a urine sample. The sample is taken by placing a thin rubber tube (called a catheter) through the urethra into the bladder. A nurse or a trained technician may do this.

First, the area around the opening of the urethra is thoroughly washed with a germ-killing (antiseptic) solution. The tube is inserted into the urethra. The urine drains into a sterile container, and the catheter is removed.

Rarely, the health care provider may choose to collect a urine sample by inserting a needle directly into the bladder from the abdominal wall and draining the urine. However, this is most often done only in infants or to immediately screen for bacterial infection.

The urine is sent to a laboratory. Tests are done to determine if there are germs in the urine sample. Other tests may be done to determine the best medicine to fight the germs.

How to Prepare for the Test

Do not urinate for at least 1 hour before the test. If you don't have the urge to urinate, you may be instructed to drink a glass of water 15 to 20 minutes before the test. Otherwise, there is no preparation for the test.

How the Test will Feel

There is some discomfort. As the catheter is inserted, you may feel pressure. If you have aurinary tract infection, you may have some pain when the catheter is inserted.

Why the Test is Performed

The test is done:

• To get a sterile urine sample in a person who cannot urinate on their own

• If you might have a urinary tract infection

• If you cannot empty your bladder (urinary retention)

Normal Results

Normal values depend on the test being performed. Normal results are reported as "no growth" and are a sign that there is no infection.

What Abnormal Results Mean

A "positive" or abnormal test means germs, such as bacteria or yeast, are found in the urine sample. This likely means that you have a urinary tract infection or a bladder infection. If there is only a small amount of germs, your provider may not recommend treatment.

Sometimes, bacteria that do not cause urinary tract infections may be found in the culture. This is called a contaminant. You may not need to be treated.

People who have aurinary catheter in all of the timemay have bacteria in their urine sample, but it does not cause a true infection. This is called being colonized.

Risks

Risks include:

• Perforation (hole) in the urethra or bladder from the catheter
• Infection

References

Dean AJ, Lee DC. Bedside laboratory and microbiologic procedures. In: Roberts JR, Custalow CB, Thomsen TW, eds. Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 67.

Germann CA, Holmes JA. Selected urologic disorders. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 89.

James RE, Fowler GC. Bladder catheterization (and urethral dilation). In: Fowler GC, ed. Pfenninger and Fowler's Procedures for Primary Care. 4th ed. Philadelphia, PA: Elsevier; 2020:chap 96.

Trautner BW, Hooton TM. Health care-associated urinary tract infections. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 302.

What is the best method of collecting urine from a patient with indwelling catheter?

What is the correct method of collecting urine sample?