Urinary Tract Infection — Urine Collection Methods — Clinical Pathway: All Settings

Urinary Tract Infection (UTI) Clinical Pathway — All Settings

Urine Collection Methods, Nursing Care

Collection Methods for POC Urine Dipstick and Cultures

Not Toilet-trained

Bagged Urine Specimen For Urine POC Dipstick
  • Use for POC urine dipstick as screening method for children ≥ 3 months until toilet trained
  • Never send bag specimens for culture
  • Can consider using catheterization to collect urine for POC dipstick and culture if high probability using the UTICalc  
Urinary Catheterization
  • Children < 3 mos:
    • Perform catheterization to obtain urine for POC dipstick and urine culture
  • Children ≥ 3 mos to Toilet-trained:
    • Send urine for culture if initial specimen was obtained by catheterization
    • Use UTICalc   with child’s risk factors + POC urine dipstick results to determine need for culture
    • Can go straight to catheterization if high probability using the UTICalc  

Toilet-trained

Clean-catch
  • Specimen can be used for POC urine dipstick and culture
  • Toilet trained is defined as daytime dryness without accidents

Nursing Care

Indications for Placing Urine Bag
or
Obtaining Clean Catch
  • Females:
    • Temperature ≥ 38.5°C and ≥ 48 hrs and age < 24 mos/not yet toilet trained
  • Males:
    • Temperature ≥ 38.5°C and ≥ 48 hrs
    • Uncircumcised < 24 mos, circumcised < 12 mos
  • All:
    • History of UTI, symptoms suggestive of UTI
Talking Points
Placing the Bag
  • Cleanse the perineum with baby wipes for bag or clean catch
  • Reduces rate of contamination
  • Retract foreskin in uncircumcised males
  • Choose appropriately sized urine bag
  • Use no-sting barrier to improve adhesion
  • Ensure bag is visible outside the diaper for prompt recognition
  • If specimen is contaminated with stool, discard and collect a new sample
  • Provide beverage if PO status allows and check for urine in 30 minutes x 2
  • If no urine after 1 hour, consult MD for further plan
POC Testing
  • Perform Urine POC within 1 hour to ensure accurate results
  • Do not send abnormal urine for formal UA unless clinically indicated
    • e.g., Concern for other process such as glomerulonephritis
Cultures
  • Do not send from urine obtained via bag
  • Send all specimens obtained by catheterization for culture per lab directory
  • Inpatients, ED, Main OR:
    • Sterile, leak-proof container sent to lab within 2 hours
    • Requires 0.5 mLs of urine
  • Outpatients:
    • Grey top tube if sample not received within 2 hours
    • Requires 3 mLs of urine
  • For isolated hematuria, it is reasonable to send a urine culture if symptoms
Uncircumcised Males with Phimosis Consider treatment with betamethasone 0.05% cream twice daily for 4 weeks and/or refer to Urology
Labial Adhesions
  • Consider treatment with estradiol 0.1% cream twice daily for 2-4 weeks
  • Alternative: betamethasone 0.05% cream 2x/day