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Wednesday, January 5, 2011

HOW TO OBTAIN A URINE SAMPLE FROM A UROSTOMY

by JC Leahy, RN, BSN, MA
Sigma Theta Tau's "100 Most Extraordinary Nurses" Award

Background
This week, one of my outpatients was shunted from clinic to clinic within the hospital and finally  to the ER.  This happened simply because the nurses did not know how to obtain a a pre-surgical urine sample from his urostomy.  The family came to me for suggestions.  I offered to obtain the urine sample myself.  If you are familiar with the procedure, collecting a urine sample from a urostomy is not rocket science.  I’m writing it down here for others who might need to know.
A urostomy is a surgical diversion of urine from a point before it reaches the bladder to an opening in the abdominal wall.  A urostomy is necessary when the bladder has been injured or surgically removed.  The artificial passageway for the urine is called a conduit and the opening in the abdominal wall is called a stoma.  The conduit is constructed from a section removed from the intestine.  If the large intestine is used, the conduit is called a colonic conduit.  If the small intestine (ileum) is used, it is called an ileal conduit.  Some urostomies drain continuously and are called incontinent urostomies.  Others have an internal collection reservoir and do not drain continuously.  They are called continent urostomies.  Patients with incontinent urostomies wear an external collection appliance (bag) which they empty as needed.  Those with continent urostomies must perform in-and-out catheterization on themselves, through their stomas,  4 to 6 times per day.
From the standpoint of the nurse, the urostomy will be a hole in the side of the abdomen and there may or may not be an external collection appliance. 
Preferred Procedure
 If a laboratory urine sample is needed,  whether it be a continent or incontinent urostomy, the vastly preferred method is to catheterize the stoma.  Before you begin, you will need to gather some supplies:
  1. Replacement supplies, if needed, for re-installing the external collection bag after catheterization.
  2. A #14 in-and-out rubber urine catheter
  3. Povidone-iodine (Betadine)
  4. Sterile 4x4 gauze
  5. Warm water
  6. Surgical lubricant
  7. Clean gloves
  8. Sterile gloves
  9. Surgical mask and eye protection
  10. A sterile specimen container :
Once you have gathered your supplies follow this procedure
  1. Explain to the patient what you are going to do.
  2. Wash your hands.
  3. Don clean gloves.  Surgical mask and eye protection are a good idea, too.
  4. Open your catheter package without actually touching the catheter itself, or if it’s in a kit open that kit. 
  5. Squeeze some surgical lubricant onto the tip of the tip of the catheter
  6. Remove the old collection pouch, if any.
  7. Clean the stoma site with warm water and sterile gauze. Very scant bleeding around the edges of the stoma may be normal, but bleeding from within the stoma may indicate a urinary tract infection or other abnormality.  If there's any bleeding, the best thing to do is report it to the physician.
  8. Don sterile gloves
  9. Clean the stoma site with providone iodine and sterile gauze
  10. Insert the #14 rubber in-and-out catheter into the stoma site and advance it about 2 to 2.25 inches.  If you meet resistance before reaching 2 inches, rotate the catheter gently until it slides forward.  If it still meets resistance, do not force it any farther.
  11. If urine does not flow into the catheter, ask the patient to shift position and/or cough to mobilize the urine.
  12. Place the other end of the urine catheter in the sterile container to receive the urine specimen.
  13. When you have enough urine for a laboratory sample, remove the catheter and cap the specimen container.
  14. Reapply the external collection appliance, if any.
Alternate Procedure
If the patient cannot be catheterized, the alternative procedure is to gently cleanse the site with warm water and apply a fresh, new collection appliance.  Wait for urine to collect in the appliance and then use the appliance’s drain to place urine into the sterile specimen cup.  If the patient is an outpatient coming to a clinic, you could even ask the patient or family to perform the warm water cleansing and application of a fresh, new appliance that morning; then there will be urine in the bag when he arrives for his appointment.

Further reading

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MESSAGE FOR THE NEW REPUBLICAN HOUSE OF REPRESENTATIVES: LADIES AND GENTLEMEN, LOSERS COMPROMISE!!!  DEMOCRATS MUST COMPROMISE NOW, AND THAT COMPROMISE MUST BEGIN WITH COMPLETE REPEAL OF THEIR HEALTH CARE LAW.   I REPEAT: COMPLETE REPEAL!!   THIS WRITER ADVOCATES THAT IT BE REPLACED WITH THE SILVER PENNANT HEALTH CARE PLAN.  LOSERS COMPROMISE!!!  DON'T BE LOSERS THIS TIME, REPUBLICANS!!!  FOLKS,  PAY ATTENTION TO THIS!!!  LET'S MOVE ON TO 2012 AND FINISH THROWING THE RASCALS OUT!!!!!!!! --JC LEAHY, RN, BSN, MA
 

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