Which would the nurse need to do when collecting a urine sample from a toddler who is not toilet trained?

Bag urine

An adhesive bag is attached to the baby’s genitalia. The accuracy of this method is debatable with many false positive results obtained due to contamination.

Procedure

• Apply the adhesive bag securely to the baby’s genitalia:
  
  
  
  • Girl – apply first to the perineum and then over the vulva.
    
  • Boy – insert the penis into the bag and stick down firmly.
  
  
• Ensure there are no creases to prevent the skin becoming sore.
  
• Check the bag regularly and remove as soon as the baby has passed urine.
  
• If the urine is contaminated with faeces, the process will need to be repeated.
  
• Transfer urine to sterile specimen pot.
  
• Wash and apply cream to the baby before reapplying a nappy.

Clean catch/midstream urine

A clean catch or midstream urine sample is the recommended method for urine collection. The method used will depend on the age of the child.

Toilet-trained/older child

• Ensure they have a suitable sterile container to collect the urine, and check that the child understands the importance of not contaminating the container.
  
• The child should pass a small amount of urine into the toilet; this eliminates bacteria from the per-urethral area.
  
• The sterile container is used to catch the middle stream of urine.
  
• The child continues to empty his/her bladder in the usual way.

The younger child

• As above, except the parent/nurse removes the nappy from the child and waits to ‘catch’ the urine in the sterile container.
  
• Giving the child drinks at this time may hasten the process.

Pad urine

A sterile pad is placed in the baby’s nappy.

Procedure

• Place the sterile pad inside the nappy, taking care not to contaminate the pad by touching it.
  
• The nappy should be inside out to allow the pad to absorb all the urine.
  
• Check the pad regularly and remove when the pad is wet.
  
• Replace pad after 30 minutes if the child has not passed urine to prevent contamination from skin flora.
  
• Using the sterile syringe supplied in the pack,withdraw the urine from the pad and place in the sterile urine container. This may have to be repeated several times until enough urine is extracted for testing.
  
• If the pad is contaminated with faeces, it needs to be discarded and the process started again.

Suprapubic aspiration (SPA)

SPA may be described as the gold standard for collecting a sterile urine sample from a child, however, it is painful, invasive and not without risk and is therefore not commonly performed in general paediatrics. When it is not possible or practical to collect urine by non-invasive methods, catheter samples or suprapubic aspiration (SPA) should be used. SPA is a medical procedure although the children’s nurse will be required to reassure and provide explanations to the family and to hold the baby in the supine position with legs extended. It is recommended that a scanner is used to ascertain if the baby’s bladder contains urine. The skin should be cleaned using an alcohol swab and allowed to dry. A 23-G needle with syringe attached is inserted through the abdominal wall into the child’s bladder and the urine withdrawn. A small plaster is applied after the procedure.

Points to note

• Analgesia may be required prior to the procedure.
  
• The parents should be warned that haematuria (blood in the urine) may occur after the event.
  
• Localised bleeding may occur.

Throughout the preparation and during the procedure, someone should be available to catch some urine as the child may pass urine at any time during the process.

Catheter specimen of urine (CSU)

If a child already has a urinary catheter, a sample of urine can be obtained from the sampling port on the catheter tubing, this may require a needle and syringe or may be a needleless port.

Procedure

• Use universal precautions of wearing an apron and gloves.
  
• If available, clamp the urinary drainage tube below the sampling port to allow the urine to collect in the tube.
  
• Clean the sampling port using an alcohol swab and allow to dry.
  
• Either insert a needle at 45° angle, to prevent needle piercing the tubing wall, or use the needleless port.
  
• Withdraw urine into the syringe, remove the needle and swab the area with a clean alcohol swab and leave to dry.
  
• Unclamp the drainage tube.
  
• Put urine into sterile collecting pot and safely discard needle and syringe.
  
• Do not collect samples from the drainage bag as these are likely to be stale and contaminated.