Urine Culture Collection
What is the Urinalysis with Culture Reflex order mean? How is this specimen sent to lab?
This will be run as a UA first...if it meets criteria (increased WBCs, nitrites, bacteria, or leukocytes) it will then be cultured.
The specimen is sent in the culture tubes to the lab.
I am caring for a patient with a broken hip who has had an indwelling urinary catheter placed for immobilization. After surgery, the patient has orders for PT to get them out of bed and moving. I can DC the IUC per the nurse driven protocol?
Yes, immobilization is part of the nurse driven protocol.
When reviewing my orders in the morning, my patient has an indwelling urinary catheter (IUC) maintain order for "retention." After reviewing the chart, there is no documentation for retention. What are my next steps?
I should question this order and discuss with the provider to remove this IUC and initiate the bladder management protocol.
My patient has a temperature of 99.9 with no other symptoms of infection. The provider has ordered a urine culture. What are my next steps?
1. Question the order? Does the patient really need this urine culture.
2. Is the provider pan culturing?
3. Recommend urinalysis with culture reflex be collected.
4. Consult IP for assistance.
I have to place an indwelling urinary catheter in my new admission patient who has a temp. of 102F. It is acceptable to collect the ordered urine culture from the bag after insertion since it is brand new. Why or why not?
No, it is not acceptable. You must collect the urine per policy from the port.
1. Clean port
2. Use vacutainer and gray top tube to obtain urine OR use a syringe to pull urine and place in gray top tube
3. Label per policy and send to lab
A patient is being transferred from MICU to 3 East. The patient had a Strict I&O foley indication. Is this an appropriate order for 3 East?
No, this is not an appropriate order for 3 East. This foley should be removed before leaving MICU or when the patient arrives to 3 East. The bladder management protocol should then be followed.
You receive a bladder scan of 350ml after 6 hours after the patient not voiding. What are your next steps?
Perform straight catheterization, repeat scan in 6 hours, continue protocol for 24 hours.
When reviewing my orders in the morning, my patient has an indwelling urinary catheter (IUC) maintain order for "retention." After reviewing the chart, there is no documentation for retention. What are my next steps?
I should question this order and discuss with the provider to remove this IUC and initiate the bladder management protocol.
How many times should an isolation gown be used before being disposed of?
Once
Describe which urine test goes with what urine lab tube:
1. Yellow and red top
2. Gray top
3. Yellow top
1. Urinalysis only
2. Urinalysis with culture reflex and urine culture
3. Other urine tests - pregnancy, legionella, etc.
My SICU patient is being transferred out to a lower level of care. The patient currently has a maintain order for the indwelling urinary catheter (IUC) for Strict I&Os. I can remove this IUC before transfer using the nurse driven protocol.
Yes. Just make sure to document the removal time in the LDA.
You discontinued indwelling urinary catheter (IUC) at 12pm. At 7pm the patient has not voided and the bladder scan shows 80ml. What are your next steps.
Is the patient dry? Can the patient have fluids? Encourage drinking. Encourage patient to void. Recheck in 2 hours and continue for 24 hours.
The urine in the foley bag is very dark and malodorous when emptying the bag. A urine culture order should be obtained to make sure this patient does not have a UTI. True/False.
False. These are not symptoms of a UTI. Symptoms include a fever of 100.5 or greater, suprapubic pain, urgency, frequency, etc.
For CBI, a new new irrigation set and Tumi syringe should be replaced every 24 hours. True/False
False, it should be be used only once and thrown away. A new set should be used for each time the IUC is irrigated.
I have received an order to get a urinalysis with culture reflex. The patient is sleeping. Is it acceptable to obtain the sample from the purewick canister? Why or why not?
No. This is never an acceptable location to collect the urine. You must collect from the IUC port.
Urology placed an indwelling urinary catheter (IUC) during a surgical procedure. Once that patient is getting up with PT, it is OK to remove the IUC to make the patient more comfortable?
No. This IUC was urologically placed. The provider will provide a DC order when it is time to come out.
Your patient has been on the bladder management protocol for 24 hours and has not voided on their own. The provider orders an indwelling urinary catheter. Is this an appropriate order?
Yes. The patient has completed the protocol appropriately.
A patient has a urinalysis with culture reflex specimen pending in the computer. Micro has received the specimen but it has not resulted. Another urine culture should be ordered to speed up the results. True/False
False - wait for the first specimen to finish resulting. We should not order multiple urine cultures on the same patient.
All indwelling urinary catheters (IUC) are replaced every 30 days per protocol?
False, if the red seal is intact...it can stay inserted. Keep in mind, if a urine culture is ordered, please look to see how long the IUC has been in before collecting.
I have received an order for a urinalysis with culture reflex order. The patient has an IUC and it has been in for 8 days. What are my next steps to collect the urine?
1. Question the order, is the patient symptomatic?
2. Replace IUC since it has been in for greater than 6 days.
3. Collect urine per protocol.
You notice your patient has an active retention maintain order for an indwelling urinary catheter (IUC). There is not evidence of bladder scans, straight caths, or the bladder management protocol. What are your next steps?
Question the retention maintain order. Contact the provider to see if the IUC can removed and you could start the bladder management protocol.
The bladder management protocol must be initiated and completed before the insertion of a new indwelling urinary catheter (IUC) for retention. True/False
True. There must be documentation of bladder scans and/or straight caths before an IUC is placed.
My patient has cloudy urine with visible sediment in the foley bag. This is a sign of a UTI and I need to contact the provider to obtain a urine culture. True/False
False...these are not signs of infection. Symptoms of infection can include a fever of 100.5 or greater, suprapubic pain, etc.
What PPE should be worn with C-Diff? What should you clean the room with? How should you complete hand hygiene?
Gown, gloves
Bleach
Soap and Water