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

Clinical effectiveness and cost-effectiveness of tests for the diagnosis and investigation of urinary tract infection in children: a systematic review and economic model.

Whiting P, Westwood M, Bojke L, Palmer S, Richardson G, Cooper J, Watt I, Glanville J, Sculpher M, Kleijnen J. Whiting P, et al. Health Technol Assess. 2006 Oct;10(36):iii-iv, xi-xiii, 1-154. doi: 10.3310/hta10360. Health Technol Assess. 2006. PMID: 17014747 Review.

Background: The method of collection of the urine sample is of paramount importance in making a diagnosis of urinary tract infection in infants and children. Squeezing urine out of disposable diapers can provide a urine sample that can be used to detect chemical abnormalities as well as a specimen suitable for microscopic examination. To date there have been no reported studies on the use of this technique for urine culture as compared with samples collected by suprapubic aspiration and catheterization.

Methods: Urine was obtained from 38 infants aged under 2 years who presented with fever with no obvious cause. All infants had urine collected either by catheterization or suprapubic aspiration and by extraction from a disposable diaper. The urine samples were cultured using standard bacteriologic techniques.

Results: Five infants had a urinary tract infection, as shown by a pure growth of more than 10(5) colonies/mL of a single species of bacterium. In all the cases the same result was obtained from both the diaper urine sample and the sample obtained by suprapubic aspiration or catheter. In 31 infants the urine samples collected by both techniques (diaper and catheter or suprapubic aspiration) were negative, and in only 2 infants did the diaper specimen yield a positive result, while the urine obtained by suprapubic aspiration or catheter was sterile.

Conclusions: Urine obtained from a disposable diaper can provide a valid sample for diagnosing urinary tract infection. The technique is simple, and can be carried out readily in ambulatory settings with minimal equipment and expense.

Urine is a waste product produced by the kidneys, so testing it can show if the kidneys are not working well. Testing a urine sample is usually the first stage in carrying out a general assessment, before blood tests are needed. This information sheet from Great Ormond Street Hospital (GOSH) explains how to collect a clean urine sample for testing.

Make sure you do not touch the inside of the urine sample bottle or test tube or the top edge – you may introduce bacteria which could contaminate the sample.

Only use the urine sample bottle or test tube provided – if you have not been given one, ask at your family doctor (GP) surgery.

The bottle or test tube does not need to be completely full – usually a small sample is enough for testing.

You will need:

Clean container or foil bowl
Urine sample bottle or test tube as provided
Clean funnel or oral syringe (if required)

What to do:

Wash the genital area with water and pat dry with a clean towel
Wash your hands with soap and water
Ask your child to start weeing and then use the container to catch their wee
Do not collect the first few drops – wait a second or two before starting to collect
Pour the sample from the container into the urine sample bottle (using a funnel or syringe if needed)
Screw the lid on tightly and put in the biological hazard bag you have been given then give to your doctor

You will need:

Cotton wool or gauze
Syringe
Urine sample bottle or test tube as provided

What to do:

Wash the genital area with water and pat dry with a clean towel
Wash your hands with soap and water
Put a thick layer of cotton wool or gauze inside your child’s nappy
Wait 10 minutes and check whether it is wet
If it is wet, use the syringe provided to draw up the urine to put in the urine sample bottle or test tube.
Screw the lid on tightly and put in the biological hazard bag you have been given then give to your doctor
If it not wet, replace the nappy and wait another 10 minutes before checking. Replace the pad every 30 minutes to avoid contamination.

You will need:

Urine collection bags
Urine sample bottle or test tube as provided

What to do:

Wash the genital area and pat dry with a clean towel
Wash your hands with soap and water
Attach the bag around your child’s genitals using the sticky strip
Check the bag regularly and remove when your child has weed.
Cut the corner off the bag and pour urine into the urine sample bottle or test tube.
Screw the lid on tightly and put in the biological hazard bag you have been given then give to your doctor or nurse.

Quite often, the doctor or nurse will test the urine straightaway using a testing strip. This contains chemicals that react with the urine.

If there is protein in the urine sample, the kidneys may not be filtering it out well.
If there is sugar in the urine sample, this might be an indicator that sugar levels in the blood are too high.
If your child has a urine infection, the bacteria may be present in the urine sample.

Once the doctor or nurse has dipped the strip into the urine sample, they wait a few seconds until the colours develop and then compare it with the colours on the bottle to get the results.

Occasionally, particularly if an infection has been identified, the doctor or nurse may send the sample off to the laboratory for testing. The laboratory will grow the bacteria in the sample to try to work out the particular type. This means that any antibiotic your child has will work specifically against the bacteria present.

The Urodynamics department in collaboration with the Child and Family Information Group