Preparation and Handling of Nonblood Specimen

• Urine analysis


  • Monitoring wellness
  • Determination and treatment of urinary tract infections
  • Detection and monitoring progress of treatment in metabolic diseases
  • Determines the effectiveness of an administered therapy as well as checking if the patients exhibited any therapy-related complications

  
• Urine formation in nephrons

  1. Glomerular filtration

  2. Tubular reabsorption

  3. Tubular Secretion

  
• Urinary tract infections (UTI)

  • Caused by micro-organisms or germs, usually bacteria
  • Upper UTI (Pyelonephritis)
  • Lower UTI (Cystitis)
  • Urethritis
  • Vaginitis

  
• Therapy-related complications


  • Side effects of medication
  • Antibiotics that can damage kidney such as those nephrotoxic
  • Third generation pain reliever such as ibuprofen, paracetamol, naproxen, and mefenamic
  • Opioid addictive drugs with mix addictive drug to prevent the pain such as fentanyl, cocaine and heroin
• Fizzy - foamy or bubbly urine


  Caused by excess protein or kidney problem
• Foam shake test


  Form of layer of bubbles
• Certain foods cannot be break down by your body

  Seen in urine
• Purple to wine-like color urine


  Found on patients with porphyrias "vampire disease", which are collection diseases involved in the ineffective heme synthesis
• Blue urine


  • High indican urine, can also be seen in babies called blue diaper syndrome
  • In the infection of urine in UTI, turbid blue means more white blood cells caused by pseudomonas infection
• Turbid yellow urine


  Caused by E.coli, and staphylococcus
• Green urine


  Physiologic causes which mean that urine that is being green is normal due to Chlorophyll, excessive intake of vegetables
• Factors affecting accuracy of urine analysis results

  • Collection method
  • Container use
  • Transportation and handling of specimen
  • Timeliness of the testing
• Routine urinalysis (UA)


  • Frequently ordered urine test that screens the patient for any urinary or systematic disorders
  • Covers physical, chemical and microscopic analysis of the specimen

  
• Anuric


  Individual that cannot produce urine
• Routine urinalysis


  1. Physical evaluation

  2. Chemical evaluation

  3. Microscopic evaluation
• Random urine specimen


  Most commonly collected but the most ideal is early morning mid-stream collection
• Midstream collection


  Recommended and ideal to ensure that there is no contamination caused by genital secretions, pubic hair or bacteria surrounding the urinary opening

  
• Urine specimen container


  Should be clear and dry with tight-fitting lids and they should be chemically cleaned
• Urine specimen handling


  • Transported to the laboratory immediately but it could be held at room temperature for 2 hours or it could be refrigerated if transport will take longer than prescribed
  • Formalin, boric acid, and ethanol used to preserve the urine if not transported immediately

  
• Photosensitive analytes in urine

  Bilirubin, Vitamin A (retinol), Amphotericin B, Carotene, Chlordiazepoxide, Chlorpromazine, Isoniazid, Methotrexate, Porphobilinogen, Porphyrins, Pyridoxal 5-phosphate, Rifampin, Thioridazine, Trifluoperazine, Vitamin B1, Vitamin B2, Vitamin B3 (niacin), Vitamin C, Vitamin E, Vitamin K1
• Culture & sensitivity (C&S) urine test

  1. Requested if the patient has symptoms of a urinary tract infection (UTI)

  2. Midstream clean-catch collection

  3. Cultured on a special nutrient medium for 18 to 24 hours

  4. Sensitivity or antibiotic susceptibility test performed

  
• Antimicrobial Susceptibility Testing


  • Used to determine which specific antibiotics a particular bacteria or fungus is sensitive to
  • Resistant (≤9 mm), moderately sensitive (10-11 mm), or sensitive (≥12 mm) to the antibiotic
• Urine cytology study


  1. Requested by the physician to detect cancer, cytomegalovirus, & other viral and inflammatory diseases in the urinary system

  2. Fresh clean-catch specimen required

  3. Smear from the cells of the lining of the urinary tract is stained using the Papanicolaou (PAP) method and examined under the microscope for abnormal cells

  
• Renal tubular epithelial cell (RTEC)


  Indicates renal failure
• Urine drug testing


  1. Performed to detect illicit use of recreational drugs, use of anabolic steroids to enhance performance in sports, and unwarranted use of prescription drugs

  2. Monitors therapeutic drug use to minimize the symptoms associated with the withdrawal and also confirm drug overdose

  3. Requires chain of custody use as legal bases
• Urine glucose and ketone testing

  1. Performed to screen diabetes and determine the glucose level for patients who are already diabetics

  2. Urine ketone level test used to determine if the patient is suffering from diabetic ketoacidosis

  3. Color changes in the test strip compared to a color chart to interpret the result
• Nocturia


  The need for patients to get up at night on a regular basis to urinate
• Urine pregnancy testing


  1. Used to confirm pregnancy which can be detected 8 to 10 days from conception

  2. First morning urine specimen preferred because it has the highest concentration of human gonadotropin (HCG)

  
• Types of Urine Specimens

  • Random
  • First morning/8-hour urine specimen
  • Fasting
  • Timed
• 24-Hour Urine Collection Procedure


  1. Empty the bladder upon waking up

  2. Affix the label in the container and write down the time and date of the specimen collection. Start timing

  3. Collect all the urine that has been passed for the next 24 hours

  4. Refrigerate the specimen collected all throughout the collection period

  5. Take one last void at the end of the 24 hour collection period

  6. Seal the container before placing in the cooler. Arrange to transport the specimen to the laboratory at the soonest possible time
• Urine Collection Methods


  • Regular voided
  • Midstream
  • Midstream clean-catch
  • Catheterized
  • Suprapubic aspiration
  • Pediatric
• Capnophiles


  Microorganisms that thrive in environments with high levels of carbon dioxide (CO2) but low levels of oxygen
• Amniotic fluid collection


  1. Collected by the physician using transabdominal amniocentesis (fluid collection) preferably 15 weeks after gestation

  2. About 10 mL of fluid is aspirated from the amniotic sac thru the needle inserted in the mother's abdominal wall into the uterus
• Cerebrospinal fluid (CSF) collection

  1. Collected via lumbar puncture between the 3rd and 4th lumbar vertebrae

  2. Used to diagnose meningitis and other disorders such as brain abscess, Guillain-Barre syndrome, and multiple sclerosis

  
• Anaerobes


  Microorganisms that thrive in environments with high levels of carbon dioxide (CO2) but low levels of oxygen
• Amniotic fluid collection


  1. Specimen is collected by the physician using transabdominal amniocentesis (fluid collection) preferably 15 weeks after gestation

  2. Procedure is guided by the ultrasound machine

  3. About 10 mL of fluid is aspirated from the amniotic sac thru the needle inserted in the mother's abdominal wall into the uterus
• Amniotic fluid test


  • Detects any genetic disorder, checks any problem in fetal development and verifies the gestational age
• Cerebrospinal Fluid (CSF)


  Liquid that surrounds brain & spinal cord
• CSF collection


  1. Collected via lumbar puncture between the 3rd and 4th lumbar vertebrae

  2. First tube - chemistry and immunology test

  3. Second tube - microbiology studies

  4. Third tube for cell counts or hematology

  
• CSF testing


  • Used to diagnose meningitis and other disorders such as brain abscess, CNS cancer and multiple sclerosis