Urine, Midstream Collection

I. Principle:

The purpose of a midstream urine collection is to provide a urine specimen, which is relatively free of contaminants for analysis.

II. Clinical Significance: N.A.

III. Specimen:

1. The urine specimen must be properly identified. The identification label must be attached around the side of the urine specimen container, not on the lid. (Refer to the "Specimen Handling: Identification, Integrity & Rejection" policies.) Identify the urine as a clean catch specimen.

2. Minimum specimen requirements:

A. Routine urinalysis:
adults (≥ 2 yrs): 5 ml minimum volume, 10 ml preferred
infants (<2 yrs): 3 ml minimum volume

B. Urine culture: 5 ml.

3. It is very important that urine specimens be transported to the lab as soon as possible for prompt analysis. Urine specimens should be screened from strong light and may be held from the time of collection for up to 2 hours at room temperature. If the delay between collection and analysis will be greater than 2 hours, the specimen may be refrigerated at 2-8°C for up to 4 hours.
Note: Urine specimens must not be refrigerated for more than 4 hours.
Note: Any specimen that has not been refrigerated and is more than 2 hours old upon arrival in the laboratory or is past 4 hours from the time of collection may be rejected. (Consult with a pathologist)

IV. Materials:

1. Sterile urine cup (CardinalHealth #C8846-19SP)

2. Castile Soap Towelettes: (CardinalHealth #40000-190)
OR

3. Midstream Urine Collector Kit: includes white cap urine cup and towelettes (CardinalHealth #U3031-22)

V. Reagents: N.A.

VI. Standardization: N.A.

VII. Procedure:

Provide the patient with a sterile urine cup and three castile soap towelettes or midstream urine collector kit. Instruct the patient:

1. Male patient: Click to open male patient instructions for printing.

A. Wash hands.

B. Open specimen cup.

C. Place the lid on a flat surface with the cap facing up. Do not touch the inside of the lid.

D. Open the three towelettes.

E. Retract the foreskin if present.

F. Use the first towelette to cleanse the tip of the penis with a single downward stroke. Repeat the procedure using the two remaining towelettes.

G. Urinate into the toilet. As urinating is continued, bring the collection cup into the midstream until the cup is approximately one third full. Remove the cup and continue urinating into the toilet. Avoid collecting the last few drops of urine.

H. Replace the cap tightly.

I. Place specimen where instructed.

2. Female patient: Click to open female patient instructions for printing.

A. Wash hands.

B. Open the specimen cup.

C. Place the lid on a flat surface with the cap facing up. Do not touch the inside of the lid.

D. Open the three towelettes.

E. While seated on the toilet, spread the labia (outer folds).

F. Use the first towelette to wipe one side of the inner fold using a single stroke from front to back. Use the second towelette to repeat the procedure on the opposite side. Use the third towelette to cleanse the center area with a single stroke from front to back. Discard the towelettes.

G. Keep the labia separated and urinate into the toilet. As urinating is continued, bring the collection cup into the midstream until the cup is approximately one third full. Remove the cup and continue urinating into the toilet. Avoid collecting the last few drops of urine.

H. Replace the cap tightly.

I. Place the specimen where instructed.

VIII. Limitations: N.A.

IX. Results Derivation: N.A.

X. Expected Result(s) and/or Critical Values: N.A.

XI. Quality Control: N.A.

XII. References:

1. Urinalysis and Body Fluids, Ringsrud and Linne, 1995.

2. Sage products - Directions for use.

 

i. 2-2-86 E. Steiner

ii. 10-2-96 R. Maiers (Revised: IV.)

 

Pathologist:

Technical Director: