Collection of urine sample

importance and how to collect urine from children

1. Collection of urine sample from children Dr. Manori Gamage Senior lecturer – Faculty of Medical Sciences University of Sri Jayewardenepura -SL

2. Urine is a very important specimen which helps to diagnose many conditions in children . But collection of a urine sample is a challenging task.

3. To increase the diagnostic value, it is very important to pay attention to collect the urine sample, (a) at correct time (b) to correct bottle (c) in correct or sufficient volume (d) using correct method

4. Who needs collection of urine samples (a) Children suspected to have urine infection. (b) Children suspected to have certain in born errors of metabolism. (c) Children suspected to have urinary electrolyte losses. Out of them most attention should be paid to collection of urine culture for children suspected to have UTI.

5. Urine collection for urine culture Gold standard investigation to diagnose UTI. Very important to collect before commencing antibiotics. Number of colony forming units to diagnose UTI vary depending on the collection method.

6. To interpret a urine culture report, - Number of colony forming units - Number of organism types are very important. Therefore important to avoid contamination of urine specimen during collection.

7. How urine get contaminated, (a) Not cleaning the genitalia properly. (b) Not collecting the urine sample correctly. How to minimize contamination (a) Proper cleaning of genitalia. (b) Collecting urine with out contaminating the collection bottle. - Not to touch inside the bottle. - Not to touch child’s skin with the bottle.

8. Methods of urine culture collection Invasive Supra pubic aspiration (SPA) - Require skilled hands - Very reliable - Quick - minimal contamination risk Non invasive Mid stream urine sample - In children who cannot void on demand , need to wait for spontaneous voiding Disadvantages - Time consuming - Moderate risk of contamination

9. Invasive 2. Catheterisation - Low contamination rate - Reliable - Useful even when bladder has a very low volume of urine Non invasive 2. Bag sample - Not recommended due to high contamination rate Cont.... .

10. Most of the international guidelines have recommended, Clean catch method (MSU sample) to collect urine for urine cultures in children.

11. I t is important to select the best collection Method, If not ☆ Delayed collection delay in commencing antibiotics ☆ Missed sample delay in treatment ☆ Contamination misdiagnosis/ inappropriate antibiotic usage

12. Factors important to select the best method Age of the child Acute condition of the child - well/ ill

13. Younger children / more unwell, An i nvasive method will be a better option. Older children/ well or not ill A Non invasive method (clean catch) will be the best option .

14. Urine Culture collection methods 1. Clean catch (MSU) - Commonest method - Non - invasive - Time consuming - Very stressful to parents Has a significant contamination risk (10% - 25%)

15. 2. Catheterisation - Invasive - Insert a catheter/ feeding tube Collect urine directly from bladder Remove after collection of specimen Also known as “in - out ccatheter” specimen Very rarely could cause urethral injury Low contamination rate (10%)

16. 3. Supra pubic aspiration (SPA) - Invasive/ painful - Minimal contamination (1%) - Low success rate if little urine in the bladder Contraindications Bleeding risk Abdominal distension or intra - abdominal organ anomalies Skin sepsis at the overlying skin Rarely cause bowel perforation

17. How to make the collection method successful Give proper and clear advice on collection to parents/ by stander. Hydrate the baby. Change the method and try again. It’s important to, - send samples to the labs immediately. - keep it refrigerated if there is a delay.

18. How to interpret MSU (Clean catch) Colony count > 10 5 of single organism type SPA and Catheter Even single colony count is sufficient to diagnose UTI.

19. Thank you!