Scenario 2 
Tom is working on a medical unit. His patient, Mrs. X, has a urinary catheter and is febrile. The doctor has ordered a urinalysis and urine culture. Tom collects the specimen and asks that it be transported to the lab. Later that night, Tom discovers that the specimen has been sitting for 4 hours. He is very busy and does not have the time to collect another specimen. For a moment, he wonders if he should just send the specimen. He rationalizes that it really could not make that much of a difference, and he does have several more pressing priorities. Later that night, he notices that the urine looks very cloudy, although it is draining well. He is concerned that he may have to replace the catheter. The nursing assistant reports that the catheter came apart earlier. Rather than replace the catheter, he contemplates whether irrigation might be necessary.

Question:
When Tom finds out that the specimen has not been sent, he should:

  1. send the specimen anyway. It does not really make a difference.
  2. call the lab and explain so that they can adjust their procedure accordingly.
  3. discard the specimen and obtain a new one.

Question:
Should Tom irrigate the urinary catheter when he finds that the urine is cloudy?

  1. He should not irrigate but should change the catheter instead.
  2. He should irrigate the catheter, and if it remains cloudy, he should change the catheter.
  3. He should irrigate but not change the the catheter.
 
 

Correct Answer

The CLSI Guidelines recommend that a urine specimen be cultured within 2 hours of its collection. Overgrowth of bacteria can readily occur with mishandled specimens, and this will cause a false positive or an unreliable culture result.

Correct Answer

Routine irrigation is not recommended unless obstruction is anticipated. The urine is cloudy but free-flowing with no evidence of obstruction. Because a disconnection was reported and the cloudy urine may indicate a UTI, it is recommended that the urinary catheter be changed.

Learning Points

  • The CLSI Guidelines recommend that a urine specimen be cultured within 2 hours of its collection. Overgrowth of bacteria can readily occur with mishandled specimens, and this will cause a false positive or an unreliable culture result.
  • Unless obstruction is anticipated (eg, as may occur with bleeding after prostatic or bladder surgery), bladder irrigation is not recommended.
  • Change catheters and drainage bags based on clinical indications such as infection, obstruction, or when the closed system is compromised.