Urine Specimen Analysis and Rejection Criteria

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Questions and Answers

What information is essential to include on urine specimen labels immediately after collection?

  • Date and time of collection, along with the collector's initials.
  • Patient's last and first name with identification number. (correct)
  • Patient's room number and physician's name.
  • Type of urine specimen and tests requested.

Which of the following is the primarily purpose of including the date and time of urine collection on requisition forms?

  • To ensure proper billing and coding for laboratory services.
  • To correlate results with the patient's medication schedule.
  • To track the specimen's transit time to the laboratory.
  • To accurately document the timing of specimen collection. (correct)

In a urinalysis laboratory, what is the importance of conical bottom tubes?

  • For storing urine specimens long-term.
  • For measuring the specific gravity of urine.
  • For sediment analysis. (correct)
  • For automated reagent strip testing.

Why is it important to state specific information on specimen collection and handling at the beginning of each procedure listed in the manual?

<p>To guarantee accurate and reliable test results. (B)</p> Signup and view all the answers

What type of urine collection container is most appropriate for automated reagent strip testing?

<p>Round bottom tubes (C)</p> Signup and view all the answers

What is the primary advantage of using a collection container that holds 12 mL of specimen for microscopic analysis?

<p>It accommodates sufficient volume for microscopic analysis, repeat tests, and mixing. (A)</p> Signup and view all the answers

For which type of urine analysis is it most crucial to use individually packaged sterile containers with secure closures?

<p>Microbiological studies to prevent contamination. (D)</p> Signup and view all the answers

What is the recommended action to preserve a urine specimen that cannot be tested within 2 hours of collection?

<p>Refrigerate the specimen or add an appropriate chemical preservative. (A)</p> Signup and view all the answers

What is the primary function of the BD Vacutainer Urine Transfer Straw?

<p>To facilitate sterile transfer of urine to tubes containing preservatives. (A)</p> Signup and view all the answers

What is the most significant consequence of allowing a urine specimen to remain unpreserved at room temperature for more than 2 hours?

<p>Changes related to the growth of bacteria, affecting the accuracy of test results. (A)</p> Signup and view all the answers

Which urine preservative is LEAST suitable when performing chemical tests for glucose, blood, and leukocyte esterase?

<p>Formalin (Formaldehyde) (C)</p> Signup and view all the answers

A urine specimen requires preservation for drug analysis. Which preservative is MOST appropriate?

<p>Sodium fluoride (D)</p> Signup and view all the answers

Which of the following is a disadvantage of using hydrochloric acid as a preservative for urine samples?

<p>It interferes with analysis of drugs and hormones. (B)</p> Signup and view all the answers

Which type of urine specimen is MOST susceptible to showing erroneous results due to dietary intake or physical activity right before collection?

<p>Random (B)</p> Signup and view all the answers

For general urine screening, which specimen type is considered the ideal choice?

<p>First morning (A)</p> Signup and view all the answers

Which of the following is a key advantage of using formalin as a urine preservative?

<p>Excellent sediment preservation (D)</p> Signup and view all the answers

What is a primary advantage of using hydrochloric acid or acetic acid as a urine preservative?

<p>Prevents bacterial growth and metabolism (A)</p> Signup and view all the answers

A physician orders a urine culture transport. Based on the materials, which would be best?

<p>Hydrochloric acid (D)</p> Signup and view all the answers

What change occurs in the urine's odor when it is left unpreserved for a long time?

<p>Increased ammonia smell (B)</p> Signup and view all the answers

Which of the following best describes the effect of long-standing, unpreserved urine on the concentration of glucose?

<p>Decreased due to glycolysis and bacterial use (B)</p> Signup and view all the answers

Why does the pH of an unpreserved urine sample typically increase over time?

<p>Loss of carbon dioxide and breakdown of urea to ammonia (D)</p> Signup and view all the answers

How does exposure to light affect the bilirubin levels in an unpreserved urine sample?

<p>Decreases bilirubin levels due to photo oxidation to biliverdin (D)</p> Signup and view all the answers

What is the primary reason for refrigerating urine specimens?

<p>To decrease bacterial growth and metabolism (B)</p> Signup and view all the answers

What effect does refrigeration have on amorphous urate and phosphate crystals in urine?

<p>Causes precipitation of the crystals (A)</p> Signup and view all the answers

A urine specimen is preserved using commercial preservative tablets. What is a major consideration when using this method?

<p>The tablet composition should be checked to avoid interference with desired tests (B)</p> Signup and view all the answers

What happens to red blood cell (RBC) and white blood cell (WBC) casts in an unpreserved urine sample that has been standing for an extended period?

<p>They disintegrate due to the dilute alkaline urine. (B)</p> Signup and view all the answers

What is the primary reason for refrigerating urine specimens during the collection period?

<p>To prevent bacterial growth and maintain sample integrity. (C)</p> Signup and view all the answers

In a pre- and post-massage test (PPMT), a positive result for significant bacteriuria is indicated when the post-massage specimen exhibits how many times the bacterial count of the pre-massage specimen?

<p>10 times (B)</p> Signup and view all the answers

What error in urine collection is specifically associated with a timed collection?

<p>Inaccurate recording of the total urine volume. (B)</p> Signup and view all the answers

In the Stamey-Meares test for prostatitis, which specimen represents the urethral specimen?

<p>VB1 (voided bladder 1) (C)</p> Signup and view all the answers

If a urine specimen requires a chemical preservative, what characteristic should the preservative possess?

<p>It should be nontoxic to the patient and not interfere with the tests to be performed. (B)</p> Signup and view all the answers

Which of the following describes the correct method for collecting a catheterized urine specimen?

<p>Passing a hollow tube through the urethra into the bladder and collecting urine from the drainage bag. (C)</p> Signup and view all the answers

In the Stamey-Meares test, what is the correct order for collection?

<p>VB1, VB2, EPS, VB3 (B)</p> Signup and view all the answers

What volume of urine is collected for VB1 and VB2 in the Stamey-Meares test?

<p>10 mL (D)</p> Signup and view all the answers

What is the primary reason for maintaining a strict chain of custody for urine specimens?

<p>To prove that no tampering of the specimen occurred, maintaining its integrity for legal purposes. (C)</p> Signup and view all the answers

Which type of identification is acceptable for the individual providing a urine specimen?

<p>Either photo identification or positive identification by an employer representative with photo ID. (B)</p> Signup and view all the answers

When is a 'witnessed' urine specimen collection typically indicated?

<p>When the donor may alter or substitute the specimen or when required by the client's policy. (D)</p> Signup and view all the answers

If a witnessed urine specimen collection is required, who should observe the collection?

<p>A same-gender collector will observe the collection process. (B)</p> Signup and view all the answers

What volume of urine is typically collected during a witnessed urine specimen collection?

<p>30 to 45 mL (C)</p> Signup and view all the answers

After a witnessed or unwitnessed urine specimen collection, what is the immediate next step?

<p>The collections should be handed to the collector immediately. (A)</p> Signup and view all the answers

What is the main purpose of the 'chain of custody' documentation in drug testing?

<p>To keep a secure and unbroken record of the handling of the urine specimen. (C)</p> Signup and view all the answers

What does the absence of a complete chain of custody documentation for a urine specimen imply?

<p>The specimen's integrity is questionable, making it difficult to defend in legal or employment disputes. (B)</p> Signup and view all the answers

Flashcards

Urinalysis Introduction

The study of urine specimens for diagnostic purposes.

Specimen Labeling

Process of labeling urine specimens immediately after collection.

Types of Urine Specimens

Different urine samples collected for specific testing needs.

Requisition Forms

Forms that specify the type of specimen required for testing.

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Specimen Handling

Protocols for collecting and maintaining urine samples correctly.

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Specimen Volume for Analysis

12 mL of specimen is needed for microscopic analysis.

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In vivo vs. In vitro

Changes in urine composition occur both in the living (in vivo) and in glass (in vitro).

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Microbiological Studies

Sterile containers are needed for urine microbiological studies.

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Time Sensitivity of Urine Specimens

Specimens should be tested within 2 hours of collection to prevent significant changes.

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Changes in Urine Color

Modified or darkened color due to oxidation or reduction of metabolites.

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Decreased Clarity in Urine

Decreased clarity caused by bacterial growth and precipitation of material.

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Increased Ammonia Odor

Odor increases from ammonia due to bacterial breakdown of urea.

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Increase in Urine pH

Increased pH from breakdown of urea to ammonia by bacteria.

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Decreased Glucose in Urine

Glucose levels decrease due to glycolysis and bacterial consumption.

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Decreased Bilirubin in Urine

Decreased bilirubin caused by exposure to light and photo oxidation.

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Increased Nitrite in Urine

Nitrite increases due to multiplication of nitrate-reducing bacteria.

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Specimen Preservation Method

Refrigeration preserves urine by decreasing bacterial growth and metabolism.

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Hydrochloric Acid

A strong acid used in various biological applications.

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Acetic Acid

A weak acid commonly used in vinegar and as a preservative.

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Tartaric Acid

A naturally occurring acid found in grapes, used in baking.

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Formalin (Formaldehyde)

A solution used for preserving biological specimens.

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Sodium Fluoride

A preservative used in urine samples, especially for drug analyses.

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Random Specimen

The most common urine specimen collected at any time.

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First Morning Specimen

Urine collected immediately after waking, ideal for screening.

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Midstream Clean-Catch Specimen

Urine specimen collected after a preliminary cleaning to avoid contamination.

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Invalid Third Specimen Result

If the third specimen is positive, it is considered invalid.

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Specimen Refrigeration

All specimens should be refrigerated during collection to prevent contamination.

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Pre-and Post-Massage Test (PPMT)

Test involving clean-catch midstream urine collection before and after prostate massage.

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Significant Bacteriuria

A positive post-massage result shows significant bacteriuria over the pre-massage count.

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Timed Collections Errors

Common errors in urine collections include loss of specimen and transcription errors.

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Stamey-Meares Test

A four-glass urine collection technique for prostatitis diagnosis.

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Voided Bladder Samples

The Stamey-Meares test includes a voided bladder sample for urethral assessment.

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Expressed Prostatic Specimen (EPS)

Fluid collected during prostatic massage, the third specimen in Stamey-Meares.

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Midstream Clean-Catch

A standardized urine collection method to reduce contamination.

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Bacterial Culture

A test to identify bacteria in a urine sample.

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Suprapubic Aspiration

A procedure to obtain urine directly from the bladder.

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Cytologic Examination

Analysis of urine cells to check for abnormalities.

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Two-Hour Post Prandial

A blood test that checks glucose levels after a meal.

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Glucose Tolerance Test

A test to determine how well the body processes glucose.

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Witnessed vs. Unwitnessed Collections

Urine collections that are supervised or unsupervised to prevent tampering.

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Identification Requirements

Need for proper ID verification when handling urine specimens.

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Study Notes

Urine Specimen Analysis

  • Urine analysis is a biohazardous substance, requiring Standard Precautions (gloves).
  • Specimen collection containers must be clean, dry, leakproof, and ideally disposable.
  • Screw-top lids are preferable to snap-on lids to prevent leaks.
  • Wide-mouthed containers are recommended for ease of collection, especially from females.
  • Containers should be clear for visual assessment of color and clarity.
  • A recommended capacity of 50ml is sufficient for analysis and microscopic examination.
  • Sterile containers are essential for microbiological studies.
  • Specimens must be labeled with patient details, collection date and time, method of collection, and preservative(s) used.

Specimen Rejection Criteria

  • Improperly labeled or unlabeled specimens.
  • Mismatched labels and requisition forms.
  • Specimens contaminated with feces or toilet paper.
  • Contaminated container exteriors.
  • Insufficient specimen volume.
  • Improper transport or handling.

Specimen Handling and Preservation

  • Deliver specimens to the laboratory promptly, ideally within 2 hours of collection.
  • Refrigerate specimens if testing cannot be performed within 2 hours.
  • Chemical preservatives can be used for longer-term storage (i.e., 24 hours).
  • Refrigeration can induce precipitation of amorphous urates and phosphates.
  • Preservatives must not interfere with analysis.

Types of Urine Specimens

  • Random specimen: Collected at any time; convenient for routine screening but can be affected by recent food or activity.
  • First morning specimen: Collected upon arising; highly concentrated; useful for detecting trace elements or for pregnancy tests.
  • 24-hour specimen: Collected over a 24-hour period; used to measure substances with varying diurnal patterns.
  • Catheterized specimen: Collected through a catheter; sterile; useful for bacterial culture and microbiological testing.
  • Midstream clean-catch specimen: Collected in the middle of urination, after cleansing to minimize contamination.
  • Suprapubic aspiration: Collected through a needle inserted into the bladder; sterile; often used in infants or when a specimen for bacterial culture is required.
  • Three-glass collection: Collected using midstream clean-catch technique following prostate massage for detecting prostatitis.
  • Four-glass collection: (Meares-Stamey test) A modified three-glass collection to detect prostatitis.
  • Fasting (second morning) specimen: Collected after an overnight fast; used for monitoring glucose levels in diabetes.
  • 2-hour post-prandial specimen: Collected 2 hours after eating, used for monitoring glucose levels in diabetes.

Additional Notes

  • Urine temperature: The temperature of urine should be between 32.5°C and 37.7°C upon arrival in the laboratory; otherwise, repeat collection may be required.
  • Urine Color: Important for detecting impurities or unusual substances in the urine.
  • Urine pH: Urine pH greater than 9 may likely require a re-collection of the specimen.
  • Chemical tests: Some chemical tests may be affected by improper specimen handling and storage.
  • Preservation: Different methods of preservation exist and must be specified and applied accordingly.

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