June 14, 2014 at 12:21 PM #13574
Jason Hautala RNMember
I made a FB page to upload the ABG cheat sheet, just so people would have a place to go to get it without me having to send out so many emails. You need at least one follower to make a FB page, so I forced one of my friends to join. I figured people would come, download the file if they wanted, and then go about their business … but many people have actually “liked” the page. As a Thank You to those, I added a WWJD (What Would Jason Do) article about urine dips, so I figured I would bring it here, since this is my home away from home (that doesn’t make sense, I do most of my Mighty Nurse surfing from home … anyway…)
Which brings us to urine dips. It amazes me how many people dip urine incorrectly … I believe it has something to do with the name, urine DIP. One should NEVER actually take the test strip and dip it in the urine (Unless you are in a 3rd world country and the dip is the only test your are going to do on the urine and you have no intention of saving any for culture.
When the test comes back with leukocytes, nitrites, or blood, and you know most of them will, otherwise you wouldn’t be dipping it in the first place; you are going to want to send it to the lab for culture and sensitivity.
When you culture the urine, you only want the bacteria from the urinary system infection to grow, you don’t want the bacteria that was in the urinal or toilet hat and you sure don’t want the bacteria that was on the test strip to grow in the culture. They have been sitting in the dirty utility room for weeks and everyone has put their gloved fingers in the bottle to get a strip after touching God knows what. If you are going to go through the hassle of collecting a urine, and you aren’t going to get a cath specimen, at least make it a good clean catch midstream collection.
Give the patient a couple moist towelettes, have them clean around the urethra, have women hold the flesh away so the urine comes out in a straight stream without touch the skin on either side, (some women say it is easier to get a clean catch if they sit backwards on the toilet, facing the wall … I don’t have that type of plumbing, so I don’t know,) have them urinate a little into the toilet to flush the distal skin and bacteria out, and then catch the rest into the cup. Remind them not to touch inside the cup or lid with their fingers, penis, or anything else.
Now that you have this liquid gold, don’t ruin it by contaminating it with a filthy urine dip stick. Get a paper towel, lay the strip down on it, face up, open the lid, and then open a sterile syringe package. Without touching the tip of the syringe, put it in the urine, pull back a little urine (If you have plenty in the cup, go ahead and pull back a few CCs of urine, but if you only have a little, you can do a dip with 0.4 CCs of urine. Squirt or gently dribble urine onto the test strip squares, saturating each square, hold it sideways and dab the edge to the paper towel to wick away the excess urine and then wait SIXTY SECONDS.
Seriously, you can NOT dip a urine in 10 seconds. Look at the clock and find some way to amuse yourself for SIXTY SECONDS. After 60 seconds, record all of the results, except for the leukocytes. If the leukocytes are negative at the 60 second mark, go ahead and record that too, and then throw the strip away. If the leukocyte square is positive, even a little, at the 60 second mark, you have to wait ANOTHER SIXTY SECONDS, and record the leukocyte results at 120 seconds.
Got that? Record negative leukocytes and all of the rest of the strip at 60 seconds, but positive leukocytes you record at 120 seconds.
That, my friends, is the correct way to DIP a urine.
No urinals, no hats, no actual dipping. Keep your sample clean for cultures and wait the appropriate amount of time to record the results.
Added bonus, when it comes to the blood/hemoglobin square. If there are green little dots, that is caused by intact red blood cells, so record your result based on how many little green dots there are. If the entire field has turned a shade of green, that is caused by burst red blood cells and is the hemoglobin that is turning the square green. If your record sheet has different places for blood and hemoglobin, record the correct result. It is rarely positive for hemoglobin and blood, it is one or the other.June 19, 2014 at 4:02 PM #13649
Good point about the dipping, Jason. I’ve seen nurses in practice for decades who still don’t realize that the strips are not sterile, and will contaminate the remaining urine. We used to keep sterile pipettes for this (cheaper that syringes) but I haven’t seen them in a while.
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