Urine Collection Techniques Reading Assignment: CTVT pages 604-609 & DRG pages 434-436

Anatomy Review Urine accumulates in the bladder: we need to understand anatomy, to understand how to get to our goal. Where is the bladder is located? What else is contained within the abdomen around this location? What is the bladder made of? Ventral aspect of caudal abdomen, gravity; CRAINIAL- sm intestine; DORSAL- lg intestine, uterus; smooth muscle & transitional epithelium

Canine Anatomy LANDMARKS

Feline Anatomy

Indications for Urine Collection Why would a veterinarian request a urinalysis? Concern with bladder or kidneys Urolithiasis, infection, dehydration, disease (FLUTD, FIC, blocked tom, pyelonephritis) What exactly are we testing for? Color, specific gravity, ketones, protein, glucose, hematuria, crystals, microorganisms, etc. *Note: samples tested for bacteria/fungi are typically sent out referred to as “culture and sensitivity”

Collection Techniques Voided/Free catch Manual expression Urinary catheter Cystocentesis

Voided/Free Catch Gather your supplies Dog: Cat: Advantages: Disadvantages: MIDSTREAM; AD- easy and non-invasive; DIS- not acceptable for culture due to skin cells, bacteria, debris etc from hair, skin and LOWER genitourinary tract.

Manual Expression Technique: Indications: Contraindications: INDICATION- relieving bladder for patient; routine testing CONTRA- blocked/pyo, abdominal sx

Manual Expression Advantages: Disadvantages: Complications that could happen: AD- easy, done at home; DIS- no culture, contamination from LUT

Expressing the Bladder

Urinary Catheterization Define urinary catheterization- Indications: Contraindications: A hollow tube is advance through the urethra, directly into the bladder; Urine sample (repeated urine testing), constant emptying of bladder (long sx), monitoring urine output amount, reliving a urethral obstruction (TOM CATS), allowing access to the bladder for radiology (CYSTOGRAPHY USING CONTRAST AGENTS), and treating P with conditions for which an indwelling urinary catheter is indicated EX Samuel; 2nd best method for Cx

Types of Urinary Catheters Red Rubber or Polypropylene Catheter Foley Catheter Tom Cat Catheter Measured in French sizes

Urinary Catheterization Male dog: The technically easiest patient 1. Aseptic technique: Prepuce hair must be clipped Flush prepuce with _________ ______________________ Rinse with warm water or sterile saline 2. Wear gloves: exam or sterile? 3. Handle catheter aseptically at all times Butterfly tabs 4. Apply lubrication Local anesthetic? Dilute chlorhexidine solution; STERILE lube

Urinary Catheterization Male dog continued: 4. Restrainer will pull back prepuce to expose penis 5. Advance catheter through tip of penis, into urethra Continue until urine is seen 6. Aspirate urine, or secure catheter in place Use white tape and at least two ______ sutures Note: If collecting urine for testing- discard the first 2 ml aspirated Stay suture video

Urinary Catheterization Female dog: more challenging than male dog Prep is the same as male dog Speculum and light source required Find urethral opening 2-4 cm inside the vagina Secured by taping catheter to the tail

Urinary Catheterization Male cat: Most common reason - urethral obstruction Sedation or anesthesia possible Prep site as normal; hind limbs are pulled cranially Check for mucus plug; if cannot be removed advance tom cat or polypropylene catheter Use sterile saline to push blockage Secure with stay sutures

U. Catheterization Notes Monitoring output Closed system is created by attaching the catheter to an IV line and then a collection bag. Normal patients should produce _______________ of urine Maintenance Urinary catheters must be removed every ______ days.

Urinary Catheterization Complications from receiving a urinary catheter: UTI, urethral irritation or inflammation, trauma

Cystocentesis Define cystocentesis- Indications: Contraindications: Percutaneous aspiration of urine from the bladder; INDICATION: sterile urine sample for analysis *CULTURE Insufficient urine in bladder, patient resists restraint, recent abdominal sx, trauma, pyo, bleeding dis. etc.

Cystocentesis Advantages: Sample is free from all contaminations/disease in lower urinary tract Considered the most sterile form of urine collection Quick, minimal supplies Minimizes iatrogenic UTI or trauma Complications: Possible laceration of bladder Trauma/laceration of other anatomy Iatrogenic hematuria Isolates disease to specific part of urinary tract

Cystocentesis Gather your supplies Dog: Cat: Positioning 3-12 cc syringe, 22g needle, 1- 1.5 inch, alcohol, V-trough, towel

Cystocentesis Locating the bladder: Palpation

Bladder Location Canine landmarks

Bladder Location Tools available

Cystocentesis Procedure 1. Wet injection site with alcohol 2. Hold syringe so you can aspirate w/o changing position 3. Place needle directly into bladder (or where you believe bladder is), with intent, at a 45-90° angle. Length of needle will determine depth into patient 4. Use aspiration to withdraw desired amount of urine. 5. Stop aspirating 6. Bring needle straight out

Cystocentesis Troubleshooting If you aspirate blood in your needle: Abort mission, come straight out Change needle and syringe and try again If you get negative pressure: May go deeper into animal BUT must first release pressure from aspiration Aspirate again- if no urine, may change depth again (based on needle length) If no urine: _____________________ & bring needle straight out *MAY NEVER REDIRECT IN THE BLADDER

Urine Storage Non-sterile urine is transferred into a specimen cup or RTT Sterile urine is transferred to a ______ _______ tube Tightly sealed to prevent evaporation Urine must be transferred directly through the rubber top Change needle first! Urine must be analyzed within 30 minutes of collection Red top tube; ketones Crystal formation Bacteria will eat things.

Urine Storage up to 24 Hours Why do we keep it in the refrigerator? Slow the deterioration of some components Maintain current bacterial population Why do we keep it out of sunlight? UV light breaks down ____________ Glucose; Bilirubin