Urine Collection Techniques

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?

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:

Manual Expression Technique: Indications: Contraindications:

Manual Expression Advantages: Disadvantages: Complications that could happen:

Urinary Catheterization Define: Indications: Contraindications:

Types of Urinary Catheters Red Rubber Polypropylene Foley Tom Cat

Urinary Catheterization Male Dog: technically the easiest patient 1. Aseptic Technique 2. Wear gloves 3. Handle catheter aseptically at all times 4. Apply lubrication

Male dog continued 5. Restrainer pull back prepuce to expose penis 6. Advance catheter through tip of penis into urethra, continue until urine is seen 7. Aspirate urine, or secure catheter in place Note: If collecting urine for testing, discard the first 2 ml aspirated

Urinary Catheterization Female dog: more challenging Prep is same 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 commonly for urethral obstruction Sedation or anesthesia possible Prep site as normal Pull hind limbs cranially Check for mucus plug: if cannot be removed advance tomcat or polypropylene catheter use sterile saline to push blockage secure with stay sutures

Urinary Catheterization Monitoring Output: Closed system is created by attaching the catheter to an IV line and then a collection bag Normal patients should produce 1-2 ml/kg/hr of urine Maintenance: Urinary catheters must be removed every 4-5 days Daily cleaning/maintenance q 24h

Cystocentesis Define: Indications: Contraindications:

Cystocentesis Disadvantages: 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 Disadvantages: Possible laceration of bladder Trauma/laceration of other anatomy Iatrogenic hematuria

Cystocentesis Gather your supplies: Positioning:

Cystocentesis Locating the bladder : Palpation Landmarks Canine Feline Tools:

Cystocentesis Procedure Wet injection site with alcohol Hold syringe so you can aspirate without changing position Place needle directly into bladder, with intent, at a 45-90 degree angle Use aspiration to withdraw desired amount of urine Stop aspirating Bring needle straight out

Cystocentesis Troubleshooting Blood in needle? Abort mission, come straight out Change needle AND syringe and try again Negative pressure? May go deeper, but release pressure from aspiration FIRST Aspirate again If no urine: stop aspirating and bring needle straight out *NEVER REDIRECT NEEDLE IN THE BLADDER!!!!!

Urine Storage Non-sterile urine is transferred into a specimen cup or RTT Should be tightly sealed to prevent contamination or evaporation Sterile urine is transferred to a Red Top Tube Must be transferred directly through the rubber top – Change needle first! Urine must be analyzed within 30 minutes of collection If cannot be analyzed within 1 hour, must be refrigerated

Urine Storage Up to 24 hours – 12 hours is ideal Why refrigerator? Slow the deterioration of components Maintain current bacterial population *Note: refrigeration may cause crystal formation Why do we keep out of sunlight? UV light breaks down components like Glucose and Bilirubin