1. Urine Collection Techniques
Reading Assignment: CTVT pages
& DRG pages

2. 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

3. Canine Anatomy
LANDMARKS

4. Feline Anatomy

5. 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”

6. Collection Techniques
Voided/Free catch
Manual expression
Urinary catheter
Cystocentesis

7. 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.

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

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

10. Expressing the Bladder

11. 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

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

13. 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

14. 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

15. 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

16. 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

17. 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.

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

19. 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.

20. 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

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

22. Cystocentesis
Locating the bladder:
Palpation

23. Bladder Location
Canine landmarks

24. Bladder Location
Tools available

25. 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

26. 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

27. 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.

28. 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