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Urinalysis

11/14/2011

Clinical Skills Resource Centre, University of Liverpool, UK

Urinalysis

Can be used as:

screening test
to aid detection of abnormalities and aid
diagnosis.
for monitoring and management of the patients
condition.

May be routine - part of health check well


woman / well man OR
Indicated by patient history and presentation.

11/14/2011

Clinical Skills Resource Centre, University of Liverpool, UK

Urine Dipstick Analysis

Large range of sticks available

Some very specific eg. screen for glycosuria.

Many have multiple tests on each strip.

11/14/2011

Clinical Skills Resource Centre, University of Liverpool, UK

Urine Dipstick Analysis


Before using CHECK
Appropriate for purpose (patient) - what do you

want to look for ?


Container has not been left open and the sticks
are in date.
That you are clear about the timings required for
each test and know how to read the strip
accurately. You must be familiar with the sticks
you are using.

11/14/2011

Clinical Skills Resource Centre, University of Liverpool, UK

Check container carefully


Consider Tests Required ?
How to read the
strip?

11/14/2011

Clinical Skills Resource Centre, University of Liverpool, UK

Remove strip and close container

11/14/2011

Open the test strip container


and remove a strip.

Replace the top immediately

Exposed strips absorb


atmospheric moisture and
renders the test zones
inaccurate.

Clinical Skills Resource Centre, University of Liverpool, UK

Urine Dipstick Analysis


Patient samples may be obtained in
different ways, e.g. clean catch or mid
stream specimen urine (MSSU) or via a
catheter.
Samples should be as fresh as possible.
Check the details on the sample container
match your patient details, e.g. Name DOB
Hospital Number .

11/14/2011

Clinical Skills Resource Centre, University of Liverpool, UK

Urine Dipstick Analysis


Take a moment to consider the colour and
turbidity (cloudiness of the urine ) as these
may be significant - and be linked to
pathology or dietary and drug causes.
You should be bare below the elbows
Wash hands and put on a pair of gloves
prior to opening the sample container.

11/14/2011

Clinical Skills Resource Centre, University of Liverpool, UK

Dip strip in urine

11/14/2011

Briefly (no longer than one


second) dip the test strip into
the urine to wet all the test
zones.

Alternatively the patient can


be given the strip and asked
to urinate directly onto the
strip.

Clinical Skills Resource Centre, University of Liverpool, UK

Withdraw strip

11/14/2011

Withdraw strip, dragging the


edge along the rim of the
container to remove excess
fluid.
Use the second hand of a
watch to time the period
since dipping. Take care as
different tests require
different times.

Clinical Skills Resource Centre, University of Liverpool, UK

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Compare strip and colour scale

Compare test zones with the colour


scale on the side of the strip container at
the time indicated by the manufacturer.

Make sure you orientate the


strip correctly against (BUT NOT
TOUCHING) the chart / container
The colours are stable for at least
another minute allowing plenty of
time for reading. NOTE your
results

11/14/2011

Clinical Skills Resource Centre, University of Liverpool, UK

11

Some Dos of urinalysis .DO


Check expiry date on container before use.
Replace cap & Store strips in a cool, dry
place.
Read instruction on pack insert
Time accurately for each test on the strip.
Dispose of ALL waste appropriately AND
WASH YOUR HANDS AGAIN

Document in full in black pen - including


negative findings.
IF it isnt recorded IT wasnt DONE
11/14/2011

Clinical Skills Resource Centre, University of Liverpool, UK

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And some Donts of urinalysis .


Dont
DO NOT - Transfer strips to another pack
DO NOT - Prolong dipping of test strip (1 second
is enough)
DO NOT - Hold the stick vertically after dipping
DO NOT - Touch the test zone with fingers
DO NOT - Dispose of urine anywhere other than
down a sluice or toilet. If either of these are not
available give the sample back to the patient to
dispose of at home.
11/14/2011

Clinical Skills Resource Centre, University of Liverpool, UK

13

What can you test for

Glucose is not normally present in the urine.


Presence may be due to elevated blood glucose
levels or reduced renal threshold.
Protein (Albumin) albumin and globulin in is
normally in too low a concentration to give a
positive reaction. False positive results occur in
strongly alkaline urine. Abnormal proteinuria is
usually due to glomerular disease, which may be
caused by a variety of conditions, including
diabetes mellitus and hypertension.

11/14/2011

Clinical Skills Resource Centre, University of Liverpool, UK

14

What can you test for

Blood suggest urological disease and/or urinary tract


infection (UTI). Results may be false positive if the
container is contaminated with bleach, perianal skin,
providone iodine, stale urine or menstruation.
pH Value is usually slightly acidic within pH 5-6 (range
4.8 to 8.5). Lowest after overnight fast, highest after
meals. Can be helpful when screening for renal
disease, respiratory disease, certain metabolic
disorders and specific therapeutic regimens, such as,
sodium bicarbonate.

11/14/2011

Clinical Skills Resource Centre, University of Liverpool, UK

15

What can you test for


Nitrites are not normally present; produced
by gram negative bacteria converting nitrates
to nitrites. Ideally specimen should be
obtained about 4 hours after last voiding.
Indicates a UTI and the sample should be
sent for further testing.
Ketones are abnormal urinary constituents,
being breakdown products of fatty acid
metabolism.

11/14/2011

Clinical Skills Resource Centre, University of Liverpool, UK

16

What can you test for


Bilirubin indicates hepatic or biliary disease.
Urobilinogen is normally present in urine,
elevated levels may indicate liver
abnormalities or excessive destruction of red
blood cells. Urobilinogen tests should be
considered with the bilirubin result to provide
a differential diagnosis. A false negative
result may be obtained from a stale sample.

11/14/2011

Clinical Skills Resource Centre, University of Liverpool, UK

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What can you test for

Leucocytes
A positive result suggests pyuria associated with a
UTI. Isolated results may not be significant
repeated positives should not be ignored but be
aware of possible sources of contamination or other
factors which may limit sensitivity to this test such
as urine positive for glucose or certain medication.

11/14/2011

Clinical Skills Resource Centre, University of Liverpool, UK

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What can you test for

Specific Gravity (SG) sometimes called density

Normal ranges given do vary between 1.001 1.035 so do check your product instructions
carefully. Increased SG is seen in conditions
causing dehydration, glycosuria or renal heart
failure or inappropriate antidiuretic hormone
secretion or proteinuria. Decreased SG may be
seen in excessive fluid intake or renal failure or
pyelonephritis.

11/14/2011

Clinical Skills Resource Centre, University of Liverpool, UK

19

What can you test for


Tests can be falsely positive or falsely negative
so remember to be aware of other factors
Consider whether
The sample could have been contaminated ?
The patient medication could have affected
the results or the sensitivity of the test?
The patients condition could have affected
the results or sensitivity of the test?
11/14/2011

Clinical Skills Resource Centre, University of Liverpool, UK

20

Urinalysis

Sources and useful resources

Siemens Multistix 8 SG
www.patient.co.uk
Urine Dipstick Analysis - Patient PLUS article
http://www.whnt.nhs.uk/document_uploads/Pat
ientInfo_Urology/mssurv.pdf

11/14/2011

Clinical Skills Resource Centre, University of Liverpool, UK

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