In this article, we are going to discuss about Catheter Urine Sample Collection or CUS which you may get as a skill to demonstrate for your NMC OSCE Exam. This is a very simple procedure. Time limit allowed is 8 minutes which was previously 15 minutes. You should note that Catheter Urine Sample Collection is a clean procedure. Main things to consider is wearing of apron while touching catheter, clamping & unclamping of catheter tubing, wiping of sampling part twice and non touch technique of transferring urine from your syringe to sample bottle.

Catheter Urine Sample Collection Procedure for NMC OSCE

We will go through the procedure through the following phases,

Introductory Phase

• Entering the patient room, checking for scene safety, ensuring that scene is safe to approach
• Protecting the privacy and dignity of patient by closing the curtains and doors
• Doing the hand rub using seven steps of hand hygiene
• Hello, myself ‘name of candidate’ and am your attending nurse today
• Can you tell your name please?
• What can i call you?
• Can you tell me your date of birth?
• Can i confirm the same with your id tag (Name, date of birth, hospital number)
• How are you now?
• Are you comfortable?
• I understand that you are having a urinary catheter and am here to take your urine sample from your catheter for culture
• Is that ok with you?
• Do we need a chaperone for this? (Normally examiner tells no need for that)
• Do you have any allergies?
• Are you in any pain?
• Do you need to use the toilet now, as our procedure will take another 15 minutes, is that ok for you?
• Let me tell you that this will not be a painful procedure and i will be withdrawing 20 ml of urine from your sampling port using a 20 ml syringe, ok
• So, now i am going to assemble things required and if you needs any assistance feel free to call me or press the call bell, is that okay?

Clamping the Catheter

• I am going to put an apron and gloves
• Confirming with the examiner that trolley is clean with soap and water in past 24 hours
• I am taking the clamp with me and clamping the urinary catheter few cms distal to the sampling port (Verbalize to patient that in case of any discomfort or fullness of bladder, call you so that you can unclamp the catheter – In usual scenario, catheter will be clamped and consent will be taken and given in the scenario)
• I am removing the apron and gloves, discarding it  into clinical waste
• If using needle and syringe:
  – inserts needle into port at an angle of 45°, using a non-touch technique,       and aspirates the required amount of urine, then withdraws needle.

– If using needless system: inserts sterile syringe firmly into centre of sampling port (according to manufacturer’s guidelines) using a non-touch technique, aspirates the required amount of urine, and removes syringe.

Assembling Articles Phase

• Am now doing a hand washing using seven steps of hand hygiene at the wash basin provided
• Now am wiping my hands with paper from fingers to arm
• I am now assembling things required for the procedure in the kidney tray (disposible one) or in the trolley if available
• I require an incontinent pad, 2 alcohol swabs, 20 ml syringe, sample bottle (pre labelled), clean gloves packs, sample bag and filed in investigation slip
• Am taking every thing to patient side after wearing an apron. Also placing it on the cardiac table or in my trolley if available

Procedure Phase

• Asking the patient, are you comfortable now, can we go on with the procedure?
• Am wearing gloves
• Am putting my incontinent pad beneath patients sampling port
• Am wiping the port for 30 seconds and allowing it to dry for another 30 seconds
• Opening the 20 ml syringe and withdrawing the urine, showing to examiner that 10 ml of urine (as given in scenario) is withdrawn and urine is clear in normal color
• Am opening sample bottle with one hand and pouring the urine to the container with out touching anywhere, closing the bottle, putting it in bag
• Putting the used syringe in the kidney tray (disposible one) or clinical waste
• Am now wiping the port again with alcohol wipe for another 30 seconds and leaving it to dry
• Removing the incopad and putting it in clinical waste
• Un clamping the catheter
• Removing gloves to the kidney tray or clinical waste
• Discards needle and syringe into sharps container (if relevant).

Post Procedural Phase

• Verbalizing to the patient that procedure is over, are you comfortable now?
• Telling to the patient that i will be sending the sample to the laboratory now, if not possible i will be refrigerating it at 4 degree Celsius and will try to send it within 4 hours
• Give the call bell to the patient and asks him to press the call bell if he or she needs any assistance
• Am taking back my trolley, discarding waste, cleaning it and making it ready for next use
• Filling the culture form, documenting the procedure along with the color and nature of urine observed
• Opening the curtains back
• Doing a final hand washing and leaving the room

Pitfalls – Candidate can fail if Candidate takes the sample from the incorrect port, either leg bag emptying port OR water balloon port.

Conclusion

Key points are you should state the condition of urine after pouring it to the container. You should unclamp the catheter / discard needle in the sharps bin and you should wipe sampling port twice. Normally, urine sample will be needed to place on the shelf. No need to document as it will be pre documented as per scenario.

Disclaimer – Click Here

We are also adding a flow chart video to help candidates appearing for NMC OSCE remember the steps very easily which you can watch here. Please note that time is changed to 8 minutes now.

Thank you for reading this article. And please do share this article among your friends who are attempting NMC OSCE for UK NMC registration as an RN by clicking the icons below.