PROCEDURE3-5: Obtain a Clean Catch Midstream Urine Specimen

Name______Date______Time______

PROCEDURE3-5: Obtain a Clean Catch Midstream Urine Specimen

Equipment/Supplies: Sterile urine container labeled with patient’s name, cleansing towelettes (two for males; three for females), gloves if you are to assist the patient, hand sanitizer

Standards: Given the needed equipment and a place to work, the student will perform this skill with _____ % accuracy in a total of _____ minutes. (Your instructor will tell you what the percentage and time limits will be before you begin.)

Key: 4 = Satisfactory0 = UnsatisfactoryNA = This step is not counted

Procedure Steps / self / PARTNER / INSTRUCTOR
1. Obtained the physician order.Washed your hands; put on personal protective equipment / □ / □ / □
2. Assembled the equipment and supplies / □ / □ / □
3. Identified the patient and yourself; explained the procedure; asked for and answered any questions / □ / □ / □
4. If the patient was to perform the procedure, provided the necessary supplies / □ / □ / □
5. Had the patient perform the procedure:
a. For males:
(1) If uncircumcised, expose the glans penis by retracting the foreskin and then clean the meatus with an antiseptic wipe. The glans should be cleaned in a circular motion away from the meatus. A new wipe should be used for each cleaning sweep.
(2) Keeping the foreskin retracted, initially void a few seconds into the toilet or urinal.
(3) Bring the sterile container into the urine stream and collect a sufficient amount (about 30–60 mL). Avoid touching the inside of the container with the penis.
(4) Finish voiding into the toilet or urinal.
b. For females:
(1) Kneel or squat over the toilet bowl. Spread the labia minora widely to expose the meatus. Using an antiseptic wipe, cleanse on either side of the meatus and then the meatusitself. Use a wipe only once in a sweep from the anterior to the posterior surfaces and then discard it.
(2) Keeping the labia separated, initially void a few seconds into the toilet.
(3) Bring the sterile container into the urine stream and collect a sufficient amount (about 30–60 mL).
(4) Finish voiding into the toilet / □ / □ / □
6. Capped the filled container and placed it in a designated area / □ / □ / □
7. Transported the specimen in a biohazard container for testingor test the urine specimen according to office policy and procedure. / □ / □ / □
8. Properly cared for or disposed of equipment and supplies; cleaned the work area; removed your gloves and washed your hands
9. Document the procedure in the patient paper or electronic medical record. / □ / □ / □

Calculation

Total Possible Points: _____

Total Points Earned: _____ Multiplied by 100 = _____

Divided by Total Possible Points = _____%

PassFail



Student’s signature ______Date ______

Partner’s signature ______Date ______

Instructor’s signature ______Date ______