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Difficulty: MediumInfection Control and Hospital-Acquired Conditions

A 72-year-old man who was admitted 5 days ago for a severe exacerbation of chronic obstructive pulmonary disease has had an indwelling urinary catheter in place since admission due to acute urinary retention. He now has a temperature of 38.4°C (101.1°F) and new-onset suprapubic discomfort. The physician orders a urinalysis and urine culture to evaluate for a possible catheter-associated urinary tract infection (CAUTI). Arrange the following steps for obtaining the urine specimen in the most appropriate chronological order to ensure an uncontaminated sample and maintain the integrity of the closed urinary drainage system.

  1. 1Clamp the drainage tubing below the sampling port to allow fresh urine to accumulate.
  2. 2Cleanse the needleless sampling port vigorously with a disinfectant swab.
  3. 3Aspirate the urine directly from the sampling port using a sterile syringe.
  4. 4Remove the syringe and immediately unclamp the drainage tubing.
  5. 5Transfer the aspirated urine from the syringe into a sterile laboratory container.

Answer

The correct sequence is: Clamp the drainage tubing, cleanse the sampling port, aspirate the urine with a syringe, unclamp the tubing, and transfer the specimen to a sterile container.
The correct sequence ensures an uncontaminated, highly representative urine sample while protecting the patient from complications. Clamping the tube ensures fresh urine is sampled for an accurate culture. Disinfecting the port prevents environmental contamination. Using a syringe maintains the closed system. Prompt unclamping prevents iatrogenic urinary retention, and transferring the sample readies it for lab analysis.

Step-by-Step Solution

1
Identify the goal of the procedure.
The goal is to obtain a sterile urine sample for culture from a patient with an indwelling catheter without introducing infection.
Proper technique prevents both false-positive CAUTI diagnoses and the introduction of new pathogens.
2
Determine the proper source of the sample within the system.
The sample must be taken from fresh urine accumulating in the tubing, not from the collection bag.
Urine in the collection bag sits at room temperature and allows for rapid bacterial overgrowth, leading to inaccurate culture results.
3
Sequence the technical steps for aseptic collection.
First, clamp the tubing to collect fresh urine. Next, disinfect the port to prevent contamination. Then, aspirate the sample with a sterile syringe.
This progression safely acquires fresh urine while strictly maintaining a closed drainage system, which is the primary defense against CAUTI.
4
Sequence the post-collection safety and administrative steps.
Immediately unclamp the tubing, then transfer the urine to a laboratory container.
Unclamping immediately is critical to prevent iatrogenic bladder distension and potential urinary reflux, avoiding patient harm before finishing sample processing.

Key Concept

Aseptic technique for obtaining urine cultures from an indwelling catheter to prevent CAUTI and false-positive laboratory results.
Estimated Time:1m 0s
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Topics

Infection Control and Hospital-Acquired Conditions

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