Urinary Catheter

UTI Myths and Misconceptions

EMKF

  • UTI is a clinical diagnosis, not a laboratory one. Dysuria plus urinary frequency in the absence of symptoms of STI is diagnostic.
  • Most patients with a clinical picture consistent with a lower UTI do not require urine tests.
  • The indications for urine tests for suspected lower UTI include immunocompromised patients, history of multiple courses of antimicrobial therapy, history of antibiotic resistance and history of multiple drug allergies.
  • While bacteria seen on microscopy is predictive of a positive culture, it is not necessarily diagnostic of a UTI as the positive culture could represent a contaminant or asymptomatic bacteriuria.
  • A common pitfall is treating non-pregnant patients with asymptomatic bacteriuria with antibiotics. Asymptomatic bacteriuria is very common in all age groups and is often misdiagnosed as a UTI.
  • Do not routinely treat catheterized patients found to have pyuria or candida in their urine.
  • A common pitfall is to assume that the cause of altered level of awareness in an elderly is a UTI upon finding pyuria or bacteriuria on urinalysis leading to premature closure and missing a more serious diagnosis.
  • Imaging is not routinely required for patients suspected clinically of pyelonephritis.
  • Cranberry juice, direction of wiping and voiding post intercourse are not effective in preventing recurrent UTIs
  • 3-5 days duration of therapy is sufficient for the vast majority of lower UTI

 

Quick-Wee

EMKF

A clinician (or parent/carer with supervision) rubs the suprapubic area of the child ( 1-12 months) in a circular pattern with gauze soaked in cold saline held with forceps until clean catch urine sample is obtained.

 

Pee on demand: making babies pee for msu testing

EMKF

Procedure:

It takes a minimum of two people to perform this procedure. However, it is better with three, one dedicated to making the catch.

  1. Encourage oral fluid intake.
  2. 25 minutes following this feed, the baby/infants genitals are cleaned thoroughly with warm soapy water and dried with sterile gauze.
  3. A sterile container is prepared to collect the specimen.
  4. Baby is held under the armpits (just above the bed) with legs dangling (the parents can easily assist with this).
  5. The nurse then starts bladder stimulation which consists of gentle tapping in the suprapubic area at a rate of 100 taps per minute for 30 seconds.
  6. Next, the lumbar paravertebral zone (think the small of the lower back) is massaged in a light circular motion for 30 seconds.
  7. Step 5 and six are repeated until urine is released.
    Stand clear & catch the mid-stream.