NONINVASIVE STRATEGY FOR OBTAIN A CLEAN-CATCH URINE SAMPLE IN INFANTS

NONINVASIVE STRATEGY FOR  OBTAIN A CLEAN-CATCH URINE SAMPLE IN INFANTS

By MEGAN BROOKS- source from Medscape Nurses

NEW YORK (Reuters Health) - A bladder stimulation technique is a quick and effective noninvasive way to obtain a clean-catch urine sample in infants, a new study confirms.
Obtaining a urine sample for diagnostic studies in infants can be time-consuming and require uncomfortable invasive procedures (urethral catheterization or suprapubic aspiration).

In 2013, researchers described success with a noninvasive technique of bladder and lumbar stimulation for obtaining clean catch urine (CCU) in infants < 30 days (http://bit.ly/2bqDtKI), but questions remain regarding bacterial contamination as well as usefulness in older children. A study in Pediatrics online August 19 addresses the contamination potential and assesses the technique in infants up to six months of age.

The CCU technique involves letting the infant breastfeed or bottle-feed for 20 minutes. After genital cleaning, the infant is held under their armpits by a nurse or parent, legs dangling in boys and hip flexed in girls.

The nurse then begins to stimulate the bladder by gently tapping the suprapubic area at a frequency of 100 taps or blows per minute for 30 seconds. They then stimulate the lumbar paravertebral zone in the lower back with a light circular massage for 30 seconds. The two stimulation maneuvers are repeated until micturition begins (or for a maximum of 300 seconds) and a midstream urine sample is caught in a sterile container.

The new study by Dr. Jocelyn Gravel of CHU Sainte-Justine in Montreal, Quebec, Canada, and colleagues was conducted at a pediatric emergency department and involved 126 infants (64 boys, median age 55 days) needing a urine sample. The most common indication for urine collection was fever of unknown origin. Urinary tract infection was diagnosed in 11 children (9%).

Within five minutes of stimulation, 66 (52%) infants provided a urine sample. However, four samples were considered a failure because of insufficient urine quantity or the presence of stool in the sample, leaving 62 (49%) successful CCU procedures with a median time of 45 seconds.
This proportion increased to 61% in infants < 30 days and to 58% in those < 90 days. The success rate in children 91 to 180 days old was 26%. Age < 90 days was a "strong predictor" for success, Dr. Gravel and colleagues report, while gender, low oral intake, and having urinated within the hour were not predictors of success.

To allow comparison for bacterial contamination, an invasive method (either urethral catheterization or suprapubic aspiration) was performed after CCU procedures in the case of either a positive urinalysis, decision to prescribe antibiotics, or unsuccessful CCU sampling.
The contamination proportion was 16% in the CCU group, which was not statistically different relative to the invasive method group (6%), the researchers report. In addition, the contamination proportion with CCU maneuvers was similar to that reported in the literature for urethral catheterization (12%-14%) and lower than for those reported for collection bag specimens (44%-46%), they say.

These findings "support the use of the CCU standardized stimulation technique as an alternative to invasive methods to obtain a urine specimen," Dr. Gravel and colleagues conclude.
Dr. Gravel told Reuters Health by email, "The technique is ready for use in the ED but nurses have to be trained to use it. We are now using it in our ED but it is not all the nurses who have been trained to use it. We are aware of other EDs who have trained their nurse to use it in their setting."
She added, "Parents are never happy to hear that we will do a urethral catheterism to their young baby. They are happy to see that we are trying to avoid it using new techniques. Babies cry sometime while doing the procedure because they are held by strangers but the families and the medical staff believe that it is less invasive to use the stimulated clean-catch technique."
The researchers suggest using the CCU procedure as a first attempt in well-appearing children aged two to six months to rule out UTI, noting that a child with a negative urinalysis has a < 1% chance of having a UTI.

It would also be useful as a first attempt in children aged zero to six months who merely need a urinalysis and for whom urine specimens are usually obtained by a noninvasive method (including febrile infants in a low-risk group for having UTI, they advise.
The study had no commercial funding and the authors have disclosed no conflicts of interest.