Guidance for GP's
You may need a second opinion in some cases where my experience will be helpful to deal with complex paediatric problems. Dr Tewary is willing to discuss these issues/queries any time and help you with further information/clarification where needed.
He has fixed as well as flexible attachment with various private hospitals. This allows him to help patients who want to be seen privately according to earliest mutual convenience. Having worked at senior positions in India and UK, he has developed expertise in advanced & tropical diseases. His sub-specialist interest is in paediatric nephrology and he is one of the few paediatricians providing this unique service in the West Midland.
He provides a detail feedback to you after his consultation, explaining the management plan and next course of action. Where relevant he can perform the follow-up sessions in his NHS Clinic.
Guideline Title: Clean Catch Urine Collection in Children
Date of Implementation: October,2016.
Authors Title: Tewary K
- Urine culture is the golden standard test to support the diagnosis of UTI in children, especially <3 years old.
- While this is a straightforward test to carry out, the chances of getting a contaminated sample is high, and it is extremely important to establish that the urine sample is taken in a ‘clean catch urine’’ manner, the child may otherwise be subjected to unnecessary further investigations and antibiotic management.
- It is also important to document the method of urine collection in the clinical notes once done.
Method of collecting a clean catch sample-
Boys Retract the prepuce (as possible) and wash the glans with lukewarm water, either directly or through cotton balls soaked in water..
Girls Spread the labia in frog leg position and wash with lukewarm water, directly or through cotton balls.
For the very young child a sterile container with provided funnel (available in children’s ward) can be used to collect the sample into the container.
If toilet trained it may be easy to place a sterile bowl into a pot and collect the urine in this. Urine can then be poured from the bowl into the sterile container.
An older child may be able to urinate directly into the container.
A “mid-stream” sample of urine is best for the sample collection, as the initial stream may be contaminated with the bacteria from skin.
Only a small amount of urine is required for the test.
- Avoid the container touching the child’s skin while collecting urine as it may contaminate the sample from bugs normally found on skin..
- Also be careful not to touch the rim of the bottle with your fingers for the same reasons.
- Always try to collect urine sample before starting antibiotics ( However this may be overridden if child extremely sick needing urgent antibiotics, and urine collection is delayed)
What if it is difficult to collect urine directly into the pot/container?
- Other non-invasive methods such as urine collection bags /pads can be used for a dipsticks test only, and is not suitable for a culture. Cotton wool balls, gauze and sanitary towels should not be used for urine collection.
- When it is not possible to collect urine by non-invasive methods, a catheter sample can be obtained, or a suprapubic aspiration done under ultrasound guidance by a senior paediatrician.
- Urine sample should be sent to laboratory within 4 hours of collection for further processing.
- Sample can be kept in fridge if collected out of hours, and not possible to send to lab immediately, or preserved with boric acid (Manufacturer’s instruction to follow).
- Try collecting urine a non-sterile pot such as cleaned potty or jugs, they can give rise to contamination despite thorough cleaning.
- Collect urine and submit for test after 4 hours of collection and kept outside fridge.
- Touch the sterile pot inside, and avoid urine flow touching any part of skin before going in the pot.
- Clean the genital area with wipes; they are not ideal substitute for cleaning with water.
Reference: NICE guideline, CG54; Urinary Tract infections in under 16s: Diagnosis and Management.