of Urine Specimens to Exclude Urinary Tract Infection
|Reviewed by Jodie
Urine collection by bladder stimulation technique
This guideline is intended for
situations where antibiotic therapy needs to be commenced within two days. For other
purposes, e.g. monitoring for infection in asymptomatic infants with
anomalies, infection screen in 'well' infants with risk factors, a bag urine may
suffice if negative on culture.
A suprapubic bladder aspiration
should be attempted. This is considered a reliable method of obtaining urine
for culture in infants. This should be performed prior to handling the baby for
any other invasive procedure. The method is as described in McDonald &
If this is unsuccessful and
other investigations can be delayed, replace the infant's nappy and
reattempt suprapubic aspiration after 30-45 minutes provided that the nappy
is still dry.
If no urine has been
collected after two attempts at suprapubic aspiration of if therapy needs to be
commenced urgently, then a collection by urethral catheterisation should be
Catheterisation should be
performed by a member of the medical or nursing staff who is familiar with
the technique (see
catheterisation protocol). An appropriate sized urinary catheter or if not available
size 5 French feeding tube or 3.5 umbilical catheter (in that order of
preference) should be used. Try to use the smallest-diameter catheter to
avoid traumatic complications.
If the catheter does not pass easily, particularly in a baby boy, do not use
force because of the risk of urethral trauma.
Collect specimen for culture. Remove the catheter as soon as possible to
avoid infectious complications.
N.B Feeding Tubes are not to
be left insitu.
Suprapubic Bladder Aspiration and Bladder
Catheterization, In: Atlas of Procedures in Neonatalogy (4th Ed). MacDonald, G.M.
& Ramasethu, J. (Eds), 2009, (pp 108-116).