1.

Kelly Forceps (straight and curved): Used to clamp larger

Surgical instrumentation blood vessels.
Types 2. Mosquito Forceps: Used to clamp smaller vessels and tissues.
1. Cutting and Dissecting 3. Right angle Forceps / Mixter Used to clamp hard to reach
2. Clumping and Occluding blood vessels and to place suture around or behind the vessel.
3. Grasping and Holding
4. Retracting and Exposing III. GRASPING AND HOLDING

I. CUTTING AND DISSECTING Used to hold tissues, drapes and sponges.

These are sharps and used to cut body tissue and surgical supplies.
1. Adson: Used to grasp delicate tissues.
A. Blade / blade handle: 2. Allis: Used to hold tissues.
1. Handle #7 with blade # 15 (deep knife ) 3. Needle Holder: Used to hold the needle.
Used to cut deep, delicate tissue. 4. Thumb: Used to grasp tough tissues.
2. Handle #3 with blade #10 (inside knife) Used to cut superficial 5. Towel Clips: Used to hold drapes/towel
tissue.
3. Handle #4 with blade #20 ( skin knife ) Used to cut skin IV RETRACTING AND EXPOSING

B. scissors Used to hold back or retract organs or tissue to gain exposure to the
1. Straight mayo scissors: Used to cut suture and supplies. operative site.
2. Curved mayo scissors: Used to cut heavy tissue.
3. Metzenbaum scissors: Used to cut delicate tissue  SELF-RETAINING: Stay open on their own.
4. BANDAGE SCISSORS - also called BANDAGE FORCEPS, are
 MANUAL RETRACTORS: Held by the hand
angled p scissors, with a blunt p on the boom blade, which
helps in cung bandages without gouging the skin.
1. Army Navy: Used to retract shallow and superficial incisions
5. TENOTOMY SCISSORS - is a special type of scissors used for
2. Deaver: Used to retract deep abdominal and chest incisions.
delicate dissecon and cutng, commonly in ophthalmologic,
3. Malleable / Ribbon: Used to retract deep wounds.
neurological, and plasc surgery procedures.
4. Richardson: Used to retract deep abdominal and chest incisions.
5. Self-retaining: Used to retract shallow incisions.
Others
 RONGEUR - is heavy-duty surgical instrument with a Common Hand-held Retractors (Manual)
sharpedged, scoop-shaped tip, used for gouging out bone.
Rongeur is a French word meaning rodent or 'gnawer'. A 6. Senn - is a handheld, double-ended retractor used to retract
rongeur can be used to open a window in bone, often in the primarily surface tissue. "Often used in plastic surgery, small bone
skull, in order to access tissue underneath and joint procedures, or throidectomy and dissection of neck
 OSTEOTOME - an instrument used for cutting or prepa ring tissue."
bone. Osteotomes are similar to a chisel but bevelled on bo th 7. Balfour Abdominal Retractor - Retract wound edges during deep
sides. They are used today in plastic surgery, orthopedic abdominal procedures.
surgery and dental implantation 8. Weitlaner - It is a popular instrument, most commonly used in
basic plastic surgery, large bone and joint procedures.
II. CLAMPING AND OCCLUDING
These are used to compress blood vessels or hallow organ for
HEMOSTATIC or to prevent spillage Suture
Sutures are used by doctor to clse wounds to your skin or othe
tissues. When doctor sutures a wound, they’ll use a needle attached
to a length of “thread” to stitch the wound shut.

Types of suture

It can be:
 Absorbable or non – absorbable
 Actual structure of the material
 Natural or synthetic material
ABSORBABLE SUTURE  This structure is relatively more resistant to harbouring
microorganisms
It is dissolvable stitches; do not need to be removed. They are made
of special materials that can remain in the body for an extended BRAIDED SUTURES
period of time. Over week o months, your body dissolves the sutures
is because enzymes found in the tissues of your body naturally It consists of several small threads braided together. This can lead to
digest them better security, but at cost of increased potential for infection.

Types NATURAL SUTURE

 Polydioxanone (PDS) - this synthetic monofilament suture can May cause tissue reaction and sutue antigenicity lead to
be used for many types of soft tissue wound repaire (such as inflammatory reactions
abdominal closures) as well as for pediatric procedures
 Poliglecaprone (MONOCRYL) – This synthetic monofilament SYNTHETIC SUTURE
suture is used in soft in soft tissue repair. This material
shouldn’t be used for cardiovascular or neurological Less reaction and inflammatory reaction
procedures. This suture is most commonly used to close skin in
an invincible manner.
 Polyglactin (Vicryl) – This synthetic braided suture is god for
repairing hand or facial lacerations. It shouldn’t be used for
cardiovascular or neurological procedures
NON - ABSORBABLE SUTURE

 Can be permanently implanted in the body or can be removed

after few days of surgery depending on the kind of surgery
 It will need to be emoved by the doctor at a later date or in
some cases left in permanently.

Types

 Nylon
o A natural monofilament suture
o It is remarkably smooth, soft and gives excellent knot
security
o Widely used for general closure, skin and plastic
surgery
 Polypropylene (Prolene)
o A synthetic monofilament suture
o It is indicated for skin closure and general soft tissue
approximation and ligation
 Silk
o A braided natural suture
o It is usually used to close incisions, wounds, and cuts
in the skin

 Polyester (Ethibond)
o A braided synthetic suture
o It is indicated for use in general soft tissue
approximation and/or ligation, including use in
cardiovascular, ophthalmic and neurological
procedures.

MONOFILAMENT SUTURES

 Consist of a single thread. This allows the suture to more easily

pass through tissues.
 7. Safely transfers client to operating table and positions client
Surgical Team according to surgeon preference and procedure type.
8. Applies return electrode pad to client if electrocautery used; may
CIRCULATING NURSE prepare client’s skin; may apply ECG electrodes for local case.
A qualified registered nurse, works in collaboration with surgeons, 9. Explains briefly to client what the circulating nurse and the scrub
anesthesia providers, and other health care providers to plan the nurse are doing.
best course of action for each patient 10. Assist surgical team by tying gowns and arranging tables.
11. Assist anesthesiologist during induction and extubation.
MAIN RESPONSIBILITIES 12. Continuously monitors procedure for any breaks in aseptic
Verifying consent; Coordinating the team; and ensuring cleanliness, technique or to anticipate needs of the team; opens additional
proper temperature, humidity, lighting, safe function of equipment, sterile supplies for scrub nurse; ensures standard precautions
and the availability of supplies and materials maintained.
13. Handles surgical specimens per institutional policy.
RESPONSIBILITIES 14. Documents care on perioperative nurse’s notes.
 Manages the OR and protects the patient’s safety and health by 15. Performs sponge, sharp, and instrument counts with scrub nurse
monitoring the activities of the surgical team, checking the OR at beginning of wound care
conditions, and continually assessing the patient for signs of
injury and implementing appropriate interventions. SCRUB NURSE
The scrub nurse sets-up and maintains the sterile field, passes the
 The circulating nurse monitors aseptic practices to avoid breaks sterile instruments and supplies to the surgeon (s) and ensures
in technique while coordinating the movement of related patient safety. Possess basic knowledge of the procedure and the
personnel (medical, x-ray, and laboratory), as well as required instruments and supplies in order to anticipate the
implementing fire safety precautions surgeon’s needs.

 The circulating nurse also monitors the patient and documents RESPONSIBILITIES
specific activities throughout the operation to ensure the  Registered nurse, licensed practical nurse, or surgical
patient’s safety and well-being. technologist (or assistant) performs the activities of the scrub
role, including performing a surgical hand scrub; setting up the
 Is the surgical team member responsible for documenting sterile tables; preparing sutures, ligatures, and special
patient care, ensuring patient safety and monitoring sterility of equipment (eg, laparoscope); and assisting the surgeon and the
the sterile field. Directs the practice of the scrub nurse and is surgical assistants during the procedure by anticipating the
legally responsible for his/her actions. instruments and supplies that will be required, such as sponges,
drains, and other equipment
 Also a patient’s advocate ensuring privacy, preventing injury
from equipment and positioning and reassuring vigilant for  As the surgical incision is closed, the scrub person and the
breaks in technique that may result in surgical site infection. circulator count all needles, sponges, and instruments to be
sure they are accounted for and not retained as a foreign body
 Responsible for ensuring that the second verification of the in the patient
surgical procedure and site takes place and is documented
ROLE OF THE CIRCULATING NURSE  Standards call for all sponges to be visible on x-ray and for
sponge counts to take place at the beginning of surgery and
1. Organizes and prepares OR before start of case; checks to see twice at the end. Tissue specimens obtained during surgery are
equipment works properly. labeled by the person in the scrub role and sent to the
2. Gathers supplies for case and opens sterile supplies for scrub laboratory by the circulator.
nurse.
3. Counts sponges, sharps, and instruments with scrub nurse before ROLE OF SCRUB NURSE:
incision is made.
4. Sends for client at appropriate time. 1. Assist circulating nurse in preparing OR, opening supplies.
5. Conducts preoperative client assessment, including the following: 2. Performs surgical hand scrub and dons sterile gown and gloves.
a) Explains role and identifies client. 3. Sets up sterile field with procedure-appropriate supplies and
b) Reviews medical record and verifies procedure and instruments, verifying all are in working order.
consents. 4. Performs sponge, sharp, and instrument counts with circulating
c) Confirms dentures and prostheses removed nurse before the incision is made.
d) Confirms client’s allergies, nothing by mouth (NPO) status, 5. Gowns and gloves surgeons and assistants as they enter the OR.
laboratory values, electrocardiogram (ECG), x ray films, 6. Assists surgeons with sterile draping of client.
skin condition, circulatory and pulmonary status. 7. Keeps sterile field orderly and monitors progress of procedure and
any breaks in aseptic technique.
8. Passes instruments and supplies to surgeons and assistants. Before the patient enters the OR, often at preadmission testing, the
9. Handles surgical specimens per institutional policy anesthesiologist or anesthetist visits the patient to perform an
10. Constantly monitors location of all sponges and sharps in the assessment, supply information, and answer questions
field and performs closing sponge, sharp, and instrument counts
with circulating nurse. When the patient arrives in the OR, the anaesthesiologist or
anesthetist reassesses the patient’s physical condition immediately
THE SURGEON prior to initiating anesthesia.
The surgeon performs the surgical procedure, heads the surgical
team, and is a licensed physician (MD), osteopath (DO), oral surgeon During surgery, the anaesthesiologist or anesthetist monitors the
(DDS or DMD), or podiatrist (DPM) who is specially trained and patient’s blood pressure, pulse, and respirations as well as the
qualified. electrocardiogram (ECG), blood oxygen saturation level, tidal
volume, blood gas levels, blood pH, alveolar gas concentrations, and
Qualifications and training must adhere to the Joint Commission body temperature.
standards, hospital standards, and local and state admitting
practices and procedures

THE REGISTERED NURSE FIRST ASSISTANT

The registered nurse first assistant (RNFA) is another member of the
OR team. Although the scope of practice of the RNFA depends on
each state’s nurse practice act, the RNFA practices under the direct
supervision of the surgeon.

RESPONSIBILITIES
RNFA responsibilities may include handling tissue, providing
exposure at the operative field, suturing, and maintaining
hemostasis

The role requires a thorough understanding of anatomy and

physiology, tissue handling, and the principles of surgical asepsis.

The RNFA must be aware of the objectives of the surgery, must have
the knowledge and ability to anticipate needs and to work as a
skilled member of a team, and must be able to handle any
emergency situation in the OR.

THE ANESTHESIOLOGIST AND ANESTHETIST

 An anesthesiologist is a physician specifically trained in the art
and science of anaesthesiology
 anesthetist is also a qualified and specifically trained health
care professional who administers anesthetic medications.
 Most anesthetists are nurses who have graduated from an
accredited nurse anesthesia program and have passed
examinations sponsored by the American Association of Nurse
Anesthetists to become a certified registered nurse anesthetist

RESPONSIBILITIES

anesthesiologist or anesthetist assesses the patient before

surgery, selects the anesthesia, administers it, intubates
the patient if necessary, manages any technical problems
related to the administration of the anesthetic agent, and
supervises the patient’s condition throughout the surgical
procedure.
Continuation
 the umbilicus extends across the abdomen to the 7th and 8th
costal interspaces into the thorax

 Examples of use include esophageal varices

MOST COMMONLY USED OPERATIVE POSITIONS • Thoraco-abdominal incision
Dorsal Recumbent or Supine • Abdominal Incisions
 Used for hernia repair, exploratory laparotomy, • Longitudinal Midline Incision
cholecystectomy, gastric and bowel resection, mastectomy
 It begins in the epigastrium at the level of the xiphoid process
Prone and may vertically to the suprapubic region.
 The arm should be well protected and carefully positioned to  It offers excellent exposure of and rapid entry into upper
prevent ulnar or radial damage abdominal content
Trendelenburg Pfannenstiel Incision
 For operation of the lower abdomen and pelvis to obtain good  This incision provides good exposure and strong closure
exposure by displacement of the intestine in the upper for pelvic procedure
abdomen
 Primary use is for an abdominal hysterectomy and
Lithotomy
Caesarian section
 This position is used for perineal, rectal and vaginal surgery

Lateral Positions

 This position is used for kidney operation

Reverse Trendelenburg

 Used to obtain better visualization of the biliary tract

ABDOMINAL INCISIONS

1. Kocher
2. Thoracoabdominal
3. Midline
4. Muscle splitting loin
5. Pfannenstiel
6. Gable
7. Transverse muscle Bilateral Modified Subcostal Incision (Chevron Incision)
splitting
8. Lanz  Made for increased visibility during liver transplant and
9. Paramedian resection
10. McEvedy
McBurney Incision

 Located at the right lower quadrant just below the umbilicus

 This is a fast easy incision, but exposure is limited

Midabdominal Transverse Incision

SUB COSTAL UPPER QUADRANT OBLIQUE (KOCHER)  Examples of use include choledochojejunostomy and
transverse colostomy
 It begins in the epigastrium and extends laterally and obliquely
just below the lower costal margin Paramedian Incision

 Examples of use includes biliary procedures and splenectomy  Examples of use includes access of the biliary tract or
pancreas in RUQ and access to the LLQ for resection of the
Thoracoabdominal Incision sigmoid colon
 The patient s placed in in a lateral position, either right or left Inguinal Incision (Lower oblique/ McEvedy)
incision begins at the midway between the xiphoid process and
  It provides access to the inguinal canal and cord structures

 Primary use inguinal herniorrhapy

Intravenous Therapy
A common method for replacing water, electrolytes and blood
products and is also used for the continuous administration of drugs.

TYPES OF IV DEVICES

 Angiocaths
METHODS OF INTRAVEOUS ADMINISTRATION
 Winged “Butterfly” catheters – portacath insertion
1. LARGE VOLUME INFUSIONS – administers 1L or 500mL of solution
 Midline catheter (MLC) (1-4 weeks)
2. INTERMITTERNT INTRAVENOUS INFUSIONS – administers small
 CVD (central vascular devices)
amount of IV solution (e.g. 100 ml or 50ml) via piggyback port
EQUIPMENT 3. VOLUME – CONTROL INUSIONS – use of volume control infusion
set (e.g. Soluset) attached bellow the primary infusion line
1. Solution an tubing 4. INTAVENOUS PUSH – administration of undiluted site or into the
2. Pump and pole venipuncture site or into an existing IV line
3. Various needles/Angiocaths
4. IV Start kit or tape, betadine, ETOH (Ethyl Alcohol) wipes, IV FLOW RATE
tourniquet & dressing Common drop factors
5. Towel Macro: 10 gtts = 1ml
6. Gloves 15gtts = 1ml
20ggtts = 1ml
Micro: 60gtts = 1 ml

SETTING UP AN IV SOLUTION
1. Verify Physician’s Order READ CAREFULLY.
Example of an IV ORDER
D5 LR i liter to run for 8 hours
2. Observe the 10 rights when preparing and administering IVF.
3. Introduce self. Verify patients’ identity ALWAYS MAKE SURE YOU
HAVE THE RIGHT PATIENT. Maintain a nurse patient relationship.
4. Explain to the client the procedure, purpose and how can he/she
can cooperate.
5. Perform infection control procedure.
6. Provides client’s privacy.
7. Open and prepare the infusion set.
8. Spike the solution container.
9. Apply the IV label on the solution container.
10. Hang the solution container on the pole. (1 meter above the
Blood Transfusion Tubing clients’ head.
11. Partially fill the drip chamber with solution by squeezing the
PARTS OF IV CANNULA FOR CONTINUOUS AND INTERMITTENT chamber gently.
THERAPY 12. Prime the tubing.
SITE SELECTION
1. Good light
2. Position Patient
3. Patient preference
4. Ask the patient if (+)CVA?
(+) Mastectomy?
5. Avoid areas of flexion
6. Consider medical hx, age, size, general condition, level of activity
7. Type of infusion
8. Expected duration of IV therapy

SITES TO AVOID
1. Foot, leg & ankle veins
2. Veins below a previous IV infiltration
3. Veins below a phlebitic area
4. Sclerosed or thrombosed veins
5. Areas of skin inflammation, disease, bruising or breakdown
6. An arm effected by radical mastectomy, edema, blood clot or
infection
7. An arm with an arteriovenous shunt or fistula

NEEDLE SELECTION
•¾ to 1¼ inches long
•Consider condition and Type of solution
•24-22 gauge for children & elderly MONITORING AN IV SOLUTION
•24-20 gauge for medical & post-op pts 1. Verify written doctor’s order.
•18 gauge for surgical pts 2. Assess:
•16 gauge for trauma pts  Appearance of infusion site
 Patency of system
TOURNIQUET CONSIDERATIONS:  Type of fluid being infused
•Ask pts for Latex allergies  Rate of flow
•4-6 inches above venipuncture site  Response of the client
•Should be able to palpate distal pulse 3. Ensure that the correct solution is being infused.
4. Observe the flow rate every hour
Site Preparation 5. Inspect the patency of the IV tubing and needle.
1. DO NOT SHAVE-clip hair if necessary  Observe the position of the solution container. Follow the
2. Cleanse site correct height.
3. DO NOT CONTAMINATE AFTER CLEANSING  Observe the drip chamber
 Open the drip regulator and observe for a rapid flow of fluid
CHARTING from the solution container into the drip chamber.
Date & time, type and gauge of the needle  Inspect the tubing for pinches, kinks or obstruction to flow.
• # of attempts  Lower the solution container below the level of the infusion
• Site (exact location) site. Observe for the return flow of blood from the vein.
• Type of dressing applied  Determine whether the level of the catheter is blocked against
• Pt’s response the wall of the vein. If it is blocked, adjust accordingly to re-
• Special precautions (positional, armboard, pumps) established flow.
• Fluid type, amount & rate  If there is leakage, locate the source. If the leak is at the
• Parenteral fluid sheet I & O catheter connection, tighten the tubing into the catheter. If
cannot be stop change it to a new tubing
SAMPLE DOCUMENTATION
2/25/09 2 \PM Inserted 20 gauge angiocath in left metacarpal area
on first attempt. D5 LR i liter + 10 units Syntocinon infusing at
125ml/hour. Explained reason for IV. Stated understanding by
restating the instructions given- - - - M. Vico RN

INTRAVENOUS FLUID SHEET

PURPOSE:
To provide complete information about patients intravenous
therapy and blood therapy.
GUIDELINES:
1. Fill out patients data including name, ward number, and room
number.
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6. Inspect the insertion site for complication. If complication is 2. Explain to the client the procedure.
present, stop the infusion. Restart the infusion at another site. 3. Perform infection control procedure.
7. If complication is not evident, calibrate the IV solution as ordered. 4. Prepare the materials needed for IVF removal.
8. Document and endorse accordingly. 5. Provide client’s privacy.
6. Verification of doctor’s order.
NURSING CONSIDERATION IN IV THERAPY 7. Remove the dressing applied on the catheter carefully.
Solution 8. Using your non-dominant get a dry cotton balls and place it over
• Do not hang longer than 24 hours the IV catheter. No pressure applied. While your dominant hand is
• Never let run dry gently pulling the IV catheter. Apply a gentle pressure on the site in
Tubing order to control the bleeding. Leave the cotton ball in place and
• Change according to hospital policy cover it with a micropore.
• Ensure all connections are secure 9. Dispose used materials appropriately according to hospital policy.
Site 10. Wash hands.
Needle 11. Documentation.
Dressing

PATIENT TEACHING Urinary catheterization

1. Do not kink, compress or lie on tubing
2. Avoid using the IV arm to eat, hygiene
A urinary catheter is any tube system placed in the body to drain
3. DO NOT adjust clamp or change level of bag
and collect urine from the bladder.
4. When walking--call for help, don’t pull on tubing, use IV pole,
bend arm at waist. Types
5. Call nurse when--bag is low/empty, any wetness/blood, pain,
burning, swelling, alarming pump. 1. Latex
2. Silicon
CHANGING OF AN IV SOLUTION
1. Establish Nurse patient relationship. Purpose of Urinary Catheterization
2. Explain to the client the procedure.
 Relieve urine retention
3. Perform infection control procedure.
 Obtain a sterile urine specimen from a female patient
4. Provide client’s privacy.
5. Verification of doctor’s order.  Measure residual urine
6. Set-up the intravenous equipment.  Empty the bladder before, during or after the surgery
7. Check sterility and integrity of the IV solution.  Allows accurate measurement of urine output.
8. Changing of IV Bottle
2 categories of urinary catheters
9. Regulate flow rate as per doctor’s order.
10. Dispose used materials appropriately according to hospital  Straight or Robinson Catheter a single lumen tube with a
policy. small eye or opening about 1 ¼ cm from the insertion tip.
11. Documentation.  Used primarily for obtaining urine specimen and residual
urine
LABEL OF THE IV SOLUTION
 Retention (indwelling or Foley) catheter is a soft plastic or
• TYPE OF FLUID
rubber tube that is inserted into the bladder to drain the
• MEDICATION ADDITIVES AND FLOW RATE
urine
• USE OF ANY ELECTRONIC DEVICES
 French #8 or #10 used for children
• DURATION OF THERAPY AND NURSES SIGNATURE
 French #14, #16, #16 for adults
• DATE AND TIME OF INSERTION
 Two way catheter – two openings one to drain the urine
the other to in inflate the balloon
IV LABEL example
 Three way catheter – same with two way except that it has
NAME: Juan Delacruz
third channel through which the sterile fluid can flow into
AGE: 54 yo
the urinary bladder
IVF: D5LR 1 L x 30 gtts/min
MEDICATION ADDITIVES: none
DATE AND TIME: 12/12/19, 1700H
NURSES SIGNATURE:
Karen Deguzman

DISCONTINUATION OF IV THERAPY
1. Establish Nurse patient relationship.
Complications of catheter use:
How to care for your catheter
 Urinary tract or kidney infections
 Most expert advice against routine changing (replacing) of
 Blood infections (septicaemia)
the catheters. Must include daily cleansing of the urethral
 Urethral injury
area (where the catheter exits the body) and the catheter
 Skin breakdown
itself with soap and water.
 Bladder stones
 You should increase your fluid intake, unless you have a
 Blood in the urine (hematuria)
medical condition prohibiting large amounts of fluid
 After many years of catheter use, bladder cancer may also intake, to reduce the risk of developing complications
develop.
 The drainage bag must always stay lower than the bladder
to prevent a back flow of urine back up into the bladder
Long term (indwelling) urethral catheters
 The drainage device should be emptied at least every 8
There are 2 types of drainage bags. hours, or when the device is full.
 Wash your hands before and after handling the drainage
 Leg bag – a smaller drainage device that attaches by elastic device
bands to the leg
 Larger drainage device (down drain or urine bag) that may be How to clean your drainage bag
used during the night. This device is usually hung in the bed or  Remove the drainage bag from the catheter (attach the
placed on the floor. catheter to a second drainage device during the cleansing).
 Cleanse and deodorize the drainage bag by filling the bag with 2
pats vinegar and 3 parts water
 Let this solution soak for 20 minutes
 Hang the bag with the outlet valve open to drain and dry the
bag

Promoting Urinary Elimination

Changes in Micturation:

1. Hematuria (red blood cells in the urine)

2. Proteinuria (albuminuria)
3. Dysuria (painful or difficult voiding)
4. Frequency – void occurs more requent that usual
5. Urgency (strong desie to urinate)
6. Burning upon urination
7. Enuresis (involuntary voiding during sleep)
8. Nocturia (excessive urination at night)
9. Incotinence (involuntary loss of urine)
10. Oliguria (small volume of urine)
11. Anuria (absence of urine in the blader)
12. Polyuria (large volume of urine voided in given time) • It’s also done to measure protein, hormones,
13. Urinary retention – inability to void even the bladder contains
minerals and other chemical compounds.
excessive amunts or urine

Contraindications CONTRAINDICATION / RISKS

Certain factors or conditions may interfere with the
 Traumatic injury to the lower urinary tract (eg. Urethral tear).
This condition may be suspected in male patients with a pelvic accuracy of a 24-hour urine collection.
or straddle-type injury. Signs that increase suspicion for injury
are a high – riding or boggy prostate, perineal hematoma, or These factors include:
blood at the meatus. • Forgetting to collect some of the urine
The alternatives to urethral catheterization • Going beyond the 24-hour collection period and
collecting too much urine
 Suprapubic catheterization
• Losing urine from the specimen container through
 Condom catheters for longer durations
spilling
Universal precautions • Not keeping urine cold while collecting it
 The potential for contact with a patient’s blod/body fluids while • Acute stress
starting a catheter is present and increases with inexperience of • Vigorous exercise
the operator
• Certain foods, such as coffee, tea, cocoa, bananas,
 Gloves must be worn while starting the Foley, not only to
protect the user, but also to prevent infection in the patient
citrus fruits, vanilla, can change urine test results
 Trauma protocol calls for all team members to wear gloves,
face and eye protection and gowns 24 hour urine collection

 Keep urine refrigerated in a wide-mouthed,

capped, clean collection bottle large enough to
hold about 2000 of urine.
 If special preservative is required , add it to the
collection before the beginning of the of the
urine collection.

IMPORTANT STEPS IN 24 HRS URINE COLLECTION

 Label the gallon-size specimen container as ‘24 hour

specimen’ and with patient’s identification, such as
name, room, bed number, according to hospital
routine. Place container in designated area, outside
24-HOUR URINE COLLECTION patient’s unit.
 Explain patient that all urine during 24 hour period
For most chemical analysis, a 24 hour specimen is is measured and saved
required, since many of solutes exhibit di-urinal  Have patient void at the time that test started (for
variations. example 7am)
 Save all the urine voided after this first time, for the
PURPOSE: next 24 hours
• The 24-hour urine collection helps diagnose kidney  Each time the patient voids, pour urine from
problems. bedpan or urinal into bottle, measure and write
• It is often done to see how much creatinine clears down the amount, then pour into the specimen
through the kidneys. container.
 At the end of 24 hours, at the same hour that • Refrigerate the collection jug away from the
collection started, have the patient void. foods to avoid contamination.
 Save urine, record amount, and pour into the • Take note the accurate time and date of its start
specimen bottle. This is the end of the collection. and ending of the collection.
 Take care of specimen according to hospital
requirement
 Label container, total number of urine (cc or ml) in
the container, and record the time that the
collection ended.
 See that cover or top of container is secure and that
there is no delay in specimen reaching laboratory

NURSING RESPONSIBILITIES
• To collect and label the specimen for analysis
and ensure the delivery to the lab.
• The appropriate infection control procedure
must be follow during collecting and storing of
urine.
• Teach the patient on how to collect her own
urine without spilling.
• Ensure that the container is properly secured
especially if it is being transported to the lab.