One of the most frustrating and time consuming activities that befalls a nurse working in the paediatric area of the emergency department is obtaining a midstream urine collection from a baby.
Some units may opt for using sterile stick-on collection bags. But my own experience has been that this method is less than effective often resulting in a contaminated specimen that is not really mid-stream anyways.
And collection of a spontaneous pee (often delegated to the parents) although hilarious to watch, is also sub-optimal.
A recent paper from Madrid proposes a method to produce a flow of urine on demand in infants. And I can report that our own unit has found it to be quite effective for both neonates, infants and some older babies.
It takes a minimum of two people to perform this procedure. However, it is better with three, one dedicated to making the catch.
- Encourage oral fluid intake.
- 25 minutes following this feed, the baby/infants genitals are cleaned thoroughly with warm soapy water and dried with sterile gauze.
- Sterile container is prepared to collect specimen.
- Baby is held under the armpits (just above the bed) with legs dangling (the parents can easily assist with this).
- 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.
- Next, the lumbar paravertebral zone (think the small of the lower back) is massaged in a light circular motion for 30 seconds.
- Step 5 and six are repeated until urine is released.
Stand clear & catch the mid-stream.
The paper goes on to discuss the theory behind this manoeuvre which aims to stimulate the detrusor muscle:
The detrusor muscle is innervated by the parasympathetic pelvic nerves (S2–S4). The spinal micturition reflex is a simple arch reflex. Distended bladder walls stimulate efferent fibres going to the medulla, the arch reflex is produced in S2–S4, and afferent fibres stimulate the detrusor muscle which contracts to pass urine. This reflex is voluntarily inhibited and controlled in continent individuals by the cortex, but not in newborns. In neonates, it can be triggered, as we propose.
A new technique for fast and safe collection of urine in newborns1
As I mentioned, our own nurses are reporting a pretty good pee-on-demand success rate using this method.
So. A relatively easy non-invasive intervention that you can try out for yourself.
Impress parents and colleagues with your skills!
Let us know how effective you find it.
- Herreros Fernandez ML, Gonzalez Merino N, Tagarro Garcia A, et al. Arch Dis Child 2013, 98, 27–29 [↩]