Dr. Paul Thiessen (biography, no disclosures)
What I did before
For collecting urine in infants typically I would apply a urine collection bag with an adhesive backing to obtain a specimen for urinalysis. If a specimen was needed for culture I would typically perform (or more realistically have a nurse perform) a sterile in and out catheter. In the more distant past I would do a suprapubic aspiration but that practice has become unpopular.
What changed my practice
What changed my practice was this simple new technique reported in an article from Spain which described a new method to obtain a midstream urine collection in which the infant is held upright and someone taps over the suprapubic region while gently rubbing over the lumbar region of the spine. In this study involving 80 infants was 86% within 5 minutes. The median time to specimen collection was 45 seconds, and this has been borne out in my experience. The reflex basis is most probably stimulating reflex contraction of the detrusor muscle by the spinal micturition reflex. This technique has only been described for infants, and the sample used in the study were all in the first month of life. The study did not address immersing in a bath.
What I do now
When a urine specimen is needed in the first months of life (I have no idea of the upper age limit – my oldest infant was 2 months) try this simple technique before resorting to either a bag or catheter specimen. Be sure to clean the infant off thoroughly before collection to reduce contamination. It is ideally performed with 3 people, whereby one holds the baby upright while one taps over the bladder and the other rubs over the lumbar spine. However I have successfully performed it with only 2 people, in which the mother held the infant upright and I did both the tapping and rubbing simultaneously.
Reference
Maria Luisa Herreros Fernandez et al, A new technique for fast and safe collection of urine in newborns. Archives of diseases in childhood 2013:98; p27-29 (Request from CPSBC or view with UBC) http://adc.bmj.com/content/98/1/27 doi:10.1136/archdischild-2012-301872
View image in the article: New stimulation technique to obtain midstream urine in newborns:
(A) Tapping in the suprapubic area. (B) Stimulation of the lower back. (C) Midstream urine sample collection in a sterile container.
Copyright © BMJ Publishing Group Ltd & Royal College of Paediatrics and Child Health.
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Dr. Thiessen first describes rubbing over the bladder while tapping the spine, then tapping over the bladder and rubbing the spine. I assume the correct procedure is the former
Please verify – Spain did the rub over the supra pubic area and the tap over the lumbar area. You mention you do the opposite. Was this a typo? I will surely try this with my patients !
Non invasive is always good.
useful
The correct procedure is tapping over the bladder and rubbing over the spine
So simple, non-invasive and nothing lost even if it doesn’t work.
thanks you. interesting will try it next time with an infant . non invasive and moms will be happier!
Sounds quick and definitely non invasive so will try. Do you need a third hand to hold collection bottle or use bag?
Thanks for A practical tip