1. Urine Sample Collection Techniques
Reading Assignment: CTVT pages
Reading Assignment: DRG pages

2. Objectives
Understand the different urine collection techniques and when each is preferred
Understand the procedure for performing a cystocentesis
Understand the risks and possible complications associated with cystocentesis
Understand the procedure of urinary catheterization and associated complications
Skills: Demonstrate proper technique for a cystocentesis
Understand how to place a urinary catheter in male dogs and cats

3. Why Collect A Urine Sample?
Why would a veterinarian request a urinalysis?
Concern with patient’s ____________ or ______________
Examples
____________ (stones in the kidney, bladder, or urethra)
________________________(Culture & Sensitivity assay)
________________ (ex. FLUTD, FIC – feline idiopathic/interstitial cystitis, blocked tom, pyelonephritis)
Diabetes
Dehydration

4. Anatomy Review Where is the bladder located (using directional terms)?
___________ aspect of the _____________ _____________
What is the bladder made of?
__________ muscle (______________ muscle) & __________ epithelium. This muscle contracts during urination aiding is the expulsion of urine.

5. Abdominal Anatomy Female Male
What else is contained within the abdomen around this location (landmarks)?
Cranial abdomen -
Dorsal abdomen -
Female
Male

7. Collection Techniques
We will discuss:
Cystocentesis
______________ used for ____________ urine analysis
Manual Expression
_____ commonly used for _____________
Can be difficult to accomplish without practice
Voided via free catch
Most commonly used with ______
Use _______________ catch
Urinary catheter
Can be ___________ or not

8. Cystocentesis Definition: Indications: Contraindications:
__________________ of urine from the bladder
Indications:
__________ urine sample for analysis, _______________________ (isolates & identifies specific bacteria causing the infection).
Contraindications:
_____________ urine in bladder
Patient resists restraint
Recent abdominal ____________
pyometra, bleeding disorder., bladder mass. etc.

9. Cystocentesis Advantages:
1. Sample is free from all ____________________ in lower urinary tract
Considered the most _______________ of urine collection
___________ disease to a specific part of the urinary tract
2. Quick & utilizes minimal supplies
3. Minimizes __________ UTI or trauma to _______

10. Cystocentesis Complications: __________ of tissue
Iatrogenic ____________________
Bladder __________
Trauma/laceration of other anatomy

11. Cystocentesis Gather your supplies! Positioning
__________________ – lateral recumbency or standing
___________ – dorsal recumbency (need two restrainers)
Dog: dorsal or lateral recumbency or standing
Cat: lateral recumbency (____________) or dorsal

12. Internal Bladder Anatomy
Dorsal View

13. Bladder Location 1. Palpation Bladder moves _______
Use the ____________ of your _______ to palpate and manipulate the bladder
Once palpated, _______ the bladder before puncturing.

14. Bladder Location 2. Canine landmarks
Female: _______ midline between the __________ two __________ glands
Males: Reflect prepuce ___________ away from ventral midline
Localize the bladder then immobilize it _________________

15. Bladder Location 3. Machines
__________________ __ cystocentesis – used to __________ the location and the _______ of the bladder.
Allows _____________ of the needle as it enters the bladder.

16. Cystocentesis Procedure
1. Wet injection site with alcohol
2. Hold syringe so you can aspirate ___________ changing position
3. Place needle directly into bladder, with intent, between a _________ angle.
__________ of needle will determine ________ into patient
Angle needle in a _______ direction
4. Use aspiration to withdraw desired amount of urine.
*Where should you be looking?
*Watch the needle & bladder and peripherally watching the syringe
5. _______________!!!!!
6. Bring needle __________ out
THINK skin-muscle-bladder

17. Cystocentesis Troubleshooting
If you aspirate blood in your needle:
*_________*, come straight out
Change needle _______ syringe and try again
If you get negative pressure:
May go _________ into animal BUT must first ______________________ from _______________
Aspirate again
If no urine: ______________ & bring needle straight out
*__________________ IN THE ABDOMEN

18. Urine Storage
Urine is transferred to a _______ specimen cup or ________ Tube
Urine must be transferred directly through the rubber top of the tube
Why should we change our needle first?
Wipe top with alcohol first?
Should be tightly sealed to prevent ___________________ or _________________
Urine must be analyzed within _______________ of collection
If cannot be analyzed then, it must be _____________

19. Additional Notes
Lab notes: Each student will perform at least 1 cystocentesis.
You do NOT have to actually collect urine to be successful on this skill; we will be watching your preparation and technique.
Don’t take all of the urine if you’re first or second!
Charting example if you collect any urine: 1 successful cystocentesis

20. Manual Expression Procedure: Indications: Contraindications:
Use __________________ compression to empty the bladder ____________________ pressure using the palmer surface of the fingers, as the urethral sphincter doesn’t relax .
Indications:
____________ bladder for patient due to paralysis/neurological impairment or anesthetized pre-sx
Contraindications:
___________ patient
recent abdominal _______________

21. Manual Expression IF we used this for diagnostic testing: Advantages:
________ can perform
_________________ for patient
cheap for ________
Disadvantages:
________ be used for __________
contamination from the ___________________________ (LUT)
Complications that could happen:
bladder ___________ due to force

22. Voided/Free Catch Indication: Gather your supplies! Dog: Cat:
____________ urinalysis/diagnostic testing- not good for culture!
Gather your supplies!
Dog:
Cat:
_________ box
_____________ litter (i.e noSORB) or wax paper

23. Voided/Free Catch Advantages: Disadvantages:
_____________ for ______ due to skin cells, bacteria, debris etc from hair, skin and _______ genitourinary tract.
The _________________of urine contains the ____________________and should be _____________ from collection.
Our goal is to obtain a __________ catch.

24. Urinary Catheterization
Definition:
A _________ tube is advanced through the urethra, directly into the bladder
Contraindications:
urethral ___________________
scarring causing urethral ____________
*__________ technique must be followed!

25. Urinary Catheterization
Indications:
Urine sample
_________________________ = repeated urine testing
constant ______________ of bladder (long sx)
_____________ urine output amount
reliving a urethral ___________ (TOM CATS)
allowing access to the bladder for radiology (________________ USING CONTRAST AGENTS)
closed elimination system due to zoonotic disease
treating P with conditions for which an indwelling urinary catheter is indicated i.e. Samuel or Slippery Sam; 2nd best method for Cx

26. Types of Urinary Catheters
_____________ (polyvinyl)-softer, left in place
_________________ (hard plastic, only for sampling)
_______ (polypropylene) to unblock then replace with;
_________________ (polyurethane) that softens with body temp

27. Types of Urinary Catheters
__________ (silicone)- softest, helps to have stylet (best method)
Urinary catheters are measured in ________ sizes (i.e 3.5 Fr, 5 Fr, etc.)

28. Urinary Catheterization
Male dog: The “technically-easiest patient”
1. Aseptic technique:
_______________ hair must be ________
Flush prepuce with _____________________________
Rinse with warm water or sterile saline
2. Don ____________ gloves
3. Handle catheter _______________ at all times
4. Apply ______________ lubrication
Local anesthetic gel available

29. Urinary Catheterization
Male dog continued:
4. ____________ will ______________ to expose penis
5. Advance catheter through tip of penis, into ______ and continue until urine is seen
6. Aspirate urine with ________________ syringe, or secure catheter in place
Use white tape and at least two _______ sutures
*Note: If collecting urine for testing discard the ______________ ml aspirated

30. Urinary Catheterization
Female Dog:
Extra supplies may be needed: __________________ a nd __________________
If not available, a __________ technique can be used

32. Urinary Catheterization
Female Dog:
_________ any fur around vulva
________ with dilute antiseptic; rinse
Insert speculum
______________ urethral opening _________ cm insid e vagina on the ventral floor
Insert catheter until urine is observed
_____________ by taping catheter to tail or placing sta y sutures

33. Urinary Catheterization
Male cat:
Most common indication = ___________________
Sedation or anesthesia likely
Hind limbs should be pulled _______________
Aseptically prep site as normal
Extrude the penis evaluate tip for a urethral plug
Advance _______ Tomcat or polypropylene catheter into urethra
Use sterile ___________ to push blockage if necessary
Secure with stay sutures

34. Monitoring Output
A closed system can be created by attaching the catheter to an IV line and then a sterile collection bag.
Patients that are NORMOTENSIVE, NORMOVOLEMIC, and have adequate renal functions should produce ______________ of urine.
1-2 ml/kg/hr
Monitor for obstructions or kinks!

35. U. Catheter Maintenance
Urinary catheters should be removed _________
______________________ and potential for _____________
Replace indwelling catheters every _______________
4-5 days

36. Urinary Catheterization
Possible complications from receiving a urinary catheter:
______________ UTI
urethral _____________
Inflammation
trauma