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Colostomy care

Encyclopedia of Nursing and Allied Health, , by R.N.


Deanna M. Sartout!Corbeil
Definition
A colostomy is a surgically created opening in the abdominal wall through which
digested food passes. It may be temporary or permanent. The opening is called a stoma
from the Greek word meaning mouth. Stool passes through the stoma into a pouch
attached to the stoma on the outside of the abdomen. The pouch, stoma, and skin
surrounding the stoma require care and maintenance by the patient or caregiver.
"urpose
A pouch is worn over a colostomy to collect the stool passed through the stoma. There are
a variety of pouches available for use with a colostomy. ver time the patient can
determine which pouch type best suits his or her needs. A colostomy pouch is normally
emptied one or more times daily. The pouch itself usually needs to be changed every four
to si! days. The stoma and surrounding skin need to be kept clean and sanitary.
"recautions
The nurse attending to a colostomy should wash his or her hands before and after the
procedure, as well as wear late! gloves while performing care.
Description
A pouching system is normally worn over a colostomy stoma. "ouches can be obtained
from several different manufacturers in both disposable and reusable varieties. The
enterostomal therapy #T nurse can be an invaluable resource when helping patients select
a pouch system.
$olostomy pouches may be either open ended or closed. pen%ended pouches require a
clamp for closure. They can be drained simply and reused after they are emptied. $losed
pouches are sealed at the bottom and are usually used by patients who irrigate their
colostomies or who have a regular bowel elimination pattern. Two%piece pouch systems
consist of a separate flange and pouch. The pouch has a closing ring that attaches to a
matching piece on the flange. ne%piece systems have a connected wafer and pouch that
do not separate. The portion of the pouch that is applied to the abdomen is called a skin
barrier wafer. &oth two%piece and one%piece systems can be either closed or open ended.
Some patients with colostomies can irrigate their stomas using a procedure similar to an
enema. This cleans the stool out of the colon through the stoma. A special irrigation
system is used. Sometimes a special lubricant is used to prepare for the irrigation.
Irrigating often leads to increased control over the timing of bowel movements.
'emoving the colostomy appliance requires gently pushing away the skin surrounding
the stoma and pulling the appliance downwards. Adhesive remover wipes are available to
help in the removal of the wafer. The bag is then discarded in an appropriate waste
container. The stoma should be cleaned with lukewarm water and dried with a soft towel.
The stoma and surrounding skin should be assessed. The stoma should be pink or red and
moist%looking, and may bleed slightly when cleansed. The stoma normally decreases in
si(e slightly during the first weeks after surgery.
The opening in the wafer should fit snugly around the stoma. An opening that is too large
will allow intestinal contents to leak onto the skin. )easuring guides come with the
colostomy wafers so that the hole can be cut to the proper si(e. Skin barrier paste can be
used to help create a better seal between the wafer and the patient*s abdomen. +arious
skin preparation products are also available to help protect the skin under the wafer and
around the stoma. They also aid in the adhesion of the wafer. ,sing the fingertips, gentle
pressure should be applied to put the wafer in place.
After the application of the barrier, the bag should be applied -if it is a two%piece system..
If it is an open system, apply a clamp to the bottom of the new pouch.
"reparation
The nurse should instruct the patient and caregiver-s. about the procedure before it is
performed. )any people feel an!ious and nervous when first dealing with an ostomy.
#ncourage the patient to ask questions, and e!plain all steps as they are performed.
Aftercare
The nurse should assess the patient*s tolerance of the procedure and response to teaching
or education about the appliance.
Health care team roles
Although most members of the health care team will come into contact with patients
having ostomies, it is the nurse who has the responsibility for providing ostomy care and
instructing the patient and/or caregiver how to provide care independently. An
enterostomal therapy -#T. nurse is specially educated in all aspects of ostomy care.
#ey $erms
Stoma
Surgically constructed mouth or passage between the intestine and the outside of
the patient*s body.
Colostomy Care
%ENERA& 'N()RMA$')N*
+hat is a colostomy,
A colostomy is an opening that is made in the colon with surgery. After the
opening is made, the colon is brought to the surface of the abdomen to allow
stools to leave your body. The opening at the surface of the abdomen is called a
stoma. The stool leaves the colon through the stoma and drains into a flat,
changeable, watertight bag or pouch. The pouch is attached to the skin with an
adhesive -substance that seals the pouch to the skin..
A colostomy is sometimes needed for certain health conditions or diseases. Some
of these include cancer, diverticular disease, $rohn*s disease and trauma or in0ury.
A temporary colostomy may be needed to allow the colon to rest and heal for a
period of time. A temporary colostomy may be in place for weeks, months, or
years. The temporary colostomy will eventually be closed and bowel movements
will return to normal. A permanent colostomy is usually needed when a part of the
colon must be removed or cannot be used again.
+here is the colon located, The colon is part of the digestive system. The digestive
system consists of the parts of the body that are involved in the digestion -breakdown. of
food. 1ood moves from your stomach to the small intestine where food is digested and
nutrients are absorbed. The food then goes to the colon -part of the large intestine.. The
colon absorbs water from digested food and turns the digested food into stool.
+hat are the different types of colostomies, $olostomy types are related to the place
on the colon where the surgery is done. The location of the surgery depends on your
health condition and the reason you need to have a colostomy.
Ascending colostomy* This colostomy has a stoma -opening. that is located on
the right side of the abdomen. The output -stool. that drains from this stoma is in
liquid form.
$rans-erse colostomy* This colostomy has a stoma that is located in the upper
abdomen towards the middle or right side. The output that drains from this stoma
may be loose or soft.
Descending or sigmoid colostomy* This colostomy has a stoma that is located on
the lower left side of the abdomen. The output that drains from this stoma is firm.
+hat types of products are used for colostomies,
"ouch* There are a variety of si(es and styles of colostomy pouches. "ouches are
lightweight and odor%proof. "ouches have a special covering that prevents the
pouch from sticking to the body. Some pouches also have charcoal filters which
release gas slowly and help to decrease gas odor. The following is general
information about types of colostomy pouches2
o )pen!ended pouch* This type of pouch allows you to open the bottom of
the pouch to drain the output. The open end is usually closed with a clamp.
The open%ended pouch is usually used by people with ascending or
transverse colostomies. The output from these colostomies is looser and is
unpredictable -does not drain at regular times..
o Close!ended pouch* This type of pouch is removed and thrown away
when the pouch is filled. $lose%ended pouches are usually used by people
with a descending or sigmoid colostomy. The output from these types of
colostomies is firm and does not need to be drained .
o )ne!piece* A one%piece pouch contains the pouch and adhesive skin
barrier together as one unit. The adhesive skin barrier is the part of the
pouch system that is placed around the stoma and attached to skin. 3hen
the pouch is removed and replaced with a new one, the new pouch must be
reattached to the skin.
o $o!piece* The two%piece pouch has two parts2 an adhesive flange and
pouch. The adhesive flange stays in place while the pouch is removed and
new pouch is attached to the flange. The pouch does not need to be
reattached to the skin each time. The two%piece system can be helpful for
patients with sensitive skin.
o "re!cut or cut!to!fit pouches* Some pouches have pre%cut holes so you
do not have to cut the opening yourself. ther pouches can be cut to fit the
si(e and shape of your stoma. $ut%to%fit pouches are especially useful right
after your surgery because your stoma decreases in si(e for about eight
weeks.
Stoma co-ers and caps* Stoma caps or covers can be placed on the stoma when
the stoma is not active -draining.. "eople with descending or sigmoid colostomies
who irrigate may use stoma covers or caps. The cover or cap is attached to the
skin in the same way as a pouch.
S.in protection*
o (ilm* A film can be placed on the skin to protect against damage from the
adhesive material. 1ilms are helpful for people with sensitive, dry, or oily
skin.
o "ectin!based paste or paste strips/rings* These products are helpful for
protecting skin against output that contains digestive en(ymes -proteins
that break down foods.. Ascending or transverse colostomies can produce
output that contains digestive en(ymes, which can irritate or damage the
skin. The paste is also used to create a flat pouch surface by filling in
small skin creases.
Ho do ' change my pouch, The way in which you should change your colostomy
pouch depends on the type of pouch you use. 4our caregiver will give you specific
instructions on how to change your colostomy pouch. The following is general
information about how to change your pouch2
Ask your caregiver about how often to change your colostomy pouch. The amount
of time that you should leave your pouch on your abdomen depends on many
things. The type of pouch you wear affects the amount of time you can wear a
pouch. The kind and amount of stool you have also affects how long the pouch
stays on.
If you are wearing an open%ended pouch, empty the contents from pouch into the
toilet. Gently remove the pouch by pushing the skin down and away from the
adhesive skin barrier with one hand. 3ith the other hand, pull the pouch up and
away from the stoma.
$lean the skin around the stoma with warm water. 4ou may also use soap but do
not use soaps that have oil or perfumes. "at your skin dry.
,se a pouch that has an opening that is one%eighth of an inch larger than the
stoma.
,se skin protection products if you have irritated skin around the stoma. The skin
can be treated with these products to protect your skin and create a dry surface.
$enter the pouch over the stoma and press it firmly into place on clean, dry skin.
It may be helpful to hold your hand over the newly applied pouch for 56 seconds.
The warmth of your hand can help to mold the adhesive skin barrier into place.
"lace the old pouch in another plastic bag to be thrown away if the pouch is
disposable. If you use a reusable pouch, talk to your caregiver about how to clean
the reusable pouch.
Ho do ' empty my pouch,
#mpty the pouch when it is one%third to one%half full. 7o not wait until the pouch
is completely full because this could put pressure on the seal, causing a leak. The
pouch may also detach, causing all of the pouch contents to spill.
"lace toilet paper into the toilet to reduce splash back and noise.
Take the end of the pouch and hold it up. 'emove the clamp -if the pouch has a
clamp system..
4ou may need to make a cuff at the end of the pouch to keep it from getting
soiled.
7rain the pouch by squee(ing the pouch contents into the toilet.
$lean the cuffed end of the pouch with toilet paper or a moist paper towel. 4ou
may also rinse the pouch but it is not necessary. )ake sure and keep the end of
the pouch clean.
,ndo the cuff at the end of the pouch. 'eplace the clamp or close the end of the
pouch according to your caregiver*s instructions.
+hat is irrigation, "eople with descending or sigmoid colostomies may be able to
irrigate their colostomies on a regular basis. Irrigating the stoma means putting a fluid
into the stoma to empty the bowel. This may also be called an enema. Irrigation allows a
person to have timed bowel movements. Irrigation can allow a person to be free from
stool output for about 89 to 9: hours. nce stool output is regular, a stoma cap can be
used between irrigations instead of using a drainable pouch. The stoma cap will absorb
mucus and deodori(e and vent gas.
Talk to your caregiver about whether irrigation is right for you. Irrigation may be right for
you if you had regular bowel movements before the colostomy. 4ou should also be
physically able to perform the irrigation procedure. It is also important to have a lifestyle
that will allow regular irrigation. 1or e!ample, you should have a daily schedule in which
you can schedule enough time to regularly irrigate. 4ou should also be free from certain
colostomy problems. "eople with problems such as a prolapse or a hernia should not
irrigate. Irrigation could make a prolapse worse or create a hole in the bowel. Irrigation
could also cause leakage of stools between irrigations or make it hard to control bowel
movements.
Ho do ' irrigate my colostomy, As. a specially trained caregi-er such as an
ostomy nurse ho to properly irrigate your colostomy. &elow are some general steps
for irrigation2
4ou will need a plastic irrigating container with a long tube and a cone to
introduce water into the colostomy. 4ou will also need an irrigation slee-e that
will direct the output into the toilet. 4ou will need an ad0ustable belt to attach the
irrigation sleeve and a tail closure for the end of the sleeve.
$hoose the same time each day when you will not be interrupted to irrigate your
colostomy.
1ill the irrigating container with about ;< to =6 ounces -=66 to ;=66 m>. of
lukewarm water. The water should not be cold or hot. The amount of water each
person needs to put in the irrigating container varies. Ask your caregiver how
much water you will need to irrigate. ?ang the irrigation container at a height in
which the bottom of the container is level with your shoulder. Sit up straight on
the toilet or on a chair ne!t to the toilet.
Take the ad0ustable belt and attach it to the irrigation sleeve. "lace the belt around
your waist and place the sleeve over your stoma. "lace the end of the irrigation
sleeve into the toilet bowel.
'elease air bubbles from the tubing on the plastic irrigating container by releasing
the clamp. Allow a small amount of water to be released into the sleeve. $lamp
the tubing again.
)oisten the end of the cone with water or lubricate it with water%soluble
lubricant.
"lace the tip of the cone about three inches deep into the stoma. )ake sure there
is a snug fit but do not place the cone too deeply or forcefully into the stoma.
'elease the clamp on the tubing again and allow the water to flow into the stoma.
The water must go in slowly and takes about five to ten minutes. @eep the cone in
place for another ;6 seconds.
'emove the cone from the stoma. Allow the output to drain into the irrigation
sleeve for about ;6 to ;= minutes. 7ry the end of the irrigation sleeve. $lip the
bottom of the sleeve to the top with a clasp or close the end of the sleeve with the
tail closure. 4ou may move around for about 56 to 9= minutes until all the water
and stool has drained. 7rain the output from the sleeve into the toilet. $lean the
area around the stoma with mild soap and water and pat dry.
+hat are some problems that can happen ith a stoma, )ost stoma problems
happen during the first year after surgery.
Stoma retraction* 'etraction happens when the height of the stoma goes down to
the skin level or below the skin level. 'etraction may happen soon after surgery
because the colon does not become active soon enough. 'etraction may also
happen because of weight gain. The pouching system must be changed to match
the change in stoma shape.
"eristomal hernia* "eristomal hernias occur when part of the bowel -colon.
bulges into the area around the stoma. ?ernias are most obvious during times
when there is pressure on the abdomen. 1or e!ample, the hernia may be more
obvious when sitting, coughing, or straining. ?ernias may make it difficult to
create a proper pouch seal or to irrigate. The hernia may be managed with a hernia
belt. $hanges may also need to be made to the pouching system to create a proper
seal. Surgery may also be done in some people.
"rolapse* A prolapse means the bowel becomes longer and protrudes out of the
stoma and above the abdomen surface. The stomal prolapse may be caused by
increased abdominal pressure. Surgery may be done to fi! the prolapse in some
people.
Stenosis* A stenosis is a narrowing or tightening of the stoma at or below the skin
level. The stenosis may be mild or severe. A mild stenosis can cause noise as stool
and gas is passed. Severe stenosis can cause obstruction -blockage. of stool. If the
stoma is mild, a caregiver may enlarge it by stretching it with his finger. If the
stenosis is severe, surgery is usually needed.
+hat types of foods can ' eat after a colostomy,
"eople with colostomies can eat a regular diet. $hoose healthy foods from all the
food groups. To avoid constipation, eat foods such as oatmeal, whole%grain breads
and cereals, fruits and vegetables. There may be some foods that you cannot
tolerate very well. If a food gives you cramps or diarrhea, do not include that food
in your diet. Try the food again in a few weeks. #at small portions first and then
gradually increase your portion si(es.
4ou may want to avoid foods that cause gas and odor. Some foods that may cause
gas and odor are vegetables such as broccoli, cabbage, and cauliflower. ther
foods include beans, eggs, and fish. 4ou can also reduce gas by eating slowly and
not using straws to drink liquids. 1oods that may help to control odor and gas in
some people are fresh parsley, yogurt and buttermilk.
7rink at least : to ;6 -eight ounce. cups of water each day. 1ollow your
caregiver*s advice if you must limit the amount of liquids you drink. ?ealthy
liquids for most people to drink are water, 0uices, and milk. >imit the amount of
caffeine you drink, such as coffee, tea, and soda.
Ho can a colostomy fit into my lifestyle,
+or.* 4ou can go back to work when your caregiver says it is @. 4ou may
need special support to prevent a hernia if you work is heavy labor, such as lifting
or digging. 4ou may need an ostomy belt over the pouch to keep it in place if you
move a lot at your 0ob.
E1ercise* #!ercise is very important. Talk to your caregiver about an e!ercise
program once you feel stronger. Together you can plan a program that works for
you. It is best to start slowly and do more as you get stronger. #!ercising makes
the heart stronger, lowers blood pressure, and helps keep you healthy. 4our body
and mind should feel better after e!ercising. 3alking, 0ogging, bicycling, and
swimming are good e!ercises. Talk with your caregiver before playing contact
sports. 4ou may need to wear a special support or a colostomy cover to protect
your stoma. #mpty your pouch before playing sports.
2athing or simming* 4ou may take a bath with or without your pouch. 4ou can
take a shower or bath with your pouch off. 3ater will not go into the stoma during
a shower or bath. 1or swimming, you should alays wear your pouch. #mpty
your pouch before getting into the water if you swim. 4ou may want to put
waterproof tape strips over the edges of your skin barrier.
Relationships*
o 4ou may feel an!ious, nervous, or scared when you first start to care for
your colostomy. 4ou may not like the way your body looks. 4ou may feel
like you are no longer in control of your body. These are normal feelings.
Talk to someone close to you or to your caregiver about these feelings.
o >earning to live with a colostomy may be difficult for both you and your
spouse. Together you can find ways to live with this change in your life. It
will take time for you to feel better after surgery. If you had an active se!
life before colostomy surgery, it can be the same after surgery. 4ou cannot
hurt your stoma by having close body contact. &e sure to empty the pouch
before having se!.
$ra-eling* Always carry e!tra colostomy supplies and pouches with you when
traveling. Take enough supplies for your trip. 4ou may not be able to find what
you need while traveling. $ontact your local ostomy group or ostomy nurse for
help. They may be able to give you a list of ostomy caregivers in the area you are
visiting.
o If you fly, pack your supplies in your carry%on luggage not your checked
suitcase because luggage is sometimes lost or delayed.
o If you drive, do not put your supplies in the trunk or glove compartment.
This can cause your supplies to get hot, melt and not stick well. @eep your
ostomy supplies in the coolest place in the car.
+here can ' find support and more information, 4ou may feel embarrassed, an!ious,
or worried because you have a colostomy. These feelings are common. It will take time
for you to get used to your new body image and body function. Talk about your feelings
with your caregiver or with someone close to you. Ask your caregiver about support
groups for people with a colostomy or to arrange for an ostomy visitor. Such a group or
person can give you support and information. $ontact the following for more information
and support.
CARE A%REEMEN$*
4ou have the right to help plan your care. To help with this plan, you must learn about
your health condition and how it may be treated. 4ou can then discuss treatment options
with your caregivers. 3ork with them to decide what care may be used to treat you. 4ou
always have the right to refuse treatment.
89 ?,' ,'IA# $>>#$TIA
IAT'7,$TIA B There are a variety of circumstances in which collection of an
accurate 89%hour sample is important. #!amples include calculation of the creatinine
clearance, estimation of protein e!cretion, and measurement of the e!cretion of free
cortisol or steroid metabolites in patients with suspected adrenal disease.
The following are a set of instructions for the proper collection of a 89%hour urine
specimen. In some instances, a patient will be asked to collect two or three consecutive
89%hour urine samples.
IAST',$TIAS
4ou should collect every drop of urine during each 89%hour period. It does not
matter how much or little urine is passed each time, as long as every drop is
collected.
&egin the urine collection in the morning after you wake up, after you have
emptied your bladder for the first time.
,rinate -empty the bladder. for the first time and flush it down the toilet. Aote the
e!act time -eg, <2;= A).. 4ou will begin the urine collection at this time.
Into an empty collection bottle, collect every drop of urine during the day and
night.
If you need to have a bowel movement, any urine passed with the bowel
movement should be collected. Try not to include feces with the urine collection.
If feces does get mi!ed in, do not try to remove the feces from the urine collection
bottle.
1inish the collection with the first urine of the ne!t morning, adding it to the
collection bottle. This should be within five to ten minutes of the time of the first
morning void on the first day -which was flushed, in this e!ample, at <2;= A) in
this e!ample..
If you need to urinate one hour before the appointed time, drink a full glass of water so
that you can void again at the appropriate time. If you have to urinate 86 minutes before,
try to hold the urine until the proper time.
"lease note the e!act time of the final urinationC even if it is not the same time as when
collection began on day one, it is important that you accurately record the time of the
final void.
ST'AG# B The bottle-s. may be kept at normal room temperature for a day or two,
but should be kept cool or refrigerated for longer periods of time.
34!Hour 5rine Collection
-89%hour urine, urine volume.
+hat is a 34!hour urine collection,
$lick Image to #nlarge
A 89%hour urine collection is a simple diagnostic procedure that measures the components
of urine. The test is noninvasive -the skin is not pierced., and is used to assess kidney
-renal. function.
Twenty%four hour urine collection is performed by collecting a person*s urine in a special
container over a 89%hour period. The container must be kept cool during this time until it
is returned to the lab for analysis.
,rine consists of water and dissolved chemicals such as sodium, potassium, urea -formed
from protein breakdown., and creatinine -formed from muscle breakdown., along with
other chemical compounds. Aormally, urine contains specific amounts of these waste
products. If these amounts are not within a normal range, or if other substances are
present, it may be an indication of a particular disease or condition. The results of a 89%
hour urine collection may provide information to help your physician make or confirm a
diagnosis.
'elated procedures that may be used to diagnose kidney disease include kidney
ultrasound, kidney scan, kidney biopsy, and renal arteriogram.
Ho does the urinary system or.,
$lick Image to #nlarge
The body takes nutrients from food and converts them to energy. After the body has taken
the nutrients it needs from the food, waste products are left behind in the bowel and
blood.
The urinary system keeps chemicals, such as potassium, sodium, and water in balance,
allowing the body to function properly. The kidneys also remove protein waste, called
urea, from the blood. ,rea is produced when foods containing protein, such as meat,
poultry, and certain vegetables, are broken down in the body. ,rea is carried in the
bloodstream to the kidneys.
ther important functions of the kidneys include blood pressure regulation, and the
production of erythropoietin, which controls red blood cell development in the bone
marrow.
5rinary system parts and their functions*
two kidneys % a pair of purplish%brown organs located below the ribs toward the
middle of the back. Their function is to remove liquid waste from the blood in the
form of urine, keep a stable balance of salts and other substances in the blood, and
produce erythropoietin, a hormone that aids in the formation of red blood cells.
The kidneys remove urea from the blood through tiny filtering units called
nephrons. #ach nephron consists of a ball formed of small blood capillaries,
called a glomerulus, and a small tube called a renal tubule. ,rea, together with
water and other waste substances, forms the urine as it passes through the
nephrons and down the renal tubules of the kidney.
two ureters % narrow tubes that carry urine from the kidneys to the bladder.
)uscles in the ureter walls continually tighten and rela! forcing urine downward,
away from the kidneys. If urine backs up, or is allowed to stand still, a kidney
infection can develop. About every ;6 to ;= seconds, small amounts of urine are
emptied into the bladder from the ureters.
bladder % a triangle%shaped, hollow organ located in the lower abdomen. It is held
in place by ligaments that are attached to other organs and the pelvic bones. The
bladder*s walls rela! and e!pand to store urine, and contract and flatten to empty
urine through the urethra. The typical healthy adult bladder can store up to two
cups of urine for two to five hours.
two sphincter muscles % circular muscles that help keep urine from leaking by
closing tightly like a rubber band around the opening of the bladder
nerves in the bladder % alert a person when it is time to urinate, or empty the
bladder
urethra % the tube that allows urine to pass outside the body
(acts about urine*
Adults pass about a quart and a half of urine each day, depending on the fluids
and foods consumed.
The volume of urine formed at night is about half that formed in the daytime.
Aormal urine is sterile. It contains fluids, salts, and waste products, but it is free
of bacteria, viruses, and fungi.
The tissues of the bladder are isolated from urine and to!ic substances by a
coating that discourages bacteria from attaching and growing on the bladder wall.
Reasons for the Procedure
Twenty%four hour urine collection is a quick, simple diagnostic test that helps to diagnose
problems with the kidneys. It is commonly performed to determine how much creatinine
clears through the kidneys, but may also be used to measure protein, hormones, minerals,
and other chemical compounds. $reatinine clearance testing provides information about
kidney function.
>ike all organs in the human body, the kidneys may be affected by various genetic and
environmental circumstances, leading to kidney disease. @idney -renal. disease may be
temporarily or permanently damaging. Acute kidney disease has an abrupt onset and is
potentially reversible. $hronic kidney disease progresses slowly over at least three
months and can lead to permanent kidney damage. The causes, symptoms, treatments,
and outcomes of acute and chronic kidney disease are different.
$onditions that can cause kidney disease include, but are not limited to, the following2
diabetic nephropathy % a result of uncontrolled diabetes, which can cause
permanent changes, leading to kidney damage
hypertension % abnormally high blood pressure, leading to permanent kidney
damage
lupus % a chronic inflammatory/autoimmune disease that can in0ure the kidneys, as
well as the skin, 0oints, and nervous system
frequent urinary tract infections
prolonged urinary tract obstruction or blockage
Alport syndrome % an inherited disorder that causes deafness, progressive kidney
damage, and eye defects
nephrotic syndrome % a condition that has several different causes. Aephrotic
syndrome is characteri(ed by protein in the urine, low protein in the blood, high
cholesterol levels, and tissue swelling.
polycystic kidney disease % a genetic disorder characteri(ed by the growth of
numerous cysts filled with fluid in the kidneys
cystinosis % an inherited disorder in which the amino acid cystine -a common
protein%building compound. accumulates within specific cellular bodies of the
kidney, known as lysosomes
interstitial nephritis or pyelonephritis % an inflammation in the small internal
structures in the kidney
Twenty%four hour urine collection may be performed along with other diagnostic
procedures, such as cystometry and cystography.
There may be other reasons for your physician to recommend 89%hour urine collection.
Risks of the Procedure
Twenty%four hour urine collection is a safe, noninvasive procedure that is usually done
without direct assistance.
$ertain factors or conditions may interfere with the accuracy of a 89%hour urine
collection. These factors include, but are not limited to, the following2
forgetting to collect some of your urine
going beyond the 89%hour collection period and collecting e!cess urine
losing urine from specimen container through spilling
not keeping urine cold during collection period
taking certain medications and/or eating certain foods
There may be other risks depending on your specific medical condition. &e sure to
discuss any concerns with your physician prior to the procedure.
Before the Procedure
4our physician will e!plain the procedure to you and offer you the opportunity to
ask any questions that you might have about the procedure.
Generally, no prior preparation, such as fasting or sedation, is required.
4ou may be instructed to start the collection at a specific time.
If possible, choose a 89%hour period when you will be at home so you do not have
to transport your urine.
If you are pregnant or suspect that you may be pregnant, you should notify your
physician.
Aotify your physician of all medications -prescription and over%the%counter. and
herbal supplements that you are taking.
&ased on your medical condition, your physician may request other specific
preparation.
During the Procedure
Twenty%four hour urine collection may be performed on an outpatient basis or as part of
your stay in the hospital. "rocedures may vary depending on your condition and your
physician*s practices.
Generally, 89%hour urine collection follows this process2
;. 4ou will be given one or more containers for collecting and storing your urine. A
brown plastic container is typically used to store the urine. A specimen pan or
urinal may be used to collect the urine. 4ou will need to transfer the urine from
the collecting container to the storage container where it will be kept cold.
8. The 89%hour collection may begin at any time during the day after you urinate.
?owever, it is common to start the collection the first thing in the morning. It is
important to collect all urine in the following 89%hour period.
5. 7o not save the urine from your first time urinating % the starting time. 1lush this
first specimen, but note the time. This will be the start time of the 89%hour
collection.
9. All urine, after the first -flushed. specimen, will be saved, stored, and kept cold,
either on ice or in a refrigerator, for the ne!t 89 hours.
=. Try to urinate again at the same time, 89 hours after the start time, to finish the
collection process, but if you cannot urinate at this time, it is not a problem.
<. nce the urine collection has been completed, the urine containers will be taken
to the lab. If you are doing the urine collection at home, you will be given
instructions on how and where to transport the specimen.
D. The procedure is concluded at this point. 7epending on your specific medical
condition, you may be asked to perform the test on several consecutive days.
After the Procedure
Generally, there is no special type of care following 89%hour urine collection. ?owever,
your physician may give you additional or alternate instructions after the procedure,
depending on your particular situation.
Clean Catch 5rine CollectionAka: Midstream Urine
Collection, Bag Urine Collection
,rine collection technique for women
;. 3ash hands with soap and water
8. Spread labia with ; hand and hold apart for collection
5. ,se three povidone%iodine swabs to clean area
;. 3ipe down one side, front to back, with one swab
8. 3ipe down other side, front to back, with second swab
5. 3ipe down center, front to back, with last swab
9. 7ry area with sterile gau(e
=. +oid into toilet for a few seconds and then collect
<. Avoid stopping urine flow while positioning cup
;. Stopping flow increases risk of contaminated sample
D. $ollect in sterile container
:. $ap and avoid touching inside of container
8. ,rine collection technique for men
;. 3ash hands with soap and water
8. 'etract foreskin if needed
5. ,se povidone%iodine swabs to clean tip of penis
;. $lean glans penis
8. $lean urethral opening
9. 7ry area with sterile gau(e
=. +oid into toilet for a few seconds and then collect
<. $ollect in sterile container
D. Avoid stopping urine flow while positioning cup
;. Stopping flow increases risk of contaminated sample
:. $ap and avoid touching inside of container
5. ,rine collection technique for infants -urine bag.
;. 3ash hands with soap and water
8. ,se povidone%iodine swabs to clean as above
5. "lace sterile urine bag over penis or labia
9. 'eclean and replace new urine bag if no urine in 56 min
=. #mpty bag into sterile urine container