COLLEGE OF NURSING

Instruction: check on the column of your choice as to what level is the performance of the student in the following procedure. Be guided
in the scoring with the legend below:
Legend: Level of performance
4 Very satisfactory (Performed all the procedures correctly)
3 Satisfactory (Needs minimal assistance in performing the procedure)
2 Good (Needs more practice in performing the procedure)
1 Fair (inappropriate in the performance of the procedure)
STEP PROCEDURE 4 3 2 1
Check physician’s order. Assemble all equipment needed.
1 Identify client and explains the procedure. Bring needed equipment at bedside.
2. Wash hands and dry well.
3. Provide client privacy
4 If client is able, allow patient to cleanse the perineum with antiseptic solution. Instructing the client
to properly cleanse the genital.
5 Don gloves.
Clean the urethral meatus (female). Separate the labia well, cleanse the genital from front to
back.

Cleanse the glans penis (male). Retract foreskin if uncircumcised and cleanse surrounding
6
areas with antiseptic solution.
7 If female client is menstruating, insert a vaginal tampon before beginning the cleaning process.
8 Instruct the client to void and discard initial portion of flow.

Collect the middle portion in a sterilized urine container, while preventing tissues
9 surrounding the urethral orifice from coming in contact with the urine to avoid
contamination.
10 The sterile container should be held in such a way that contact with the legs, or clothing is
avoided. The container should be half-full (approximately 50 ml).
Secure lid of container. Wipe the outside part of container if soiled with urine.
11 Discards all used supplies and equipment in appropriate receptacles. Wash hands and dry well.

12 Properly label the specimen container. Bring immediately to the laboratory with requisition and do
documentation.
Total Score:
48

Remarks:

Name / Signature of Student Name / Signature of RD Instructor

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Midstream Urine Collection