Urine Dipstick

1. Testing site

1. refrigerator, testing area, and POCT log sheet binder all located in the Dirty Utility Room

2. Specimen collection and storage

1. Sterile container preferred
2. Clean container is acceptable for dipstick testing only (not acceptable for culture)
3. Acceptable specimen types: midstream and catheter
   1. Cotton balls soaked in diaper are not acceptable
   2. Urine squeezed from diaper is not acceptable
4. Label specimen with full patient name and medical record number or full name and date of birth, date, time, and initials of collector
5. Run within 30 minutes of collection
6. If not run with in 30 minutes, refrigerate specimen up to 4 hours

3. Reagents

1. Bottle
   1. Locate lot number and expiration date
   2. Check for opening date, initials of person opening bottle, and "QC'd" sticker
   3. Minimize the time the bottle is open
   4. Close lid tightly when not in use
   5. Make sure desiccant is present
2. Dipsticks
   1. Tests include: glucose, bilirubin, ketone, specific gravity, blood, pH, protein, urobilinogen, nitrite, and leukocyte esterase

4. Quality Control

1. Daily check of testing site
   1. Record temperature of refrigerator on log sheet
      1. if temperature is out of range (<35°>46°F), record action taken (temp adjusted, Facilities contacted…)
   2. Check reagent bottle
      1. ensure proper storage at room temperature
      2. check expiration date on bottle
      3. check to see if QC has been performed on bottle
2. Check of reagent performance
   1. STORAGE: QC material is to be stored in the refrigerator
   2. STABILITY: QC material is good until expiration date on bottle
   3. FREQUENCY: perform upon opening a new vial of dipsticks, if bottle is found open, if desiccant is missing, or if results do not agree with the clinical picture
   4. Procedure
      1. Check the lot number of the Dropper bottle and compare with the lot number on the “QC Log Sheet”
      2. Record the results on the "QC Log Sheet"
      3. Compare the results with the values printed on the top of each grid (Normal and Abnormal)
      4. Values are specific to each different lot (box) of QC material
      5. If the results are not acceptable (not within the printed range):
         1. DO NOT PERFORM PATIENT TESTING UNTIL QC PROBLEM HAS BEEN RESOLVED
         2. Repeat the QC testing using a new vial of dipsticks
         3. If not acceptable, repeat QC testing using a new bottle of QC material
         4. If still not acceptable, contact the Point of Care Coordinator (Adonica Wilson at x4324 or Carol Sise x5053)
         5. Document action taken on the QC log sheet

5. Processing specimens

1. Specimen should be at room temp (if the specimen has been refrigerated, allow specimen to sit at room temp for 5-10 minutes prior to testing)
2. Follow Standard Precautions
3. Gently swirl specimen to mix before testing
4. Open container
5. Shake dipstick from bottle (do not reach in the bottle to get a dipstick)
   1. Observe strip for discoloration
6. Tightly close container once strip is obtained
7. Immerse dipstick in specimen
   1. make sure all reagent pads (especially glucose) have been immersed in the specimen
   2. do not "swirl" the dipstick in the specimen (will cause reagent colors to mix)
8. Immediately remove the dipstick from the specimen
   1. run the edge of the dipstick along the rim of the container to remove excess urine from the strip
   2. do not run the reagent pads along the specimen container (will cause reagent colors to mix)
   3. "don't blot it; rim it"

6. Reading results

1. Hold the dipstick horizontally by the color chart on the bottle
   1. do not touch the dipstick to the bottle (contamination)
2. Compare the reagent pads to the color chart at the specified times:
   *pH and Protein can be read at any time from 60 seconds to 2 minutes
   1. 30 seconds: Glucose, Bilirubin
   2. 40 seconds: Ketone
   3. 45 seconds: Specific Gravity
   4. 60 seconds: Blood, ph* Protein*, Urobilinogen, Nitrate
   5. 2 minutes: Leukocyte Esterase
      
3. Dispose of all testing materials (gloves, specimen, and dipstick) in the biohazard trash

7. Documentation and Result Reporting

1. Record the results on the appropriate form (POCT Daily Log or Urine Dipstick Result Sheet if applicable) and on the patient flow sheet/EMR
2. Record FULL patient name (full first and last or last name and medical record number)
3. Do not use "--" for negative, write "neg"
4. Check for critical values (large glucose or ketones on patients less than 4 months old)
   1. record the name of the physician, date and time notified on the log sheet