Clean-catch versus straight-catheter urinalysis results in women

Correlation of catheterized and clean catch urine protein/creatinine ratios in preeclampsia evaluation

OBJECTIVE

To examine whether clean catch urine specimens correlate with catheterized specimens for determination of protein/creatinine ratios in pregnant women being evaluated for preeclampsia.

METHODS

Sixty pregnant women who were at least at 20 weeks of gestation were enrolled. Patients with ruptured membranes, vaginal bleeding, or urinary tract infections were excluded. Midstream clean catch urine specimens were collected. Catheterized specimens were then collected and used for clinical management. The specimens were analyzed for protein, creatinine, urinalysis, and culture. Based on sample size calculations, 60 participants were needed to detect a correlation of 0.90 with 80% power and alpha=0.05.

RESULTS

Mean gestational age at enrollment was 35.9 weeks (range 23.1-41.7 weeks). Median (range) clean catch and catheterized protein/creatinine ratios were 0.204 (0.089-3.465) and 0.181 (0.067-3.335), respectively, with a correlation coefficient of 0.897 (P<.001). When results were categorized by degree of proteinuria using a cutoff of 0.3, sensitivity and specificity of the clean catch protein/creatinine ratios were 95.2% and 97.4%. When using a more conservative cutoff of 0.19, sensitivity and specificity of the clean catch protein/creatinine ratios were 96.4% and 75.0%.

CONCLUSION

Clean catch and catheterized urine specimens correlate well in women with suspected preeclampsia. Routine catheterization of pregnant women is not necessary in the evaluation of preeclampsia.

Women's perception of pain and distress during intravenous catheterization and urethral mini-catheterization

A study was done to prospectively compare the pain and distress of urethral mini-catheterization (MC) with the pain and distress of intravenous (IV) catheterization in women. Ten-centimeter visual analog scales were used on which the left end represented "no pain" or "no distress" and the right "the worst pain imaginable" or "extreme distress." Distress was defined to include embarrassment, anxiety, or fear. A convenience sample of 40 adult women who presented to a university emergency department and were undergoing both procedures as part of their management appraised pain and distress after IV placement and urethral MC. The mean IV pain score was 4.2 cm, whereas the mean MC score was only 2.6 cm (P = .02). The IV and MC distress score means were similar (2.3 v 2.6 cm, P = .55). These results suggest that patients perceive urethral MC as less painful than IV placement. The distress scores of these two procedures did not differ and were low in both instances.

Urine sampling in ambulatory women: midstream clean-catch versus catheterization

We conducted a study to determine if there were any significant differences in urinalyses or urine cultures obtained by midstream clean-catch (MSCC) urine sampling in comparison with in-and-out catheterization (CATH). One hundred five women with symptoms suggestive of a urinary tract infection were studied prospectively. Each woman had a MSCC urine sample obtained initially, followed by a CATH sample. The MSCC and CATH urine samples were analyzed and compared for urine culture, leukocyte esterase, nitrites, microscopic bacteriuria, and pyuria. Of the 105 patients, 42 (40%) had a culture-proven urinary tract infection. The concordance rates between MSCC and CATH urine cultures, nitrites, leukocyte esterase, significant microscopic bacteriuria, and pyuria were 96%, 94%, 93%, 90%, and 90%, respectively. There were no statistically significant differences between MSCC and CATH sensitivities, specificities, or positive or negative predictive values for any urinalysis variable (leukocyte esterase, nitrites, significant microscopic bacteriuria, or pyuria). We conclude that if proper MSCC technique is used, the differences between MSCC and CATH urinalyses or urine cultures do not appear to be significant in the majority of ambulatory women without active vaginal bleeding who present with symptoms suggestive of a urinary tract infection.