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Epic Code LAB348 Urinalysis (UA) with Reflex to Culture if Positive (Outpatient Only)

Important Note

This test is no longer available for Inpatient ordering. This change is in compliance with the CAUTI workgroups efforts. INPATIENT ORDERING: Please use URINALYSIS [LAB2111180] and URINE CULTURE [LAB239] as the replacements for this test.

Test Name Alias

Urinalysis, Culture if Indicated | UA | Urine C&S | UA do if | Urinalysis w/Micro Exam, C&S if Indicated | 115

Interface Order Alias

10540

Clinical Information

Refrigeration of urine inhibits bacteria growth but does not prevent the lytic effects of low specific gravity or alkaline pH. Urine crystal formation may be induced by refrigeration.

Ordering Instructions

Please do not order UA do if and Urine culture together. UA do if will reflex to Urine Culture if necessary. Please indicate source, i.e. ccms, nephrostomy, straight catheter.

 

This test is only available for outpatient ordering.

 

Effective 11/17/2021: When an order for Urine Culture [LAB239] and Urinalysis, do Culture if indicated [LAB348] is placed in the same encounter, these labs will update at the time of collection to an order for Urine Culture [LAB239] and Urinalysis [LAB2111180] to decrease duplicate urine cultures. 

Icons & Photos

Collection Instructions

Specimen Collection: Urine (Clean Catch Mid-Stream/CCMS or Straight Catheter)

Container(s): 2 Pale Yellow Top Urine Tubes (UA No Additive) AND 1 Gray top urine C&S tube (contains boric acid)

Acceptable container: Sterile Cup AND 1 Gray top Urine C&S tube (contains boric acid)

Preferred Volume to Collect: 24 mL (2 × 10 mL Yellow and 1 × 4 mL Gray)

Minimum Volume to Collect: 4.0 mL

Neonate Volume to Collect: 3.0 mL

 

Collection Instructions:

  • No preservatives
  • Clean Catch Mid-Stream or Straight Catheter Collection.
  • Ambient specimen must be received in the Lab within 2 hours.
  • If delay: Keep the specimen refrigerated and send to laboratory as soon as possible.
  • Specimen must be received in laboratory for analysis within 24 hours of collection.
  • Gray vacutainer is to be used for Culture and Sensitivity (C&S).

Unacceptable

Specimens with 10 or more squamous epithelial cells are not appropriate for culture, a CCMS or catheterized may be indicated if culture is requested.

 

Processing Instructions (Laboratory, Outpatient or Off-site collection)

  • If available, two barcode labels will print at the time of collection. Apply one label to the container and place the second label in the pouch of the specimen bag.
  • Transport Temperature: 
    • Ambient: Gray top tube, Yellow Tube
    • Refrigerate: Sterile cup

Rejection Criteria

Specimens that do not meet Spectrum Health Laboratory standards may be rejected (cancelled) due to:

  • Request a repeat specimen when there is no evidence of refrigeration for a sterile cup collection and the specimen is greater than 2 hours old.
  • Foley catheter tips/bags
  • Catheter bags
  • Leaky containers
  • Non-sterile container (example: pill bottles or household containers)

Specimen Stability

2 Yellow top tubes and Urine Cup:

Ambient: 2 hours

Refrigerate: 24 hours

Laboratory Retention: 3 days

 

Gray top tube:

Ambient: 48 hours

Refrigerate: 48 hours

Laboratory Retention: 3 days

 

Reflex Information

  • Culture and Sensitivity (C&S) will be performed with 2 or more of the following abnormal findings, provided there are less than 10 squamous epithelial cells per HPF:
    • Greater than or equal to 10 WBC
    • Positive leukocyte esterase
    • Positive nitrite

    OR if the specimen is:

    • Grossly bloody
  • Specimens with 10 or more squamous epithelial cells, culture will not be performed
  • Culture and Sensitivity (C&S) will be performed if volume is inadequate for microscopic exam and Urinalysis (UA) with one or more of the following abnormal findings:
    • Positive leukocyte esterase
    • Positive nitrate
  • If urinalysis is negative, culture will not be performed.

 

Test Frequency

Available 24 hours, usual TAT 1 day

Reference Range

Urinalysis (UA) is always performed first

Color Yellow/Straw
Clarity Clear
Glucose Negative
Bilirubin Negative
Ketone Negative
Sp Gravity 1.010-1.030
Blood Negative
pH

5.0-9.0

Protein Negative
Urobilinogen Normal (0.2-1.0mg/dL)
Nitrite(reductase) Negative
Leukocyte (esterase) Negative
Ictotest Negative
Mucus None to Moderate
Epithelial Cells 0-9/HPF
RBC’s 0-3/HPF
WBC’s 0-5/HPF
Bacteria/Yeast None
Amorphous

None to Heavy

Casts

None (Few Hyaline may be normal)

Parasites None
Trichomonas None
Urine Fat None
Crystals

None (Some may be normal others pathogenic)

 

Laboratory Critical Values Table

Performing Department

URINES

Performing Department Laboratory Location

Spectrum Health Regional Laboratory, Grand Rapids, MI
Spectrum Health Big Rapids Laboratory, Big Rapids, MI
Spectrum Health Blodgett Laboratory, Grand Rapids, MI
Spectrum Health Gerber Laboratory, Fremont, MI
Spectrum Health Kelsey Laboratory, Lakeview, MI
Spectrum Health Ludington Laboratory, Ludington, MI
Spectrum Health Pennock Laboratory, Hastings, MI
Spectrum Health Reed City Laboratory, Reed City, MI
Spectrum Health United Laboratory, Greenville, MI
Spectrum Health Zeeland Laboratory, Zeeland, MI

Methodology

Methodology is available on request.

Please call the Laboratory Customer Service Call Center 616.774.7721 or send an email to LaboratoryServices@spectrumhealth.org

CPT

81001

 

This test is not limited to the CPT code(s) listed.  Others may be added if culture and sensitivity is performed and if more testing is necessary depending on the pathogens isolated (such as MIC’s and ID’s).

CDM Code

4128715

Epic Test ID

1230101265

Beaker LOINC

U CHOLESTEROL CRYSTAL: 5777-8
U PATH: N/A
U SPERM.: N/A
U SRC: N/A
U XTAL: N/A
U YLC: N/A
URINE AMMONIUM BIURATE CRYSTAL: N/A
URINE AMORPHOUS CRYSTAL: 53329-9
URINE APPEARANCE: 32167-9
URINE BACTERIA: 25145-4
URINE BILIRUBIN CRYSTAL: 33236-1
URINE BILIRUBIN: 53327-3
URINE BLOOD: 57751-0
URINE CALCIUM CARBONATE CRYSTALS: 33241-1
URINE CALCIUM OXALATE CRYSTAL: 33234-6
URINE CALCIUM PHOSPHATE CRYSTALS: 33235-3
URINE COLOR: 50553-7
URINE CYSTINE CRYSTAL: 33240-3
URINE GLUCOSE: 2350-7
URINE HYALINE CASTS: 33223-9
URINE KETONES: 50557-8
URINE LEUCINE CRYSTAL: 50232-8
URINE LEUKOCYTE ESTERASE: 60026-2
URINE MICROSCOPIC: 12235-8
URINE MUCOUS: 53321-6
URINE NITRITE: 50558-6
URINE OVAL FAT BODIES: 50228-6
URINE PH: 50560-2
URINE PROTEIN: 50561-0
URINE RBC: 46419-8
URINE SPECIFIC GRAVITY: 50562-8
URINE SPERM: 33232-0
URINE SQUAMOUS EPITHELIAL CELLS: 33219-7
URINE TRICHOMONAS: 50237-7
URINE TRIPLE PHOSPHATE CRYSTAL: 33238-7
URINE TYROSINE CRYSTAL: 50238-5
URINE URIC ACID CRYSTAL: 33233-8
URINE UROBILINOGEN: 50563-6
URINE WBC: 46702-7
URINE WHITE BLOOD CELL CLUMPS: 53317-4
URINE YEAST: 72223-1

Reviewed Date

3/5/2020

Beaker Names

Beaker Procedure Name: URINALYSIS W/MICRO EXAM, C&S IF INDICATED
Beaker Display Name: Urinalysis (UA), Do Culture if Indicated
BEAKER TEST NAME: URINALYSIS, CULTURE IF POSITIVE
BEAKER TEST REPORT NAME: Urinalysis, Culture If Positive

Beaker Synonyms

No synonym on file

Beaker Collection and Specimen Handling

BEAKER COLLECTION: CC/Random+(1)R

Beaker Location, Container and Temperature

BW URINES: UR YELLOW/GREY (Preferred)-Refrigerated
BW URINES: 10 ML URINE YELLOW TUBE (Acceptable)-Refrigerated
BW URINES: 4 ML URINE GREY TUBE A (Acceptable)-Refrigerated
BW URINES: UR CUP/GREY (Acceptable)-Refrigerated
BW URINES: URINE CUP R (Acceptable)-Refrigerated
BL URINES: UR YELLOW/GREY (Preferred)-Refrigerated
BL URINES: 10 ML URINE YELLOW TUBE (Acceptable)-Refrigerated
BL URINES: 4 ML URINE GREY TUBE A (Acceptable)-Refrigerated
BL URINES: UR CUP/GREY (Acceptable)-Refrigerated
BL URINES: URINE CUP R (Acceptable)-Refrigerated
BR URINES: UR YELLOW/GREY (Preferred)-Refrigerated
BR URINES: 10 ML URINE YELLOW TUBE (Acceptable)-Refrigerated
BR URINES: 4 ML URINE GREY TUBE A (Acceptable)-Refrigerated
BR URINES: UR CUP/GREY (Acceptable)-Refrigerated
BR URINES: URINE CUP R (Acceptable)-Refrigerated
GM URINES: UR YELLOW/GREY (Preferred)-Refrigerated
GM URINES: 10 ML URINE YELLOW TUBE (Acceptable)-Refrigerated
GM URINES: 4 ML URINE GREY TUBE A (Acceptable)-Refrigerated
GM URINES: UR CUP/GREY (Acceptable)-Refrigerated
GM URINES: URINE CUP R (Acceptable)-Refrigerated
KL URINES: UR YELLOW/GREY (Preferred)-Refrigerated
KL URINES: 10 ML URINE YELLOW TUBE (Acceptable)-Refrigerated
KL URINES: 4 ML URINE GREY TUBE A (Acceptable)-Refrigerated
KL URINES: UR CUP/GREY (Acceptable)-Refrigerated
KL URINES: URINE CUP R (Acceptable)-Refrigerated
LH URINES: UR YELLOW/GREY (Preferred)-Refrigerated
LH URINES: 10 ML URINE YELLOW TUBE (Acceptable)-Refrigerated
LH URINES: 4 ML URINE GREY TUBE A (Acceptable)-Refrigerated
LH URINES: UR CUP/GREY (Acceptable)-Refrigerated
LH URINES: URINE CUP R (Acceptable)-Refrigerated
PH URINES: UR YELLOW/GREY (Preferred)-Refrigerated
PH URINES: 10 ML URINE YELLOW TUBE (Acceptable)-Refrigerated
PH URINES: 4 ML URINE GREY TUBE A (Acceptable)-Refrigerated
PH URINES: UR CUP/GREY (Acceptable)-Refrigerated
PH URINES: URINE CUP R (Acceptable)-Refrigerated
RC URINES: UR YELLOW/GREY (Preferred)-Refrigerated
RC URINES: 10 ML URINE YELLOW TUBE (Acceptable)-Refrigerated
RC URINES: 4 ML URINE GREY TUBE A (Acceptable)-Refrigerated
RC URINES: UR CUP/GREY (Acceptable)-Refrigerated
RC URINES: URINE CUP R (Acceptable)-Refrigerated
UN URINES: UR YELLOW/GREY (Preferred)-Refrigerated
UN URINES: 10 ML URINE YELLOW TUBE (Acceptable)-Refrigerated
UN URINES: 4 ML URINE GREY TUBE A (Acceptable)-Refrigerated
UN URINES: UR CUP/GREY (Acceptable)-Refrigerated
UN URINES: URINE CUP R (Acceptable)-Refrigerated
ZH URINES: UR YELLOW/GREY (Preferred)-Refrigerated
ZH URINES: 10 ML URINE YELLOW TUBE (Acceptable)-Refrigerated
ZH URINES: 4 ML URINE GREY TUBE A (Acceptable)-Refrigerated
ZH URINES: UR CUP/GREY (Acceptable)-Refrigerated
ZH URINES: URINE CUP R (Acceptable)-Refrigerated