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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

Quick Collect

CC/Random+(1)R

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. 

Collection Instructions

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

Container(s): 3 Tubes total -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).
  • Detailed Instructions (link): Patient Collection Instructions
  • Detailed Instructions (link): Urine Collection Guide for Staff

 

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

Reference Values Inpatient/Outpatient Adult/Pediatric

 

Test Name/Units of measure

Normal Reference Range

Appearance (Clarity)

Clear

Specific Gravity

1.002 – 1.030

Urine pH

5.0 – 9.0

Glucose (mg/dL)

Negative, Normal

Ketones (mg/dL)

Negative

Protein (mg/dL)

Negative

Blood

Negative

Bilirubin

Negative, Ictotest negative

Urobilinogen (mg/dL)

0.2 – 1.0, Normal

Nitrite (reductase)

Negative

Leukocyte Esterase

Negative

WBC (HPF)

0-5/HPF

WBC Clumps (HPF)

Negative, Not Present

RBC (HPF)

0-3/HPF

Bacteria (HPF)

Negative, None

Yeast (HPF)

Negative, None, Not Present

Mucus (LPF)

Negative, None, Not Present

Squamous Epithelial (HPF)

0-9/HPF

Renal Epithelial (HPF)

Negative, None

Transitional Epithelial (HPF)

Negative, None

Hyaline Casts (LPF)

0-3/LPF

Casts (LPF)

Negative, None

Amorphous Crystals (HPF)

None to Heavy

Crystals (HPF)

Negative, None

Sperm (HPF)

Negative, None, Not Present

Trichomonas (HPF)

Negative, None

Urine Fat (HPF)

Negative, None

Laboratory Critical Values Table

 

 

If reflexed to Urine Culture:

Negative culture: No bacteria isolated

Positive culture: Identification with susceptibility on urinary pathogens with colony counts of greater than 10,000 CFU/mL

 

Performing Department

URINES

Performing Department Laboratory Location

Corewell Health Reference Laboratory, Grand Rapids, MI
Corewell Health Big Rapids Laboratory, Big Rapids, MI
Corewell Health Blodgett Laboratory, Grand Rapids, MI
Corewell Health Gerber Laboratory, Fremont, MI
Corewell Health Kelsey Laboratory, Lakeview, MI
Corewell Health Ludington Laboratory, Ludington, MI
Corewell Health Pennock Laboratory, Hastings, MI
Corewell Health Reed City Laboratory, Reed City, MI
Corewell Health Greenville Laboratory, Greenville, MI
Corewell 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

3078100101

Epic Test ID

1230101265

Reviewed Date

3/23/2022