116 Section IV ■ Miscellaneous Sampling

E. Technique

Male Infant (1,8,18–20)

1. Set up equipment and squeeze a small amount of lubricant onto a sterile field.

2. Restrain the infant supine in the frog-leg position.

3. Wash hands thoroughly and put on gloves.

4. Stabilize the shaft of the penis with the nondominant

hand. This hand is now considered contaminated.

5. If the infant is uncircumcised, gently retract the foreskin just enough to expose the meatus. Do not attempt

to lyse adhesions. The young male infant has physiologic phimosis, and the foreskin cannot be fully

retracted (19). If the foreskin is tightly adherent, attempt

to line up the preputial ring and the meatus.

6. Apply gentle pressure at the base of the penis to avoid

reflex urination.

7. Using the free hand for the rest of the procedure, clean

the glans three times with antiseptic solution. Begin at

the meatus and work outward and down the shaft of the

penis. Blot dry with sterile gauze.

8. Drape sterile towels across the lower abdomen and

across the infant’s legs.

9. Place the wide end of the catheter or feeding tube into

the specimen container.

10. Lubricate the tip of the catheter copiously.

11. Move the specimen container and catheter onto the

sterile drape between the infant’s legs.

12. Gently insert the catheter through the meatus just until

urine is seen in the tube (Fig. 20.1).

a. During insertion, apply gentle upward traction on

the penile shaft to prevent kinking of the urethra

(Fig. 20.1).

b. If the meatus cannot be visualized, insert the catheter through the preputial ring in a slightly inferior

direction. If there is any question about catheter

position, abandon the procedure.

c. If resistance is met at the external sphincter, hold

the catheter in place, applying minimal pressure.

Generally, spasm will relax after a brief period,

allowing easy passage of catheter. If not, suspect

obstruction and abandon the procedure.

d. Do not move the catheter in and out. This will

increase the risk of urethral trauma.

e. Do not insert extra tubing length in an attempt to

stabilize a catheter to be left indwelling. This will

increase the risk of trauma and knotting.

13. Collect specimen for culture.

14. If the catheter is to remain indwelling, connect the

catheter immediately to a closed sterile system for urine

collection. Tape the tube securely to the inner thigh.

15. If the catheter is to be removed, gently withdraw it

when urine flow ceases.

Female Infant (1,18–21)

1. Follow steps 1 through 3 of technique for male infant.