A randomized controlled trial of two methods for collection of sterile urine in neonates

Tobiansky, Rodney; Evans, Nicholas J.

doi:10.1046/j.1440-1754.1998.00272.x

Cited by 29 publications

(24 citation statements)

References 14 publications

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“…In addition, all boys in our study were uncircumcised, but in Kozer's study all the boys were circumcised. Finding the urethral meatus by retraction of the prepuce may be more difficult in smaller infants and in uncircumcised boys, thus making TUC more difficult [1, 6, 7]. …”

Section: Discussionmentioning

confidence: 99%

“…SPA is considered the “gold standard” [3] technique for sterile urine collection in neonates [1, 3, 4], but TUC has an acceptable sensitivity of 95% and a specificity of 99% if colony counts greater than 1000 CFU/mL are considered positive [3]. Neither method always successfully collects a sufficient volume of urine [1, 5–7], and both methods are invasive and painful [1, 5]. …”

Section: Introductionmentioning

confidence: 99%

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The Comparison of Pain Caused by Suprapubic Aspiration and Transurethral Catheterization Methods for Sterile Urine Collection in Neonates: A Randomized Controlled Study

Ghaffari

Fattahi

Taheri

et al. 2014

The Scientific World Journal

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This study was performed to compare the levels of pain experienced by young infants undergoing either suprapubic aspiration (SPA) or transurethral catheterization (TUC) for the collection of sterile urine samples. This prospective randomized clinical trial was conducted in hospitalized neonates in a university-affiliated hospital. Patients who required urine cultures were randomly assigned into one of two groups, the SPA or TUC group. The infants' faces were videotaped, and the changes in the facial expression and physiological parameters during the procedure were scored using the Premature Infant Pain Profile (PIPP) in a blind manner. The primary outcome was the severity of the pain experienced during each procedure, and the secondary outcomes were the success rate, the duration, and the complications of each procedure. Ninety-four percent of male infants in the TUC group and 77.3% in the SPA group were uncircumcised (P = 0.1). The mean (SD) of the PIPP pain scores did not differ between groups (9.95 ± 3.7 in SPA and 9.64 ± 3.2 in TUC, P = 0.6). The duration of TUC was longer. Both methods can be used to collect urine from neonates, but the difficulty of performing TUC on females and uncircumcised males should be considered.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Comparison of Pain Caused by Suprapubic Aspiration and Transurethral Catheterization Methods for Sterile Urine Collection in Neonates: A Randomized Controlled Study

Ghaffari

Fattahi

Taheri

et al. 2014

The Scientific World Journal

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“…From the three studies which directly compared SPA and UC samples, two1 3 showed no significant increase in sample contamination from catheters compared to SPA, whilst the third study2 had 22% contamination in UC samples and 0% in SPA. Simply grouping the three studies together increased the numbers in each group and, using Fisher’s exact test, shows catheter samples are significantly more likely to be contaminated than SPA samples (p = 0.002).…”

Section: Commentarymentioning

confidence: 96%

“…For example, the studies varied in their use of cleaning agent. Austin et al 2 cleaned with saline before catheter samples but alcohol before SPA, whereas Tobiansky et al 1 used the same cleaning method before both methods (aqueous chlorhexidine and iodine). It is known that cleaning with soap and water before collecting midstream clean catch samples reduces the contamination rate in toilet-trained populations,19 but there have been no studies examining the effect of cleaning with saline or sterile water versus chlorhexidine or iodine.…”

Section: Commentarymentioning

confidence: 99%

Question 1

Phillips

2009

Archives of Disease in Childhood

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“…Per the 1999 American Academy of Pediatrics UTI guideline, 10 catheterization has a sensitivity of 95% and a specificity of 99% compared with SPA, with catheterization also more likely to lead to contamination. [11][12][13][14] Although SPA would thus appear to be the gold standard, 2 additional operational factors were discovered when considering SPA to diagnose UTI. Urine catheterization is performed by nursing, whereas SPA is performed by physicians.…”

Section: Operational Factors/implementabilitymentioning

confidence: 99%

A Framework for Evaluating Value of New Clinical Recommendations

Leu

Austin

Foti

et al. 2016

Hospital Pediatrics

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To help stem ever increasing health care costs, clinicians, administrators, payors, and families must better communicate about the value of care options. Our institution sought to create a value analysis framework, based on local implementation of over 50 clinical pathways.From January to March 2015, a multidisciplinary team of clinicians, nursing, pharmacy, informatics, and analytics developed a cost dashboard, and a value analysis and decision-making framework. We reviewed all clinical pathway recommendations and measures, and examined issues related to implementing pathways. We examined specific line item costs for each pathway patient population.Our value analysis and decision-making framework is based upon 3 population-level comparisons: operational factors/ implementability, benefits, and costs/complications. We used the framework to scope new projects, to better target clinical recommendations, and to evaluate pathways postimplementation. From April through December 2015, we used this framework to prospectively analyze 19 pathway improvement proposals. The tool helped us to identify 16 improvements to implement (15 predicted to save costs), as well as identifying challenges facing 3 additional improvements.The value analysis and decision-making framework helps to ensure clinical recommendations are evaluated more broadly than just from a cost perspective. Systematic evaluation using this framework can improve populationbased decision-making. More research is needed in how to ensure that value analysis is performed to guide sustainable implementation of recommendations locally, and how to identify other institutions that may benefit from replicating successful implementations, so that the highest value care can be provided to patients everywhere.

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A randomized controlled trial of two methods for collection of sterile urine in neonates

Abstract: In this small randomized controlled trial urethral catheterization offered no significant advantage over SPA.

Cited by 29 publications

References 14 publications

The Comparison of Pain Caused by Suprapubic Aspiration and Transurethral Catheterization Methods for Sterile Urine Collection in Neonates: A Randomized Controlled Study

The Comparison of Pain Caused by Suprapubic Aspiration and Transurethral Catheterization Methods for Sterile Urine Collection in Neonates: A Randomized Controlled Study

Question 1

A Framework for Evaluating Value of New Clinical Recommendations

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