A pediatric urine collection bag, often called a U-bag, is a sterile plastic pouch with a hypoallergenic adhesive backing. This non-invasive device obtains a urine specimen from infants and toddlers who cannot provide a clean-catch sample on demand. This method allows healthcare providers to gather a sample for analysis, such as checking for a urinary tract infection, without resorting to more invasive procedures like catheterization. Successful collection relies on meticulous preparation and precise application to ensure the sample remains uncontaminated and the seal holds securely.
Essential Preparation Steps
The integrity of the urine sample depends on strict hygiene protocols, as contamination from skin flora or feces can lead to inaccurate test results. Gather all necessary supplies, including the collection bag, a clean diaper, mild soap or cleansing wipes, and a clean towel. The genital area must be thoroughly cleansed using a gentle soap or the sterile wipes provided in the collection kit.
For female infants, cleaning should proceed from front to back, wiping the area around the urethra and the labia. For male infants, the end of the penis, including the glans, must be carefully cleaned, but the foreskin should not be forcibly retracted. After cleansing, the skin must be allowed to air dry completely, as any moisture, cream, or talcum powder residue will compromise the adhesive’s ability to form a leak-proof seal.
Proper Application Technique
Applying the bag requires precision and a clear understanding of the anatomical differences to ensure a successful, non-leaking seal. Before touching the child, wash your hands and carefully peel the protective paper backing from the adhesive collar, being careful not to touch the sticky surface with your fingers. The bag should be slightly unfolded so that the collection pouch hangs freely downward once secured.
For female infants, begin the application by securing the bottom section of the adhesive first, placing it firmly on the perineal skin between the rectum and the vaginal opening. Work upward, pressing the bag over the vulval area and smoothing the adhesive along the labia folds toward the pubic bone. This technique is designed to create a seal that fully encircles the urinary opening while keeping the collection area away from the rectum to minimize the risk of fecal contamination.
For male infants, the entire penis must be carefully placed inside the bag opening. Secure the bottom portion of the adhesive first, placing it on the skin between the rectum and the scrotum. Then, firmly press the remainder of the adhesive collar onto the skin around the base of the penis and the upper part of the scrotum. Ensure there are no wrinkles or gaps in the adhesive seal on any side, which could allow urine to leak out or bacteria to enter the collection area.
Monitoring, Removal, and Sample Handling
Once the bag is secured, place a clean diaper over the infant, ensuring it is not so tight that it pulls on the collection bag and breaks the seal. The child must be monitored frequently (ideally every 15 to 20 minutes) to check for urination and ensure the bag remains correctly positioned. Keep the collection time as short as possible to maintain specimen quality.
When a sufficient volume of urine (typically 1 to 2 milliliters) has been collected, remove the bag immediately to prevent contamination. To remove the device safely, press down on the surrounding skin while slowly peeling the adhesive away, starting from the top. After removal, the adhesive edges should be pressed together to seal the bag completely and prevent any spillage.
The collected urine must then be transferred into a sterile laboratory container. Hold the sealed bag over the container and cut a small corner to allow the urine to drain directly into the cup. The sterile container must be immediately capped, labeled with patient information, and kept cool (such as by refrigeration) until transported to the lab within the specified timeframe.
Addressing Common Challenges
A frequent difficulty encountered with pediatric urine collection bags is the high potential for contamination, with studies reporting rates that can range from 26 to 62 percent. The most common cause of a contaminated sample or a leak is the failure of the adhesive seal due to inadequate skin cleaning or incomplete drying. If the bag detaches or if fecal material enters the bag, the sample must be discarded, and the entire process must be restarted with a new, sterile collection bag.
If the infant does not void within a short time frame, such as 30 to 45 minutes, it can be helpful to gently stimulate the child by offering fluids or gently stroking the lower abdomen. If the bag must be removed without a sample, or if skin irritation (such as redness) develops, safely peel the bag off and consider alternative non-invasive collection methods. Any sticky residue left on the skin after removal should be gently cleaned with warm water and mild soap to prevent lingering skin irritation.