Urinalysis with Reflexed Culture Order
Label Mnemonic: UAR, UARM and URCXR
Epic code: LAB8379
(see Comments for further details)
Order form: Laboratory Requisition
Supply order: Supply Order Form
Billing: Billing Policies
CPT code: 81003
Specimen(s):
Collection Medium:
or or
Yellow top round bottom tube (no additive) UA - C&S Collection Kit Sterile Container
Minimum:
URINALYSIS:
Collect in Random Urine Yellow Top, round bottom tube (no additive).

URINE CULTURE:
[1] UA - C&S Collection kit is preferred and is available from Hospital Stores (#91900 for clean catch urines and #91901 for Foley catheters). Transfer urine to a Gray Top C&S urine container -- tubes must be filled to 3 mL to prevent inhibition of bacterial growth.

[2] If unable to fill the Gray Top C&S tube, send any volume in the sterile container from the C&S kit or in a sterile specimen container (Hospital Stores #37777).
Rejection Criteria:
Sample will be unacceptable for future add-on requests for Drugs of Abuse or pregnancy screen testing.
Testing Schedule:
24 hrs/day, 7 days a week, including holidays.
Turn Around Time:
1 hour (upon receipt in laboratory) for urinalysis

Urine culture (if performed) turnaround time dependent on bacterial growth, typically 24-48 hours.
Reference Range:
Specific gravity: 1.001-1.029; pH: 5.0-9.0, Dipstick negative for protein, blood, bilirubin, urobilinogen, ketones, glucose, leukocyte esterase and nitrite.
Comments:
Order:
LAB8148 for Urinalysis with Reflex Culture
LAB1164 for Microscopic Exam
LAB8116 for Urine Culture Reflex

NOTE:
[1] Culture cannot be performed as an add-on test to urinalysis. Send separate samples for urinalysis (Random Urine Yellow Top, conical bottom tube (no additive)) and culture (as above).

[2] See "Microbiology Specimen Collection and Transport" and individual test descriptions in the Pathology Lab Handbook (links above).

[3] STAT Microbiology requests are not accepted for this specimen type.

UIHC's reflex culture algorithm is designed to cancel cultures based on nitrite, leukocyte esterase, and the microscopic WBC count per high- power field. Outpatient clinic algorithm is determined by nitrite and leukocyte esterase only. Combinations of test outcomes and whether they generate a reflex urine culture are summarized below.

Outpatient cultures:
Nitrite/Leukocyte Esterase
-/- --> reflexively cancel culture
Any/- --> reflex to culture
-/Any --> reflex to culture
Any/Any --> reflex to culture

Urines with source other than Foley or Indwelling Cath:
Nitrite/Leukocyte Esterase/Microscopic WBC
-/-/less than 5 --> reflexively cancel culture
+/-/less than 5 --> reflex to culture
ANY/+/ANY --> reflex to culture
ANY/ANY/>=5 --> reflex to culture

Urines with source Foley Cath or Indwelling Cath:
Nitrite/Leukocyte Esterase/Microscopic WBC
-/-/less than 10 --> reflexively cancel culture
+/-/less than 10 --> reflex to culture
ANY/+/ANY --> reflex to culture
ANY/ANY/>=10 --> reflex to culture

Voiding Trial Protocol PDF
External Catheter Alternatives
Methodology:
Reflectance Spectrophotometry
Instructions:
[1] Transport to the microbiology laboratory immediately. Samples in Gray Top C&S tubes may be stored at room temperature. Refrigerate urine samples not in Gray Top tubes. Specimens should be delivered to the lab as soon as possible and may be rejected if not received within 24 hours of collection.

[2] Gray top C&S tubes are not acceptable for urinalysis and urine chemistries because the preservative interferes with testing. This includes Epic LAB1160, LAB1164 and other urine tests that are incompatible with tube preservatives.
Sample Storage:
Refrigerate if stored overnight, weekends or holidays.
Transport Instructions:
Place labeled specimen into zip-lock type biohazard bag; seal bag.
Place completed requisition into outside pocket of bag.
Transport in cooler with refrigerated coolant packs.
CPT Code:
81003