Definition
Collection of 24 hours urine sample is a precise process used to evaluate kidney function, hormone levels, or detect substances like proteins, calcium, or cortisol.
Purpose
- To detect kidney, liver, and cardiac conditions.
- To measure total protein, creatinine, electrolytes, 17 ketogenic steroid, oxalate, porphyrins, drugs, vitamins, vanillyl-mandelic acid (VMA), minerals, hormones, etc.
Articles for Collection of 24 Hours Urine
- Clean container with preservative, of not less than 3-L capacity with label, obtained from the laboratory (biochemistry).
- Urinal or kidney tray to collect urine at each voiding.
- Appropriate laboratory form duly filled.
Procedure for Collection of 24 Hours Urine
| NURSING ACTIONS | RATIONALE | |
| 1. | Before procedure Check the physician’s order and nursing care plan. | Obtains specific instructions/information. |
| 2. | Identify the patient. | Ensures that right procedure is performed on the right patient. |
| 3. | Explain to the patient the purpose of the procedure and that all urine for the full 24 hours must be saved. | Gains patient’s consent and cooperation. |
| 4. | Instruct the patient to void at the time set to begin the procedure, e.q., at 6.00 am. Discard this specimen. Record the time when collection began in nurse’s notes. | Ensures that urine collected is produced within the 24 hours of testing. |
| 5. | During procedure Measure and pour all the subsequent voiding into the container. | A 24-h collection will accommodate all the variables in body chemistry within a representative period. |
| 6. | Collect the final specimen at exactly the same time the patient voided 24 hours earlier, e.g. 6.00 am of the following day. | |
| 7. | After procedure Send the container with urine to laboratory when the collection is over, with requisition forms. | |
| 8. | Record time of completing the collection and dispatching the urine to the laboratory in the nurse’s notes. | |
| 9. | Clean, disinfect, and replace the kidney tray or urinal if they are reusable. |
Common Analytes Measured
| Substance | Clinical Use |
|---|---|
| Protein | Detects glomerular damage (e.g., nephrotic syndrome) |
| Creatinine | Assesses filtration rate and muscle mass |
| Calcium | Evaluates hypercalciuria, bone metabolism |
| Cortisol | Screens for Cushing’s or Addison’s disease |
| Catecholamines | Diagnoses adrenal tumors (e.g., pheochromocytoma) |
| Uric Acid | Assesses gout or kidney stone risk |
Common Errors to Avoid
- Missing a void: Even one missed sample invalidates the test
- Incorrect timing: Must be exactly 24 hours—no more, no less
- Improper storage: Keep container refrigerated or on ice
- Contamination: Avoid stool, toilet paper, or menstrual blood
- Diet/medication interference: Caffeine, vanilla, or certain drugs may skew results
Interpreting Results
- Protein >150 mg/day: Suggests proteinuria
- Creatinine clearance: Compared with serum creatinine to estimate GFR
- Calcium >250 mg/day (men) or >200 mg/day (women): May indicate hypercalciuria
- Cortisol >50 mcg/day: Suggests hypercortisolism (Cushing’s)
Important Tips
- Do not miss any urine—even one missed void can invalidate the test.
- Avoid contamination with stool or toilet paper.
- Some tests require preservatives in the container—do not discard them.
- Follow any dietary or medication restrictions given by your provider.
- If menstruating, consult your provider before starting the collection.
Special Considerations
Urine sample must not be collected from the drainage bag or from the collecting tube.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884.
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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