[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Medical–surgical nursing](https://durgical.com/en/nursing/areas/med-surg/) › Urinary tract infection and pyelonephritis: the clean specimen, fluids, teaching and catheter-related infection # Urinary tract infection and pyelonephritis: the clean specimen, fluids, teaching and catheter-related infection - Safe practice In a urinary infection the nurse takes a clean sample, encourages fluids, gives the antibiotics ordered, watches for sepsis and protects catheters. Updated Nov 13, 2026 ## Key points - Clean-catch midstream sample: clean, pass the first urine into the toilet, collect the middle part, do not touch the inside of the cup. - With a catheter: disinfect the sampling port and aspirate with a sterile syringe; never take urine from the bag. - Fever, chills, flank pain or vomiting suggest kidney infection: report it. - In older adults, new confusion may be the only sign of a UTI. - Catheters: only when indicated, closed system, bag below the bladder and off the floor, removed as soon as possible. - Do not routinely screen catheterised patients without symptoms for bacteria in the urine. ## What it is A urinary tract infection may stay in the bladder or reach the kidneys (pyelonephritis). Bladder infection causes burning, frequency, urgency, cloudy or bloody urine and lower abdominal pressure; kidney infection adds fever, chills, flank pain, nausea and vomiting, and in older people confusion may be the only sign. The nurse's work is a correct specimen (clean-catch or from the catheter sampling port, never from the bag), fluids unless restricted, the antibiotics on time and to the end, watching for sepsis, and preventing catheter-associated infection: a catheter only when indicated, a closed system, free flow and removal as soon as possible. ## What it requires - Recognise bladder versus kidney symptoms. - A specimen collected without contamination, labelled and sent as the protocol sets. - Antibiotics given on time and completed even when the patient feels better. - Every urinary catheter has a current indication. ## How it is applied (and why) - Ask about burning, frequency, urgency and the look and smell of the urine — they point to a bladder infection. - Check temperature and ask about chills, flank pain and nausea — they suggest the kidneys are infected. - In an older adult with new confusion, think of a UTI and report it — it may be the only sign. - Teach the clean-catch midstream method and check the sample — contamination from the skin gives false results. - With a catheter, disinfect the sampling port and aspirate with a sterile syringe — urine in the bag is contaminated. - Label the sample and send it as the protocol sets — if it cannot go at once, store it as the laboratory instructs. - Encourage fluids, mostly water, unless the patient has a fluid limit — they are part of the advice for bladder and kidney infections. - Give the antibiotics as ordered and teach to finish them — stopping early lets the infection come back. - Check pulse, blood pressure, breathing and mental status — sepsis is the dangerous complication. - Ask every day whether the catheter is still needed and keep the system closed and draining — duration drives catheter infection. ## In nursing practice - Most bladder infections improve within 24 to 48 hours of starting treatment; kidney infection may take a week or more. - Sepsis risk is higher in very old adults and in people with weak immunity. - Recurrence soon after treatment needs reporting. - Catheter care: hand hygiene before and after handling, routine meatal hygiene with the daily wash, no antiseptic on the meatus. ## Common mistakes - Taking the urine sample from the drainage bag. - Changing catheters or bags on a fixed schedule instead of when clinically needed. - Leaving the bag on the floor or above the bladder, or the tubing kinked. - Sending urine cultures from catheterised patients without symptoms. - Not reporting fever, flank pain, low blood pressure or new confusion. ## Test yourself Think of the answer, then tap the question to see it. ## Where does the nurse take a urine culture from a patient with an indwelling catheter? From the disinfected needleless sampling port with a sterile syringe; never from the drainage bag, which is contaminated. ## Which signs suggest the infection has reached the kidneys? Fever, chills, flank or back pain, nausea and vomiting, and in older people confusion. ## Should catheterised patients without symptoms be screened routinely for bacteria in the urine? No; CDC advises against routine screening for asymptomatic bacteriuria in catheterised patients. ## Where should the catheter drainage bag be kept? Below the level of the bladder at all times and off the floor, with the tubing free of kinks. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/nursing/urinary-tract-infection-and-pyelonephritis-the-clean-specimen-fluids-teaching-an/) ## Elsewhere in DurgiPedia - [Urinary symptoms: dysuria, frequency, oliguria and hematuria](https://durgical.com/en/clinical-exam/urinary-symptoms-dysuria-frequency-oliguria-and-hematuria/) ## Connections ## Related 4 - [Specimen collection: urine, stool, sputum and swabs](https://durgical.com/en/nursing/specimen-collection-urine-stool-sputum-and-swabs/) - [Indwelling catheter care and removal](https://durgical.com/en/nursing/indwelling-catheter-care-and-removal/) - [Preventing healthcare-associated infections: the care bundles](https://durgical.com/en/nursing/preventing-healthcare-associated-infections-the-care-bundles/) - [Urinary catheterization](https://durgical.com/en/nursing/urinary-catheterization/) ## Related conditions 3 - [Urinary tract infection (acute cystitis)](https://durgical.com/en/conditions/urinary-tract-infection/) - [Acute pyelonephritis](https://durgical.com/en/conditions/acute-pyelonephritis/) - [Catheter-associated urinary tract infection](https://durgical.com/en/conditions/catheter-associated-urinary-tract-infection/) [← All of nursing](https://durgical.com/en/nursing/) Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order. Sources: [Urinary tract infection - adults, MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000521.htm) (MedlinePlus, US National Library of Medicine, 2026); [Clean catch urine sample, MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/007487.htm) (MedlinePlus, US National Library of Medicine, 2024); [Guideline for Prevention of Catheter-Associated Urinary Tract Infections (2009): Summary of Recommendations](https://www.cdc.gov/infection-control/hcp/cauti/summary-of-recommendations.html) (Centers for Disease Control and Prevention (CDC), HICPAC, 2009); [Nursing Skills (Open RN), 11.5 Obtaining Urine Specimen for Culture](https://med.libretexts.org/Courses/University_of_South_Carolina_Upstate/Nursing_Skills_(OpenRN)/11%3A_Facilitation_of_Elimination/11.05%3A_Obtaining_Urine_Specimen_for_Culture) (Open RN, Wisconsin Technical College System (CC BY 4.0), LibreTexts, 2021). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/nursing/urinary-tract-infection-and-pyelonephritis-the-clean-specimen-fluids-teaching-an/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/urinary-tract-infection-and-pyelonephritis-the-clean-specimen-fluids-teaching-an/