The Consulting Veterinary Nurse is a useful reference for all veterinary nurses who run clinics in their practice. The author, Nicola Ackerman, is an experienced Registered Veterinary Nurse and she has drawn on her knowledge to provide a comprehensive guide, which includes information on how to run efficient and effective well pet clinics and medical clinics.

The book contains a wealth of information on all aspects of running a clinic, including: how to provide clients and patients with an excellent level care; the answers to questions which clients frequently ask in a clinic; how to gather a patient’s history; carrying out an examination and the necessary equipment for this – along with a list of common abbreviations. Nicola also discusses the role of the veterinary nurse and the consideration of nutritional and behavioral issues within the setting of a veterinary nurse-lead clinic.

This book will be a useful reference for both veterinary nurses who are experienced in running clinics and those who are just starting out.

Helen Farrant on behalf of the BVNA

Abbreviations

Introduction

The role of the veterinary nurse has evolved greatly, from being merely a kennel maid to a fee-earning regulated professional. Nurses have a vital role to play in the veterinary practice, in the offering of advice to clients, performing work in order for the veterinary surgeon to make a diagnosis, and in preventive healthcare.

For a nurse with a keen interest in consulting, this is an ideal opportunity to pursue the specialism that interests them while still being of use to the veterinary practice. Veterinary practices are businesses, and nurses that consult need to perform sufficient work in order to not only cover their costs and overheads, but also to make a profit. This is not necessarily through charging for nurse clinics, but through products sold, increasing footfall through the practice, helping with client loyalty and promoting compliance with veterinary advice.

Simplistically, nurse consultations create loyalty, are a better welfare choice and add to the commercial success of the business.

Veterinary nurses who fully utilise skills learnt during training are more likely to remain with the profession, and feel more valued members of the practice. Veterinary nurses are not ‘mini-vets’ and perform a completely different role to veterinary surgeons, though veterinary surgeons also undertake many roles that can be done by nurses, such as blood sampling and postoperative checks.

The purpose of this text is to act as a source of information for those veterinary nurses who undertake consultations, clinics and other initiatives such as puppy parties.

Acknowledgements

I would like to acknowledge all of the support from all of my family, friends and colleagues that has enabled me to complete this book. The role of the veterinary nurse has changed dramatically even within the time I have been practising, and I hope that this text will enable more nurses to become involved in consulting and expand their roles within veterinary practices.

I would therefore like to acknowledge all the veterinary nurses who have led the way in enabling veterinary nursing to become a recognised profession in its own right, both the RCVS VN Council and the BVNA.

Part I
The Role of the Nurse in the Veterinary Practice

1

Ethics

The role of the veterinary nurse has evolved into a regulated profession. A registered veterinary nurse (RVN) is regulated by the Royal College of Veterinary Surgeons under the Veterinary Surgeons Act 1966 (VSA). A solid understanding of this legislation is required in order to ensure that your actions are not only within the law but also in line with the professional code of conduct.

As a consulting nurse it is important to know your own limits, both to be within the law and not to exceed your own personal limitations. Under the VSA only veterinary surgeons are permitted to make a diagnosis. When examining an animal or answering an owner’s questions, you must take care in the area of diagnosis. The veterinary nurse is permitted to inform the owner of the clinical symptoms that the animal is displaying, such as weight loss, increased thirst, tachypnoea, anaemia. You can discuss conditions that display these symptoms, and give guidance on what steps the owner needs to take next – for example, consultation with a veterinary surgeon. If it is likely that the animal will require further investigations, such as blood tests, the owner should be advised that this may occur in the veterinary consultation and the owner can prepare the animal if required; for example, they can pre-starve the patient rather than having to come back for an additional appointment.

Suitably Qualified Persons

It is useful for veterinary nurses to have the ‘suitably qualified person’ (SQP) qualification in order to prescribe and dispense appropriate medicines for animals. The SQP qualification is regulated by the Animal Medicines Training Regulatory Authority (AMTRA) and requires annual retention fees alongside continued professional development that has been approved by AMTRA. Many anthelmintics are prescription-only medicine (POM-VPS) or in the non-food animal (NFA-VPS) category, which means they can be prescribed by a veterinary nurse with the appropriate SQP qualification. It is necessary for a nurse who conducts clinics to hold this qualification, so that appropriate anthelmintics can be given without needing to consult the veterinary surgeon (Figure 1.1).

Figure 1.1 Example of anthelmintics that SQPs can prescribe.

One of the roles of the veterinary nurse is to ensure compliance with recommendations given by the veterinary surgeon. Sometimes this can refer to medications, and you should confirm with the owner that they are able to administer the medications that have been prescribed. In some cases a different format of medication, such as liquid instead of tablets, can be helpful. These cases require not just an initialled change to the prescription, but a separate prescription that must be written by the veterinary surgeon.

When animals are presented to the veterinary nurse for a repeat of injectable medications a veterinary surgeon stills needs to be present in the building as you are administering the medication under veterinary direction. The veterinary surgeon should be in a position to intervene if required, even after they have prescribed the medication.

As an RVN is it vital to have personal indemnity insurance. RVNs are responsible for their own actions, and this includes any work undertaken within a consultation or clinic. Indemnity insurance for RVNs can be included under the veterinary practice’s insurance policy for all staff, or as a personal policy for those who are self-employed. Self-employed locum nurses have to ensure that they are adequately insured.

During a consultation, the person conducting the consultation is responsible for the health and safety of all the people in the room; this includes the client. This means that if the client is hurt, even if by their own pet, the practice is responsible. Any injuries, such as bites or scratches, should be entered into the practice’s Accident Book. It is therefore prudent to ask a colleague to restrain any animals that are not being adequately cooperative. If children are being unruly, you are within your rights to request the parent/guardian to ask their children to behave. If consultations are going to be lengthy, activities to keep children occupied can be a useful distraction. Pictures to colour in, or a pretend ‘vet kit’ with a stuffed toy, can be a great hit with younger children (Figure 1.2). The pictures that they draw or colour can be put up on the wall or notice board.

Figure 1.2 Entertainment for children can prove to be a useful distraction during lengthy consultations.

2

Consulting Room and Literature

When conducting their own nurse clinics or consultations, nurses need to portray themselves as professionals. This includes how and where the nursing consultations are held. Having to conduct a consultation in the waiting room or preparation room does not portray the person holding the consultation as professional. If you are conducting your own consultations then it is important to have a room dedicated for this purpose.

The nurses’s consulting room, like a veterinary surgeon’s consulting room, needs to be clean, tidy and fit for purpose. All of the equipment that you will require to conduct the consultation needs to be in working order and easily to hand (see Box 2.1). All other members of staff, especially receptionists, need to be made aware that during the specified block of time this consulting room is to be kept solely for the use of nurse consultants.

On many occasions clients turn up to the practice in person without an appointment, or telephone in wanting advice. You should always make an effort to speak to these clients; if it is not possible to speak to them immediately, you should offer to contact them later (Figure 2.1). Receptionists should take appropriate contact details and/or make an appointment for the client to bring their pet in to see you. The consulting veterinary nurse should appear as approachable as possible.

Figure 2.1 Always be happy to speak to clients in reception.

Environmental factors within the consulting room are also important. It is important for the room to have good ventilation and temperature control (Figure 2.2).

Figure 2.2 The consulting room needs to be clean and ventilated.

Some consultations may be lengthy – for example, an initial consultation for an obesity clinic. It is therefore important to have chairs in the consulting room, as some clients will prefer to sit down.

Literature

Most clients will find it difficult to remember everything that is said to them in the course of a consultation. It is helpful to give clients handouts on what you have been discussing, and in some cases to give specific written instructions. When clients walk out of the consultation room with information in hand, they have a perception that they have received better value for money than if they just walk out empty-handed. Clients who have received written instructions, either a handout or specific written instructions, are more likely to comply with the instructions given to them.

The literature that you decide to use in your consultations with clients needs to be of a high standard. There are two views of what types of literature should be used. One approach is to use only literature that is produced by the veterinary practice itself, with the practice’s branding on it. In this case all the literature is in line with your practice policy, and you can be completely at ease with what is written there. The other approach is to use literature that is produced by manufacturing companies. This is generally well written and produced to a very high standard, but sometimes it is written around a specific product, rather than around a condition, which can be a disadvantage. Many pharmaceutical companies are now producing condition-specific literature, because of the restrictions on advertising of prescription-only veterinary medications (POM-V) directly to pet owners.

Any equipment you may need during the consultation needs to be present in the consulting room. All equipment needs to be clean and in working order. It can be useful to label equipment in order to designate it to each specific consulting room, in order to ensure that the required equipment is always to hand (Figure 2.3).

Figure 2.3 Examples of equipment required in a consulting room.

3

The Consultation

Several frameworks for consulting have been developed for medical education, but none has been developed specifically for veterinary use. There is considerable overlap between the two fields, so it was decided to adapt a widely used medical consultation model to the veterinary context, taking account of the likely differences between veterinary and medical consultations. The Cambridge-Calgary consulting model (Figure 3.1) has been adapted by the National Unit for the Advancement of Veterinary Communication Skills (NUVACS), and is therefore the most relevant to the veterinary profession.

Figure 3.1 Adapted Cambridge-Calgary model of veterinary consultation skills.

Preparation

Before starting any consultation it is important to prepare adequately. Any equipment required for the consultation should be prepared (see Chapter 2) and the consulting room needs to be clean. You should read through the clinical history of the animal, as you need to be fully aware of any relevant previous history. Whether or not the consultation is about the previous clinical history of the animal, if you mention or ask how the animal has been since the incident, the client feels that you care about their pet. It is always worth checking vaccination status, last time of worming, and other parasite control. If any relevant comments have been noted in the clinical history, the client should be reminded about these. For example, if the veterinary surgeon has requested repeat blood sampling or a repeat clinical examination in a specified period of time, the client should be reminded about it. Make a note of the animal’s name, sex and age, and use this information when talking to the client.

Your appearance is also a highly important factor in the client’s perception of you. The nurse’s uniform needs to be as clean as possible and hair should be kept tidy; long hair should be tied back. All staff members should wear name badges, which should be visible. Even though you tell the client your name at the time, many clients are stressed and do not remember many important facts, let alone the nurse’s name. When writing down any future appointment times, write your name next to the time. Photographs of staff members can be useful for clients, and help to increase the recognition of the role of the veterinary nurse within the veterinary practice (Figure 3.2).

Figure 3.2 A display of the practice nurses and their roles can help to raise the recognition of the veterinary nurse.

Initiating the Consultation

The consultation should start with your confirming the name of the client when calling them through from the waiting area. Always introduce yourself, and confirm what the appointment is for. For example, ‘Hello, my name is Nicola, I am your nurse for today. Have you brought Timmy for his blood test?’ There are many occasions when the client will make an appointment for one cat, and then bring the other instead as the initial cat hasn’t made it into the cat transport box. There are also occasions when the reason for the consultation can change, but this only becomes apparent when the animal is presented. If there has been a delay in the starting time of the appointment, you should apologise for this. Clients (and pets) don’t like to be kept waiting, and not acknowledging it can make the situation worse.

You should also acquaint themselves with the animal. Dogs should be patted and cats removed from transport baskets. Use of the pet’s name is vital. If a cat is not willing to come out of its basket, removing the top half of the basket is helpful. The cat can then be examined in the bottom half of the basket, or lifted out on its blanket on to the consulting table (Figure 3.3). This is why cat owners are always recommended to purchase cat transport boxes that can be opened from the top.

Figure 3.3 A cat less stressed in the bottom half of its transportation box.

This stage is very important for creating rapport with the client and their pet. Remember to use names, shake hands with the client, greet the pet and, most importantly, involve the pet. In order to create good rapport, veterinary nurses need to empathise with pet owners. Owners need to see, hear and feel these emotions from the practice as a whole, not just from the veterinary nurse that they see in the nurse consultations. In most cases they think of their pet as part of the family, and this special bond needs to be respected.

Information Gathering

Background information can be gained from the clinical history, but in many cases additional information is required and is obtained through questioning. Many clients are more than happy to offer information, whether it is relevant or not, but sometimes you will need specific questioning in order to get the required information. Both open and closed questioning should be used when conducting a consultation, as they will provide different types of answers (see Box 3.1). Questioning also helps provide information on the client’s expectations, concerns, wants and needs. It allows you to demonstrate your professionalism and knowledge, while helping to build rapport and show empathy. Questions also help to give you time to think and time to focus. Ensure that you show genuine interest in what the client is saying; listen to what the client is saying and if necessary repeat what they are saying back to them in order to confirm details (Box 3.2).

This is a very important stage of the consultation, and one that is often overlooked or not fully completed. Sometimes when the consultation has finished the client often asks, ‘… and another thing’. This is an indication that questioning was not sufficiently thorough in the early stage of the consultation.

In some cases the client will ask for multiple procedures to be completed, or will have a very long list of questions. Your job is to find out what all of the client’s concerns are and then prioritise which are the most important, to you as a veterinary professional and to the client. What you feel is the most important factor and what the client feels is the most important may be two different things. For example, the client may feel that having the pet’s nails clipped is what they have presented their pet for, and this is the most important thing to be done in the consultation. You, however, may feel that the animals’s dramatic weight loss and polydipsia are the most important factors to be considered. In this situation you need to ensure the client understands why you feel that these factors need to be prioritised over the nail clipping.

If the client has a long list of non-emergency questions or procedures, the consulting nurse and the client need to agree on which things are to be completed first. A subsequent appointment can be made on another day in order to complete the rest. This must be done in agreement with the client, and they must understand why some things are being deferred to another day, for the following reasons:

• Insufficient time to correctly cover all the items that the client wishes
• Too much information for the client to retain in one appointment
• The pet becoming stressed (e.g. at having all the mats combed out of its hair in one session)
• To aid in compliance.

For example, if you want to demonstrate to a client how to brush a dog’s teeth, in the first consultation you can introduce the concept of the toothpaste or gel; the second consultation is to ensure that the client is managing stage 1 and is ready to move on to stage 2.

Physical Examination

When initiating the physical examination it is important to be aware of the clinical history. If the animal is known to have a tender abdomen, or arthritic joints, it is important not to exacerbate any discomfort. With larger dogs, or those that do not like being on the consulting table, the physical examination can be conducted on the floor.

While carrying out the clinical examination it is important to talk through with the client what you are doing and looking for. Many clients comment that the veterinary surgeon only gave their pet a quick check over, or didn’t actually examine it. In fact the pet was probably given a full clinical examination, but the owner was not aware of what the veterinary surgeon was doing. What the owner perceived as the veterinary surgeon fussing the dog, was actually them checking for lumps and bumps. When checking for lumps and bumps, check whether the client is aware of any; some lumps are small and may not be noticeable to you. Talk your way through the examination, starting from the top and systematically working backwards. Having a set routine for the clinical examination will help to ensure that things are not missed out.

Start by looking at the symmetry of the head and jaw. This is important when animals are presented with dental disease, as lumps or bumps on the jawbone can be an indicator of tooth root problems. Any nasal discharge should be noted, along with colour and whether a lateral or bilateral discharge is present. When examining the eyes, the size of the pupils and symmetry between the two eyes should be examined (Table 3.1). The conjunctiva surrounding the eye should be examined in order to check for infection, and any discharge from the eye should be noted. Tear overflow, and the staining of the fur that will be seen when checking puppies (Figure 3.4), should be discussed with the client. Ears should be checked, looking for discharge, general wax and dirt. Examination of the mouth will really depend on the animal’s cooperation of the. If the animal is known to be difficult to handle, in some circumstances asking the owner to lift the animal’s lip up so that you can look at the teeth can be appropriate. If any disease is present then it should be noted and graded. The level of gingivitis, plaque and calculus should be noted.

Table 3.1 Possible underlying cause of anisocoria (unequal size of the pupils)

Figure 3.4 Tear overflow in a dog.

When feeling down the animal’s neck and shoulders, the lymph nodes should be checked. If they are palpable this needs to be noted and referred to the veterinary surgeon. The condition of the coat and skin need to be assessed, and checked for parasites. Nail length should be noted.

Part of the examination should also include the heart rate, respiratory rate and temperature. The overall condition of the animal should be noted, e.g. body condition score (BCS), muscle condition score (MCS), weight, hydration status (see Box 3.3 and Table 3.2).

Table 3.2 Assessing levels of dehydration in an animal

CRT, capillary refill time.

Explanation and Planning

Once all the information has been gathered and the animal examined, you need to explain your findings to the owner and a mutually agreed plan needs to be made. When explaining and planning the next steps it is important to convey the information in a form that the client understands. This can be oral or written, and in some cases educational DVDs can be provided. Some points will need to be reiterated, and some relayed in a different form that will enable the owner to fully understand the information that is being conveyed. When planning the next step the owner must be in agreement with the decisions that are being made and must be able to comply with the instructions given. There are three parties involved in making any plans: the veterinary profession, the client and the pet. All parties need to be in agreement in order to make a plan work. The owner may agree to daily tableting, but the pet may not be in complete agreement with this plan and therefore complications can occur.

Breaking down information into ‘digestible’ chunks can be helpful for the owner. In lengthy consultations it can be useful to ask the owner if they want to take notes – have a pen and paper ready in order to allow them to do so. It is important to ask the client if they can foresee any challenges of implementing this plan at home, as they might completely agree with what should be done, but may not be able to actually do it.

Closing the Consultation

When closing the consultation the aim is to summarise the decisions that have been agreed on, and to arrange future appointments. It can also be useful to confirm that the owner is happy with any instructions for any medications that have been dispensed or diets recommended. Make sure the client has details of how to contact you by phone or e-mail, and also write your name down again. Many people will still forget what you initially told them, as they are understandably worried about their pet.

In all consultations, remember:

• Show courtesy and respect both to the client and to their pet.
• Provide solutions: even if this means having to refer the problem on to someone else, it is part of the pathway to providing a solution. Don’t say ‘I don’t know’ in relation to a specific problem, but turn the statement around to ‘Let me find out for you’, or ‘Let’s see what we can do’.
• Keep your word: if you say you will contact the owner in a couple of days, ensure that you do.
• Ask if there is anything else that you can do for the client. If the information-gathering stage of the consultation has been completed correctly then the client will usually say no. This gives them the feeling that all of their original expectations for the consultation have been met.

Compliance

Compliance is achieved when the owner fully understands what is required, and is able to undertake these requirements. Compliance has three beneficiaries:

• The pet (its health and welfare is increased)
• The owner (being able to have a happier, healthier pet)
• The practice (increasing client service, profits and increases in staff motivation).

Compliance can break down, and this can lead to less healthy pets, and fewer bonded clients. This can occur for a number of different reasons, mainly due to lack of understanding. Many clients do not understand the nature of their pet’s disease or the requirement for continued long-term treatment, or may misunderstand what the veterinary professional has told them. In some cases the owner can be too embarrassed to ask the veterinary surgeon for further clarification. These cases tend to present as the owner stating that they felt that the pet seemed better, unsure of what the term ‘chronic’ meant, and that they felt or understood that just one course of the treatment was required. Few clients actually state cost as a factor in the breakdown of compliance. Apathy can be a major cause of compliance breakdown, but good support and client education on the importance of why medications should be given, or weight loss occur, can help to reduce apathy in pet owners.

Ensuring that all pets newly diagnosed with a disease have a follow-on appointment with a veterinary nurse a few days later is a really good protocol to instigate. The follow-up can be either in person or on the telephone if the owner is unable to attend. During these few days the client will have thought of a few questions, many of which they may feel are too trivial to ask the veterinary surgeon. Ultimately, this system will dramatically aid in increasing compliance (see Box 3.4).

4

Diagnostic Clinics

Part of the veterinary nurse’s role is to aid the veterinary surgeon in gathering data by collecting samples for diagnostic procedures. The nurse can carry out procedures such as blood sampling, blood pressure monitoring, Schirmer tear testing, skin sampling and urinalysis. Nurses are not permitted to make a diagnosis themselves, but are adequately trained in the preparation of the animal and the collection of samples so that the veterinary surgeon can make a diagnosis.

Blood Sampling

Routine sampling for many conditions can be done by the veterinary nurse within the nursing consultation. Examples include repeat sampling for fructosamine levels in diabetic patients, haematology for chemotherapy patients and biochemistry parameters for renal patients. When taking samples it is important to agree whether or not to have the owner present during the procedure. Many owners will expect to remain while you take the sample; some will not want to be present, but they need to be aware of the option. You should also inform the owner that it is essential to clip any hair away from the sampling site in order to prevent infection; aseptic preparation of the site is required. If the animal requires more than one site to be clipped it is important to inform the owner of the reasons for this. Communication is exceptionally important in all nursing clinics and consultations, and owners like to be aware at all times of things that affect their pet.

Before taking the sample it is important to confirm that the owner understands why it is being taken. If it is a repeat procedure the owner may already be fully aware, but if the veterinary surgeon has requested sampling to be done in a subsequent nurse consultation, the owner may require clarification. Information about when the animal received medication, or if and when it was fed, need to be obtained. This consultation is also a good opportunity to weigh and condition score (BCS) the animal. In some cases this appointment may be the owner’s only point of contact with a veterinary professional for the few months in between prescription or other veterinary checks. If the animal is suffering from a particular condition, it is also a good opportunity to question the owner on the animal’s overall condition, water intake, urine output, food intake, exercise tolerance and general demeanour.

Ensure that all materials required for blood sampling are prepared before bringing the client into the consulting room (Figure 4.1). All blood tubes should be labelled, and slides for haematology identified. When taking bloods for any haematological analysis, blood films should always be produced. If you are doing the sampling in the consulting room with the client present you will need a competent assistant in order to restrain the animal; always remember to introduce your colleague to the client.

Figure 4.1 Equipment required for blood sampling.

It is important to note on the animal’s clinical history where you took the sample from, and whether or not it was a stressed sampling. Blood samples taken from stressed cats will have an increased neutrophil count and stress hyperglycaemia. If the veterinary surgeon is not present when the sample is taken they will not be aware that the animal was stressed, and this can alter their interpretation of the results. Always ensure that the correct blood sampling tubes have been used for the types of tests that are to be performed, and for the laboratory that the samples are to be sent to.

Blood Pressure Monitoring

Routine blood pressure monitoring should be done in all patients suffering from renal disease, cardiac disease and diabetes, as well as all patients in the senior (mature) age category. It should ideally be done in the presence of the owner, as animals, especially cats, tend to be calmer when their owner is present. Cat owners should be encouraged to bring a blanket that the cat normally sits on at home, as this will help the cat to relax more. Most cat owners tend to put these in the cat’s travelling basket anyway. It is important to allow the cat to come out of the basket without dragging it out (alternatively, remove the top of its travel box), and for dogs to roam freely around the consulting room before monitoring the blood pressure.

All required equipment should be prepared beforehand (Figure 4.2). The cuff you will need to use should be pre-measured just before use, and the size used recorded on the clinical history. If different cuff sizes are used then different readings will be obtained. The secret here is to use the same cuff and site if you wish to monitor a patient long term. The cuff size is determined by the circumference of the limb on which it will be placed. For cats and dogs, the ratio of cuff width to limb circumference should be about 40%. If in between cuff sizes, round up. After placement, the cuff should not be so loose that it can be rotated over the site or so tight as to obstruct venous return. If it does not stay connected when inflated, select the next larger size cuff. A perfect fit will be with the self-attached loops just over the felt but not beyond.

Figure 4.2 Equipment required for blood pressure measurement.

The use of clippers to remove hair from distal to the carpal stopper pad should be avoided as this can inadvertently increase the blood pressure as a stress response in cats. Instead, wiping the area with surgical spirit and then rubbing ultrasound gel well into the hair works just as effectively. In order to remove any stress response to the noise created by the Doppler probe, headphones can be used. If these are not available, the noise should be turned off, the probe positioned, and then the volume slowly increased until the pulse is audible. (Figure 4.3).

Figure 4.3 Cats should be minimally restrained for blood pressure monitoring.

All animals will react to the increasing pressure exerted by the cuff, and therefore the first reading should always be discarded, as it will be artificially elevated. Different sources will state different methods of finding a final measurement. Some recommend taking five readings and taking an average of the five, some suggest taking the third reading; personally, I repeat the process until three readings that are similar (within 5 mmHg) are recorded. Excess gel should be wiped from the animal, and the owner should be advised that it is not harmful if the animal licks any of it. The result, the cuff sized used and the location where the cuff was placed should all be recorded on the pet’s clinical records.

Blood pressure monitoring is a useful diagnostic tool that should be used in many areas in veterinary practice. It is a good prognostic indicator for animals in a critical condition. The Doppler probes are also very useful for monitoring heart rate in small patients, such as rabbits, hamsters or birds, during general anaesthesia.

Urinalysis

The analysis of urine is a simple everyday task that can provide an excellent insight into the health of the patient. Specific gravity (SG) should be determined on every sample with use of a refractometer. When carrying out microscopy it is important not just to note whether there were crystals present but also the evidence of casts, cells and microorganisms.

Sample Collection

The easiest and most commonly used method of collecting a sample is a free flow or voided sample. Collecting a midstream overnight sample is the best for routine urinalysis, as it gives the best indication of the true composition of urine.

Figure 4.4