POCT TPR 20007
Version: 1
Page 1 of 4
TITLE: PHYDRION PAPER pH MEASUREMENT PROCEDURE
Department: Point-of-Care Testing
Reviewed Date: 1-21-2013
This procedure applies to:
Stanford Hospital & Clinics Decentralized Testing
Lucile S. Packard Childrens Hospital at Stanford - POCT
LPCH POCT Multi-Site Satellite Laboratories
1.
PURPOSE
PHydrion paper is used to measure the pH of body fluids and other aqueous solutions for
medication administration or patient treatment procedure.
SHC E1 unit tests urine pH for Bone Marrow Transplant patients to determine
medication dosage.
SHC Coordinated Care Clinic performs urine pH test to determine presence of bacterial
vaginosis.
LPCH L&D unit tests amniotic fluid to detect amniotic fluid leakage for patients who
may be in labor.
2.
PRINCIPLE
The pH paper is impregnated with an indicator dye. The color changes as the pH paper is
in contact with a fluid. The pH paper comes with a broad range of colors from red
through dark blue with a numbering system. Units may use a selected choice of pH paper
with desired ranges appropriate for patient care.
3.
SUPPLIES AND STORAGE
pHydrion paper comes in various packaging depending on the type. Units order supply
from Supply Distribution (Owen & Minor). Store supply at room temperature.
4.
TRAINING AND COMPETENCY
PH testing is a waived test and requires initial and annual competency which includes a
Quiz, a hands-on direct observation and review the testing procedure. Each user must be
trained and passed the given quiz and the direct observation of testing techniques prior to
performing patient test. The POCT department trains and certifies unit trainer(s) to train
other staff. The unit keeps the initial and annual competency papers for 3 years for the
Joint Commission inspection cycle.
5.
PATIENT PREPARATION
No patient preparation other than that required by a written protocol.
6.
PATIENT TESTING PROCEDURE
Standard Precautions must be adhered to by testing personnel.
Version: 1
POCT TPR 20007
TITLE: PHYDRION PAPER pH
MEASUREMENT PROCEDURE
Page 2 of 4
Reviewed Date: 1-21-2013
A.
Obtain a strip of pH paper approximately three inches long from the dispenser
which has a pink QC sticker. Close container to keep moisture out.
B.
Hold the paper strip in the fingers of one hand.
C.
Dip one end of the pH strip in patient sample such as urine in a container.
Remove excess sample by touching the moistened pH paper to a paper towel.
Compare the resulting color to the paper dispenser pH chart immediately.
Enter patient sample pH results in EPIC as the actual pH shown on the color
chart. PH below 7 indicates acidic and above 7 indicates alkaline.
D.
For L&D and Stanford Coordinated Care clinic patient testing, the pH paper
needs to be in contact with amniotic or vaginal fluid. Compare the resulting
color to the paper dispenser pH chart immediately. Enter patient sample pH
results in EPIC as the actual pH shown on the color chart. PH below 7
indicates acidic and above 7 indicates alkaline.
E.
Normal reference ranges:
a. For SHC E1 unit:
Ensure that urine pH is greater than 7 before administering methotrexate and for
24 hours after MTX is infused. B. Calculate Dose with Another RN: 1. Confirm
calculation of body surface area (BSA). 2. Confirm dose to be given with
attending MD. C. Administer Sodium Bicarbonate (NaHCO3): 1. Prior to
administration of methotrexate, NaHCO3 is administered in order to create an
alkaline urine and facilitate excretion of methotrexate. a. Pharmacy adds 50 mEq
NaHCO3 to 50 ml D5W. Infuse over 15 minutes. Administer every 3 hours to
achieve a urine pH greater than 7 before starting dose of methotrexate. b.
Continue every 3 hours to maintain urine pH greater than 7 for 24 hours after
each methotrexate dose.
b. For LPCH L&D unit:
Patient urine with pH reading higher than 7 indicates rupture of amniotic
fluid and appropriate patient care will be given to prepare patient for
delivery.
c.
For SHC Stanford Coordinated Care Clinic:
Physician makes a diagnosis of bacterial vaginosis may be present when
urine pH is greater than 4.5.
Criteria for Unacceptable Specimens:
Version: 1
POCT TPR 20007
TITLE: PHYDRION PAPER pH
MEASUREMENT PROCEDURE
Page 3 of 4
Reviewed Date: 1-21-2013
a. Urine sample is acceptable for testing for up to 4 hours after collection. If
testing cannot be performed within one hour after collection, the sample
should be refrigerated at 2-8ْ C immediately and return to room temperature
before testing.
b. If the vaginal or amniotic fluid specimen is contaminated with blood, it will
interfere with the reading and gives an unequivocal result. Other clinical
assessment(s) will be required prior to providing course of patient treatment.
7.
EXPECTED VALUES
Normal pH for fluid is 7. PH results below 7 indicate that the fluid is acidic. PH
Result above 7 indicates that the fluid is alkaline.
8.
QUALITY CONTROL (QC) POLICY
A.
B.
QC frequency and materials
Each pH paper lot shipment (as notified by Supply Distribution) is quality
checked by the POCT Department. Quality check results are recorded on a log. A
QC sticker indicating date/year of quality check and expiration date (3 years after
open) is pasted on the plastic container surface. Every 6-month the pH paper in
use at the unit are quality checked again for quality assurance.
PH standard solutions (pH 4, 7 and 10) are used as control solutions to check
the pH paper lot shipment. All pH standard solutions are stored at room
temperature at the Clinical Laboratory. The solutions are stable until the
expiration date written on the bottles. Only when the pH shipment lot passed the
pH quality checks are distributed to the units.
POCT manager or staff designee reviews QC data on each shipment lot and every
6-month for acceptability and documents corrective actions on unacceptable QC
data.
9.
Documentation of patient results:

The nurse enters patient pH result in the Point-Of-Care (POC) section
of the Laboratory Enter/Edit field in EPIC or Cerner. For EPIC user,
use POC 31 “POC Nitrazine Paper for pH Measurement”. For Cerner
user, go to iView to enter patient pH result. Enter patient sample pH
result as the actual pH reading shown on the color chart.

Notify the Licensed Independent Practitioner (such as physician and nurse
practitioner, etc) responsible for the test results.
Version: 1
POCT TPR 20007
TITLE: PHYDRION PAPER pH
MEASUREMENT PROCEDURE
Page 4 of 4
Reviewed Date: 1-21-2013
.
10
SPECIFIC PERFORMANCE CHARACTERISTICS
The pH paper measures pH values generally to within 1 pH unit in the range as shown by
the color chart visually. The person who performs this testing should not be color-blind.
11.
REFERENCES
Apothecon, Princeton, NJ, Nitrazine Paper, p0083-00, p—0084-00 52520.
Communication from Bristol-Myers Squibb Company, March 28, 1997.
Communication from Indra K. Reddy, Ph.D., Pfizer Endowed Professor of Pharmaceutics
and Edwin H. Adams, Pharm.D., Assistant Professor of Clinical Pharmacy Practice at
Northeast Louisiana University School of Pharmacology, Monore, LA.
Information from pHydrion reagent box and package insert.
This document is intended for use by Stanford Hospital and Clinics and LPCH staff.
No representations or warranties are made for outside use.
Not for outside reproduction or publication without permission.
Stanford Hospital and Clinics or Lucile Packard Children’s Hospital
Stanford, CA 94037