[tridil2000]

cath the pt and fill their bladder with ns?

we stopped doing thas about 4 years ago where i worked, as there was enough support that we were increasing uti risk, and making a pt with pelvic pain even more uncomfortable.

we changed to giving 1 L ns iv,bladder scan after, and call for us if scan was over 250.

what is everyone else doing?

THANKS

[Altra]

We do not fill the bladder with NSS. Most of the time the focus is on having the US completed as quickly as possible, so time isn't always allowed for the bladder to fill with IV or oral hydration either. I have heard ultrasound techs comment that the necessity of having a full bladder varies with the scan and type of equipment ... can't really comment on that as it's not my area of expertise.

I agree - cathing and instilling NSS would seem to be introducing a statistically significant risk of UTI.

[weirdRN]

I spent time as an ultrasonographer in a busy radiology dept. It truely is dependant on the type and urgency of scan needed, and the equipment available to do the scan with. The BEST tool is the experienced sonographer. They can get pics when no one else can.

Filling the bladder with nss via cath is a NO NO... damage to patient bladder, increased discomfort, potential to rupture something, increases risk of uti are the immediate things that come to mind.

[tridil2000]

thanks for the replies.

the thing is in the ed, we need to get the u/s fast, in case there's a problem, but most women who are young with normal kidney function can make 250 ml of urine after a liter of saline. it takes about an hour in most cases, and after hanging the bag, i am usually giving meds, charting and checking on my other people. once the liter is in, i bladder scan and off they go.
now, i am am asked to go back to the 'old' way at my new job. is there any research out there that supports NOT placing a cath and filling.... as there are increased risks of rupture, infection and unnecessary pain?

i would love to present the data or literature and get this outdated practice stopped!

[weirdRN]

Originally Posted by tridil2000

now, i am am asked to go back to the 'old' way at my new job. is there any research out there that supports NOT placing a cath and filling.... as there are increased risks of rupture, infection and unnecessary pain?

i would love to present the data or literature and get this outdated practice stopped!

I am sure somewhere there is. It just makes common sense to me. But then I have an education too....

Exactly what kinds of scans are you doing anyway?

[tridil2000]

Originally Posted by WhimsieRN

I am sure somewhere there is. It just makes common sense to me. But then I have an education too....

Exactly what kinds of scans are you doing anyway?

abd pelvic u/s.... like the one you get when you're pregnant. however, you're free to drink orally then.

in the er, in case of a ruptured fallopian tube or a twisted ovary, you remain npo until we know what is up.

i bet men wouldn't go for it... the foley and filling! we'd probably give them 20 of lasix and call it a day.

[weirdRN]

Originally Posted by tridil2000

abd pelvic u/s.... like the one you get when you're pregnant. however, you're free to drink orally then

ummm...... According to ARDMS standards, you are supposed to be NPO at least six hours for the abdominal scan (otherwise you have too much gas) and the pelvic you are supposed to drink, No filling via any other means. If you can not get a good scan with the transabdominal transducer, you should use the transvaginal probe and forego filling all together.

[tridil2000]

Originally Posted by WhimsieRN

ummm...... According to ARDMS standards, you are supposed to be NPO at least six hours for the abdominal scan (otherwise you have too much gas) and the pelvic you are supposed to drink, No filling via any other means. If you can not get a good scan with the transabdominal transducer, you should use the transvaginal probe and forego filling all together.

when women come in with pelvis/lower abd pain they made npo. they may end up going to the or.

being npo for hours before would be for an elective scan.... but this the er. the pt could have come directly from bbq and be full of beer for all we know.

the concern is with the diagnostics for diagnosis. a good pelvic u/s requires a full bladder, as it acts as a window then. getting the bladder full in the past required a foley and placing 300 of saline into the bladder and clamping it. in the past couple of years, the trend has been to not be as invasive and to run the iv, bladder scan for a goal of 225 and then they can go to u/s.

[debbyed]

We stopped using foley cath for Ultrasound years ago. Pt's bladder is filled either by PO or IV fluids. Transvaginal views are frequently done as well.

[Altra]

Tridil, are your sonoghraphers doing transvaginal scans? These are commonly done where I work, and I'm thinking that that cuts down on the need for a full bladder. Whimsie or another with US experience will correct me if I'm wrong ...