Simple ultrasound question

[Happy-ER-RN, RN]

This is bugging me so I can't wait until my next shift to ask. I am reading over my orientation manual and it mentioned inserting a Foley before a patient goes to ultrasound. Now, when I worked in a small ER in nursing school I remember forcing patients to wait until their bladder is full to go to ultrasound (and then of course U/S is tied up and the pt. has to wait for 2 hrs with a full bladder...) Anyway, I was just wondering, what kind of ultrasounds need a full bladder and what needs an empty one?

[dianah, ASN]

I believe pelvic ultrasounds require a full bladder. The full bladder acts like a "window" through which the probe images the uterus and ovaries.

Abd ultrasound for GB is done first thing in the a.m., pt must be TOTALLY NPO, no gum, no NOTHING! If pt eats something or even chews gum, the GB contracts and is MUCH harder to visualize (the exam can be sub-optimal to nondiagnostic).

[Aneroo, LPN]

Pelvic u/s can be done lady partslly. Not the most comfortable way, but to me, it's better. I'd rather have that in there, than resisting the urge to pee my pants. -Andrea

[suzanne4, RN]

You need a full bladder for a pelvic ultrasound. Put a thinking cap on; if you need a full bladder and your patient is NPO because they may have a surgical abdomen, what is the fastest way to get the bladder full?

Insert a foley, don't use it for drainage, actually clamp it, and instill 0.9% Normal Saline. Voila, full bladder and patient is still NPO. You just open it to drain once the procedure is finished.

Hope that this helps................. :)

[mommatrauma, RN]

We don't do foley's for pelvic uls at all...Our patients get transvag uls if they have pelvic issues...saves time...

[Gompers, BSN, RN]

Insert a foley, don't use it for drainage, actually clamp it, and instill 0.9% Normal Saline. Voila, full bladder and patient is still NPO. You just open it to drain once the procedure is finished.

I had this done to me when I was a teenager in the ER (r/o ruptured ovarian cyst vs. appendicitis) and MY GOSH was it uncomfortable. It hurt enough pushing the probe all over my aching abdomen, but with that horrible full bladder feeling...oh it just sucked!!! But you're right, it was much much faster than even running normal saline wide open - they were able to get the ultrasound within a few minutes instead of an hour.

The second pelvic ultrasound I had, I wasn't NPO, and the ultrasound tech didn't believe my bladder was full enough. Only after I had tears in my eyes and was begging to use the bathroom ("Just a little bit, I need to take the edge off or I'm going to go in my pants!") did she finally do the scan.

Just a different point of view - PLEASE take pity on your pelvic ultrasound pateints, it's agonizing!!!

And all hail the trans-lady partsl ultrasound probe! Much more comfortable than the full bladder thing.

[lifsavER67]

I personally do not like the practice of filling a bladder with a foley. The main reason is I think it is an unnecesary risk of infection. The second reason is i think the bladder does not have time to expand slowly and it is more painful. Also, that fluid is cold that is being instilled and I think causes the bladder to spasm.

A good old IV on the other hand fills the bladder quickly enough I think.

Now, our ultrasound dept totally disagrees and will do anything in their power to force us to put a foley in. I usually give the pt. a choice and explain the pro's and con's of both methods. The ones who choose the IV are then usually talked into changing their minds after US gets in there. In my experience, the foley cause more discomfort. On the other hand, you can just drain the bladder into the BSD when the procedure is done instead of the pt. having to try to make it to the BR.

No pt. with abd pain or pregancy is allowed PO fluids to fill bladder.

[teeituptom, BSN, RN]

I personally do not like the practice of filling a bladder with a foley. The main reason is I think it is an unnecesary risk of infection. The second reason is i think the bladder does not have time to expand slowly and it is more painful. Also, that fluid is cold that is being instilled and I think causes the bladder to spasm.

A good old IV on the other hand fills the bladder quickly enough I think.

Now, our ultrasound dept totally disagrees and will do anything in their power to force us to put a foley in. I usually give the pt. a choice and explain the pro's and con's of both methods. The ones who choose the IV are then usually talked into changing their minds after US gets in there. In my experience, the foley cause more discomfort. On the other hand, you can just drain the bladder into the BSD when the procedure is done instead of the pt. having to try to make it to the BR.

No pt. with abd pain or pregancy is allowed PO fluids to fill bladder.

Sounds like your US techs need to stay up and learn more about the job. Either that or all US TEchs need to sit for hours in the waiting with a full bladder witing for their US, Or should we just catheterize all US techs and inject cold saline into their bladder.