CODE: B.5 TITLE: BLADDER SCANNING CATEGORY/CLASSIFICATION: GENERAL RN ADVANCED PRACTICE LPN PURPOSE To instruct nursing to safely and accurately perform non-invasive measurement of urinary bladder volume using a portable ultrasonic bladder scanner. NURSING ALERT: Using a portable ultrasonic bladder scanner for measurement of bladder volume cannot be used in place of a diagnostic medical ultrasound. Exposure to pulsed ultrasonography has not been shown to produce adverse effects but should be used only by medical professions when clinically indicated. Indications: To identify the emptying function of the bladder To assess for posts-void or post-operative urinary retention. Contraindications: Patient is a neonate Patient is pregnant Patient has open skin or wounds in the suprapubic area Patient has ascites Cautions Conditions that may affect accuracy: Urinary catheter in situ Sutures, staples, incisions, scar tissue: use care when scanning patients with abdominal surgery Abdominal masses or malignancies, abdominal distention, bladder anomalies Free floating peritoneal, pelvic and kidney cysts Bariatric patients Approved: December 7, 2016 Page 1 of 5
EQUIPMENT 1. Portable bladder ultrasound unit with scan head probe 2. Ultrasonic transmission gel 3. Hospital approved disinfecting wipes 4. PPE gloves 5. Patient hygiene supplies; washcloth or tissue to remove gel post-scan NURSING ALERT: Ensure that all other methods of assessment are used in conjunction with the bladder ultrasonography. If a post-void residual volume is required, scan patient within 10 minutes of last void. PROCEDURE 1. Utilize two client identifiers to confirm patient s identity according to RQH Policy 612. 2. Explain procedure to patient. 2.1. Explain that the procedure is non-invasive, but may be painful or uncomfortable. 3. Perform hand hygiene and don PPE. 4. Position the bladder scanner at the patient s bedside. NOTE: If the patient is on isolation, ensure that an approved isolation drape is placed over unit before entering patient s room and that the entire unit is cleaned appropriately upon exiting patient s room. 5. Provide privacy. 6. Ensure patient is in supine position with abdominal muscles relaxed and suprapubic area exposed. 7. Clean scan head probe with hospital approved disinfecting wipes. 8. Turn bladder scanner on by pressing power button; press SCAN button to go to scanning screen. 9. Select appropriate gender icon. Select age, if applicable. NOTE: If a female patient has had a hysterectomy, the male icon must be selected. NOTE: For pediatric patients, choose the pediatric icon if patient weighs equal to or less than 60 lbs. Approved: December 7, 2016 Page 2 of 5
10. Palpate patient s symphysis pubis. 11. Place a generous amount of ultrasonic gel on dome of scan-head. If there is an abundance of hair in the area, put gel directly onto abdomen, approximately 3 cm above symphysis pubis. NOTE: Inadequate amounts of gel or bubbles in the gel can cause inaccurate readings. NOTE: Locate the patient icon on the scan-head and make sure the head of the icon will point towards the head of the patient when the scan-head is placed on the patient s abdomen. Or 12. Place scan-head midline on patient s abdomen over the ultrasonic gel. 12.1 Apply adequate pressure to move through adipose tissue and maintain contact with patient s skin. 13. Aim tip of scan-head so ultrasound is projected down at an angle in direction of expected location of the bladder, towards the coccyx. 14. Instruct patient to not move, laugh or talk during scan. 15. Initiate scan by pressing and releasing scan button on probe. Hold probe steady until scanner beeps indicating scan is finished. NOTE: Moving the probe during the scan will overestimate bladder volume. 16. Assess the shape, size and position of image. Reposition probe if necessary and continue scans until bladder is centered on screen. NOTE: Accurate results are obtained when bladder image is centered on the crosshairs of the aiming icon. If the scan-head probe is not positioned correctly, volume displayed will be lower than the true volume. If the bladder image overlaps the screen, the bladder volume is too large for the unit to measure accurately. NOTE: Consideration should be taken when assessing paediatric patients due to the varying shapes of paediatric bladders. 16.1 Re-aim the scan-head and re-scan patient if image is not centered. Repeat until image is centered. Performing several scans is recommended to ensure maximum accuracy. Approved: December 7, 2016 Page 3 of 5
NOTE: Assume that the largest volume measured is the true bladder volume. Accuracy is plus or minus 15 ml of urine when scanned. 17. Wash ultrasonic gel from patient s skin. 18. Remove PPE. 19. Perform hand hygiene. 20. Document appropriately; include symptoms and indications for scan, results obtained and patient response to the procedure. 21. Clean scanner using hospital approved wipes. Approved: December 7, 2016 Page 4 of 5
REFERENCES: Bonser, C., Molnar, M. & Waters, J. (2016). Sarasota Memorial Hospital nursing procedure bladder scan. Retrieved from http://home.smh.com/sections/servicesprocedures/medlib/nursing/nurspandp/cat14_bladder%20scan_051116.pdf Daurat, A., Choquet, O., Bringuier, S., Charbit, J., Egan, M., & Capdevila, X. (2015). Diagnosis of postoperative urinary retention using a simplified ultrasound bladder measurement. Anesthesia & Analgesia, 120(5), 1033-1038. Davis, C., Chrisman, J., & Walden, P. (2012). Peak technique. to scan or not to scan? detecting urinary retention. Nursing made Incredibly Easy, 10(4), 53-54. Eckman, M. (Ed.). (2015). Lippencott Nursing Procedures. 7 th Edition. Philadelphia, PA: Walters Kluwer. Morrell, G. (2010). False reading of retained urine from a bladder scan. Urological Nursing; 30(2):147-148. Society of Urologic Nurses and Associates. Rowe, J., Price, N., & Upadhyay, V. (2014). Evaluation of the BladderScan((R)) in estimating bladder volume in paediatric patients. Journal of Pediatric Urology, 10(1), 98-102. doi:10.1016/j.jpurol.2013.06.012 [doi] Semple, O. (2016) Westpark bladder scan learning package. Retrieved from http://seniorfriendlyhospitals.ca/toolkit/processes-care/incontinence-bladder Verathon. (2014) BladderScan BVI 9400 operations and maintenance manual. Verathon Inc. Verathon. (2015) BladderScan BVI 3000 operations and maintenance manual. Verathon Inc. Widdall, D.A. (2015). Considerations for determining a bladder scan protocol. Journal of the Australasian Rehabilitation Nurses Association (JARNA), 18(3), 22-27. Revised by: Danielle Droder, RN, CNE, Anita MacPherson, RN, CNE, Jana Lowey, RN, CNE Date: September 2016 Revised by: Danielle Droder, RN, CNE, Anita MacPherson, RN, CNE Date: November 2016 Approved by: Date: Dec. 7/16 Regina Qu Appelle Health Region Health Services Nursing Procedure Committee Keyword(s): Bladder Scanning/Scan Approved: December 7, 2016 Page 5 of 5