Peri Operative

The use of the BladderScan^® may provide Medical and Surgical Staff on Short Stay units with a noninvasive means of establishing bladder volume and hence, information regarding the necessity of voiding. In many instances, discharge from a Shortstay Unit is predicated at least in part on the patient's ability to void, particularly in postoperative patients. Many patients spend extended hours on such units awaiting discharge pending a successful void. If the status of the bladder volume could be ascertained noninvasively, the patient might be found to require more hydration, which would expedite bladder filling and speed up the voiding trial process and, hence, the patient's discharge. Conversely, the patient might be noted to already have significant bladder volume and be in need of attention to bladder decompression.

Other circumstances also exist on the Short Stay Units which would require the determination of the bladder volume and thus, the utilization of The BladderScan^®.

• Indications & Applications
• Cost Analysis
• Key Clinical Messages
• Literature

Indications / Applications

Indications for the use of the BladderScan for Anaesthesia / Recovery

• Pre-surgical determination of the maximum contents of the bladder
• Patient with a risk of urinary retention
• Patient with a risk of urinary residue
• Patient after spinal/epidural/general anaesthesia
• Patient who hasn't been able to indicate that he/she has to urinate
• Patient after removal of a S.P.C.
• Patient post-operative
• Patient who is inexplicately confused and restless
• Patient with a possible obstruction of the urinary tract

Experiences of the nursing staff in practice

• The use of the BaldderScan eliminates unnecessary catheterization
• We are able to recognize urine retention in time
• The making of a measurement with the BladderScan takes less time than a catheterization
• Less unnecessary use of disposables
• Always knowledge of the contents of the bladder
• Less deliberation about the necessity of catheterization
• Minimize risk of urinary tract infection and thus use of antibiotic
• Use of the BladderScan is more friendly to the patient than catheterization
• The BladderScan contributes to the quality of care of the patient

Cost Analysis

	Hospital - Cost Justification- Monthly Financed.pdf
	Hospital - Cost Justification-6100.pdf
	Hospital - Cost Justification-Multiple.pdf

Key Clinical Messages

Pruim E.J. (1999 NTVa,; 16:nr.3)
Non-Invasive Bladder Volume Assessment on the Recovery Ward
The study results show that BladderScanT is an easy to use , non-invasive way of ensuring that your patient is not within the (retention) danger zone with a non invasive ultrsound measurement causing little or no discomfort. Use of the protocol, instead of time limit or palpatation means less or even no unnecessary catheterisations and therefore is an improvement in quality of patient care. Using BladderScanT is cost effective

Brouwer T. (1999)
Overview case study. Post-operative care for urinary retention
This study suggests that the incidence of post operative urinary retention varies from 4%-60% depending on procedure and type of anaesthesia used.
The study demonstrates that in the post anaesthetic care units, patients who had not received peri-operative catheters, were bladder scanned at frequent intervals, and were only catheterised if the bladder volume was greater than 500ml (with spontaneous voiding not possible). If the patient leaves the PACU (recovery room) with a bladder volume less than 500ml, the responsibility for the bladderscanning protocol will transfer to the Surgical ward. Benefits of this study are that a bladder scanning protocol could prevent urinary retention and postpone urinary catheterisation with decreasing hospital costs.

Weber E. (2000)
Prevention of urinary tract complications start at the recovery room by non-invasive bladder management
Dr Weber's main concern is the peri-operative and post operative measurement of bladder volume and thus urinary production, without the need for urinary catheterisation with the use of non-invasive ultrasound imaging, using BladderScanT. BladderScanT was used in the recovery room after minor orthopaedic surgery, using both local and general anaesthesia to determine the incidence of oliguria and high bladder volumes (> 400ml). The results of this study show that 37 % of the studied population could be at risk of developing urinary tract dysfunction by oligura or urinary retention. However, by using BladderScanT to catheterise only patients with a certain measured bladder volume than urinary tract disorders may be prevented in the earliest phase. The results conclude that by using BladderScanT during the recovery period information can be gained about the vital organs (bladder and kidney) even after minor/short procedures and is considered to be a necessary measurement.

Pavlin J. et.a. (1999 Aneath.Analg.,89,90-7)
Voiding in patients managed with or without ultrasound monitoring of bladder volume after outpatient surgery
BS ultrasound monitoring facilitated determining when to catheterize patients at high risk of retention (hernia/anal surgery, spinal/epidural anaesthesia). Categories of patient risk groups are presented

Rosseland L.A. et.al. (2002 Acta Anaesthesiologica Scandinavica; 46:279-282)
Detecting postoperative urinary retention with an ultrasound scanner
A reliability test was performed on an ultrasound scanner to compare scanned and catheterised volumes. The study confirms a good correlation between the two and suggests that the routine use of a scanner should be considered to prevent the consequences of undiagnosed post-operative urinary retention and the risk of infection imposed by an indwelling catheter.

Hinman F (1976 Surgery, Gynaecology & Obstetrics; volume 142)
Postoperative overdistention of the bladder.
Recent experimental evidence shows that a single episode of overdistention of the bladder can produce chronic changes by irreversible damage to the detrusor.

Brouwer T.A. et.al (1999 Journal of clin. Monitoring and Computing 15: 379-385)
Validation of an ultrasound scanner for determing urinary volumes in surgical patients and volunteers
Ultrasonic scanning underestimated the true urine volume by about 7% over the whole range (17ml to 970 ml). R²values for correlation of measured and scanned urinary volumes ranged between 0.92 and 0.95. Two studies were performed to validate the use of this ultrasound monitor in the clinical setting. A study in volunteers was designed to measure the performance of the device at hogher volume ranges. A second study, to evaluate the use in surgical patients, was performed at lower ranges in patiensts requiring urinary catheterisation due to length of operation. The measurements in out study show that ultrasound scanning of the bladder volume produces sililar results when obtained pre- or post induction of anaesthesia, indicating that the scanner may be used throughout anaesthetic procedures to support decision making on urinary catheterisation. General guidelines indicate that catherisation should take place at estimated volumes exceeding 300-500 ml.
Catherisation itself has some major drawbacks, such as trauma, infection and patient discomfort. Therefore the aim is to catherize only when the scanned volume is around a patient's functional capacity and he/she is not able to void spontaneously. This method prevents bladder distension. No discomfort. Non invasive. Rapid results. Superior accuracy over palpation/percussion/estimation. The peri-opeative use of this device will help to define the urinary volume to be marked as "urinary rentention".

Cardenas D.D. et.al. (1988)
Residual urine volumes in patients with spinal cord injury: measurement with a portable ultrasound instrument.
The first ultrasound volume determination was comparable to the average ultrasound volume (r2=0.956). For catheterized volumes versus the initial ultrasound volume determination, r2=0.80 The average error was 18% for catheterized volumes within the range 50-700 ml. Our results compare favorably with both real-time scanning using standard equipment and other portable instruments.

Kamphuis E.T. et.al. (1998 Anesthesiology; 88: 310-6)
Recovery of storage and emptying functions of the urinary bladder after spinal anesthesia with lidocaine and with bupivacaine in men.
This study was to evaluate and compare the effects of spinal anesthesia with lidocaine and with bupivacaine on urinary bladder funtion in healthy men.
This justifies the need to accurately monitor the filling condition of the urinary bladder, to apply voluntary abdominal strain in case a full bladder is suspected, and ultimately single bladder catherization if voiding is not achieved.

Kemp D. et.al. (2000)
Postoperative Urinary Retention: part I - Overview and implications for the postanestesia care unit nurse.
Postoperative urinary retention and resulting bladder distention are common complications following surgical procedures. Unrelieved bladder distention can lead to discomfort and problems with micturation or chronic urinary retention.

Operation Theatre Anaesthesia (O.T.A.) Literature References