Stroke & Rehabilitation

The Rehabilitation unit may present the unit staff with a multitude of varied patient conditions. In many instances patients are recovering from either multiple medical conditions causing multiple system problems, chronic disease, the aftermath of surgical intervention and recovery of such conditions, or simply advanced age and frail health status.

The Rehabilitation unit may also see patients with recent or chronic neurological problems, acute cerebral vascular accidents, and spinal cord injury. Thus coupled with all other ongoing bladder conditions, the presentation of the neurogenic bladder is more frequent. This presents a need for the institution of various bladder protocols. The BladderScan^® is extremely useful in the initiation and continued delivery of these protocols to the rehabilitating patient. One such example is the need to instruct patients in timed voiding schedules and use of pharmacological agents to prevent incontinence in situations of overactive bladder function as a result of neurological disease (like Multiple Sclerosis). Urinary volumes must be monitored regularly to titrate medication against symptoms of urinary frequency, urgency and incontinence. Urinary retention and large residual volume are avoided by bladder volume measurements with the BladderScan. Patients with neurogenic bladders that cease to function may benefit from BladderScan^® determination of bladder volume during the institution of Self-Intermittent Catheterization protocols.

The advantage of BladderScan^® is that all care delivery staff, not just a few 'catheterization specialists', can utilize it. It thus provides for more efficient administration and documentation of care.

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

Indications / Applications

Indications for the use of the BladderScan^® for Stroke / Rehabilitation

• Patient with a risk of urinary retention
• Patient with a risk of urinary residue
• Patient who hasn't been able to urinate spontaneously for some time
• At a patient after removing an indwelling catheter
• Patient with incontinency problems
• Patient who is confused and restless
• Patient with a possible obstruction of the urinary tract
• Patient on a bladder retraining program

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 also the 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. et.al. (1999, ECNA Utrecht)
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 ultrasound measurement causing little or no discomfort. Use of the bladder volume 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.

Shah P.J.R. (2000 Verathon Medical publication)
Bladder Dysfunction in the Elderly
Shah discusses papers that demonstrate the percentage of continence problems in the elderly and how post void residual urine measurement is a useful clinical indicator in many of these cases. He concludes that the use of ultrasonography is a useful adjunct in the diagnosis of bladder dysfunction and states " A ward based portable ultrasound scanner offers all hospitals the opportunity to improve the quality of life of their elderly patients. The measurement of post void residual urine in elderly patients is inexpensive, non-invasive and beneficial in the diagnosis of urinary incontinence and voiding difficulty"

Chan H. (1999, AANW 0047-2603/93/2505/0319)
Non-invasive bladder volume measurement
This study shows that out of 104 stroke patients, 6 errors had been made in unnecessary catheterisations (8.57% error rate) and that BladderScan is safe, quick and also accurate

Resnick B. (1995 Rehabilitation Nursing Vol 20:4)
A BladderScan trial in Geriatric Rehabilitation
The sample size of this study was 16 patients from either geriatric rehabilitation or acute rehabilitation units. It shows that 8 patients were catheterised and 8 patients received BladderScan assessments. (5 of which were unable to void naturally). BladderScan facilitated bladder retraining by allowing the nurses to evaluate bladder function without invasive and repeated catherisations. In addition, 8 out of 16 patients had UTI's at the time of admission. However at the time of discharge, only 2 patients were still being treated for UTI.

Salcido R. et.al. (1991 Arch of Phys Medicine and Rehab Vol. 72)
Diagnostic Effectiveness of Bladder Ultrasound in a Large Population of stroke Patients.
PVR volumes correlate positively with incidence of UTI )p=.0084. The incidence of UTI in US tested patients was 21%, a significant reduction ove the rate of 38% when IC was used. High accuracy, noninvasiveness, and lowered UTI incidence illustrate that US is a viable technique for PVR determination.

Udaka F. (1999 intern report)
Department of Neurological Medicine and Urology, Sumitomo Hospital
Drug Treatment and Management of Urinary Incontinence in Elderly Patients with CNS. Disorders: Clinical Application of a Portable Ultrasound Bladder Capacity Scanning Device (PCI) with Memory Function. The study was using PCI to monitor a 24-hour urodynamic profile and to assess its applicability for therapeutic purposes. The use of the device with memory function permitted frequent measurement and noctural recording, thus enabling us to grasp the urodynamics in a more physiological fashion. Its vesical capacity alarming function made it feasible to induce voiding with appropriate timing, which proved useful also for voiding training.

Coleman Gross J. (1993)
Bladder dysfunction after stroke
This paper starts by highlighting the many bladder/voiding dysfunction after a patient has suffered a stroke and indicates that the management of bladder dysfunction after stroke is an important issue to be addressed. The study evaluates the accuracy of ultrasound readings versus actual intermittent catheterisation on 125 stroke patients and demonstrates that the measurements were consistent. It concludes that ultrasound technology offers a means to evaluate ability to empty on an ongoing basis without the cost in time, supplies and discomfort that is associated with catheterisation. It also highlights the fact that increased use of catheterisation in stroke patients raises concern about an increase in catheterized patients had a significantly higher incidence of infection (38%) than those patients who had ultrasound testing (21%) and that, where possible, portable ultrasound appears to be a valuable resource to prevent over-destination and infection.

Granier P. et.al. (2002 Ann Readaption Med Phys 45:166-172 )
Portable ultrasonographic device and bladder dysfunction management in stroke patients
A study of 33 patients showed that 10 were admitted with urinary retention. Determination of bladder volume was performed with a BladderScanT BVI 3000 portable ultrasonographic device. Retention was resolved for 7 of these patients by the time they were discharged. The portable ultrasonographic device is a simple and non-invasive tool, useful for diagnosis, follow up and therapy guidance of urinary retention after stroke is to avoid long term catheterisation and its linked infection risk.

Huddleton C. et.al. (1990 Arch. of Physical Medicine and Rehabilitation, vol.71, no. 10)
Ultrasonic Versus Catheterization Measurement of Bladder Residual Volume in the Rehabilitation Setting.
It was concluded that PVRs can be measured noninvasively with a significant reduction in time, cost and infections, while avoiding the psychologic trauma associated with catheterization.

Lewis NA (2001 program Hammarville Rehab.Center Pittsburgh)
Implementing a Bladder Ultrasound Program.
The BladderScan automatically calculates and displays bladder volume. It is simple to use, and the results are easy to read. Bladder ultrasound scanning allows nursing staff to perform noninvasive assessment for postvoid residual urine volume, assess patients who are unable to void, implement a bladder management program, or request urological evaluation as needed. The bladder ultrasound has proven to be a valuable tool in the bladder management program of this facility.

Massagli T. et.al. (1989 Publ. J.Uro 142 969)
Experience with portable ultrasound equipment and measurement of urine volumes: inter-user reliability and factors of patient position.
A portable ultrasound has been by a a trained and an inexperienced examiner. Correlation was highly significant. Accuracy and precision of the ultrasound measurements were not affected by patient position. Thus, little training is necessary to use this instrument, interuser reliability is good, and accuracy and precision are clinically acceptable whether patients are in the seated or supine positions.

O'Malley LA ea (1990 Arch. of Physical Medicine and Rehabilitation vol. 71, no 10)
Noninvasive Bladder Volume Measurement.
Comparison of infection rates (UTIs/number of discharged patients) for the two year before BVI implementation (1988, 19%; 1989, 15%) with the rate for the six months following BVI implementation (12%) suggests a benefit.

Stroke Literature References

Rehabilitation Literature References