WIP 109 - Pediatric Bladder Ultrasound Prior to Bladder Catheterization in the Pediatric Emergency Department

Poster Number: WIP 109
Publication Number: WIP 109.732

Background: Bladder catheterization (BC) is a standard procedure in young children when assessing for potential urinary tract infection. Unsuccessful BC due to inadequate bladder volume leads to repeat BCs, which is painful for the child and stressful for the caregivers and staff. Previous studies with physician-performed bladder point-of-care ultrasound (POCUS) have shown increased BC success rates and caregiver satisfaction. Since nurses primarily perform BCs, our study will add to the existing literature by determining if nurse performed POCUS changes BC success rates and caregiver satisfaction.

Objective: To assess BC success rates in children ≤24 months requiring BC, comparing POCUS to standard blind catheterization in the pediatric emergency department (ED). Patient satisfaction surveys will assess whether POCUS improves caregiver satisfaction scores using a 4-point Likert scale. Length of time from ordering to initial BC between groups will also be measured.

Design/Methods: This is an IRB-approved randomized observational study comparing BC success rates in children receiving bladder POCUS to standard BC. Patients aged 0-24 months presenting to the ED requiring a clinical BC are eligible. Exclusion criterion includes urogenital abnormality, indwelling urinary catheter, trauma, and family objection. Patients evaluated on even days are assigned to receive a bladder POCUS performed prior to BC; odd days use blind BC. If < 2 cm of urine is seen in the bladder on POCUS or the patient urinates during the POCUS, the BC is postponed, and POCUS is repeated in 30-minute intervals until urine volume is >2cm. The nurses are trained in POCUS by study staff. Analysis plan includes the chi-square test with 95% CI with odds ratios to assess the difference in successful BC rate between groups. The difference in length of time to BC between groups will be evaluated with the two-tailed T-test if normally distributed or the Mann Whitney U test if not with extreme outliers excluded (>99%). Enrolling initiated in March 2023 and will be complete in February 2024.