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Urodynamic Testing (Children) - Pediatrics Specialties Clinic (12.39)

Urodynamic Testing (Children) - Pediatrics Specialties Clinic (12.39) - Policies, Clinical, UWHC Clinical, Department Specific, Ambulatory, Clinic Specific

12.39

12.39 Urodynamic Testing (Children) - Pediatrics Specialties Clinic
Category:

UWHC Departmental Policy
Policy Number:

12.39

Effective Date:

March 25, 2015

Version:

Revision

Manual:

Ambulatory

Section:

Clinic Specific (Ambulatory)


I. POLICY

To establish a process for Pediatrics Specialties Clinic Registered Nurses (RNs) who are specifically
trained to perform urodynamic testing on pediatric patients as ordered by a Pediatrics Urologist.

II. PROCEDURE
A. Equipment/Supplies
1. Foley catheter tray
2. Urodynamic catheter (bladder)
3. Urodynamic catheter (rectal)
4. 10 mL saline syringe
5. Extension tubing (x2)
6. Pump tubing
7. Transducers and appropriate connections
8. Electromyograph (EMG) pads
9. 10 mL syringe
10. 60 mL syringe
11. Water soluble lubricant
12. Graduated cylinder
13. 4x4s
14. Alcohol wipe
15. 1 liter bag of sterile water
16. Baby wipes
17. Disposable underpad (x3)
18. Transpore tape
B. Preparation
1. Prepare Mobile Computer
a. Turn on power to the mobile computer, monitor, and printer.
b. Log in to urodynamic testing software.
c. Enter patient information from rooming documents confirming correct patient
identifiers with patient and/or family.

d. Choose protocol test mode (i.e. Pediatric Protocol).
2. Prepare Room
a. Place disposable underpad on clean cart and assemble testing supplies:
urodynamic bladder catheter, foley tray, lubricant and prepared urodynamic rectal
catheter.
b. Hang primed 1 Liter bag of sterile water on load cell pump unit, flush tubing and
place in roller pump in direction of arrows.
c. Connect Electromyograph (EMG) pads to electrodes. Connect primed extension
tubing to rectal transducer.
d. If pressure flow has been ordered, prepare flow meter and commode or as
appropriate for a patient who voids spontaneously.
3. Prepare Patient
a. Explain procedure to patient and/or parents. Screen patient utilizing Pediatric
Urology CMG Screening sheet. If patient has had recent urinary tract infection
symptoms, review with provider if okay to continue test.
b. Calculate bladder capacity referencing previous tests, reported bladder capacities
or volumes reported by patient during clean intermittent catheterizing and:
i. Age + 2 = _____ x 30 = _____ mL bladder capacity or
ii. Weight (kg) x 7 = _____ mL bladder capacity.
c. Have patient undress from the waist down.
4. Testing
a. Position patient supine on the Urodynamic table.
b. Place testing catheter in bladder using sterile technique and secure with transpore
tape. If unable to pass catheter after three attempts, page Pediatric Urologist or
resident on call.
c. Collect urine from catheter per Urinalysis order entry protocol and send for
urinalysis (UA).
d. Place testing rectal catheter in rectum using clean technique and water soluble
lubricant.
e. Remove excess lubricant from perineal opening with clean gauze, wipe liberally
with alcohol pad and dry with clean gauze.
f. Place EMG pads to patient’s perineal opening and outer thigh, secure with
transpore tape.
g. Remove all urine from the bladder using either a 60mL or 10 mL syringe
depending on volume instilled and record volume.
h. Connect catheters to transducers.
i. Connect pump tubing.
j. Select the appropriate test based on physician order. If no order and appropriate
test is not obvious to the RN, contact provider for order.
k. Calculate pump speed (bladder capacity in mL ÷ 10). RN will determine final rate
referencing estimated bladder capacity volumes.
l. Once all transducers and tubing is connected and sensing appropriately, ask
patient to cough or gently press on the patient's abdomen above bladder to check
that pressures are being sensed appropriately.
m. Start the test.
i. Fill to estimated bladder capacity as previously calculated.

 If patient is able to verbalize bladder sensations, instruct patient to
identify when they feel: first sensation to void, first desire to void,
normal desire to void, and strong desire to void, marking each
response on the test.
 If patient is unable to express sensations or does not have
sensation, monitor non-verbal cues, patient status and fill until
patient becomes uncomfortable and would evacuate bladder at
baseline.
 If patient performs clean intermittent catheterization, fill bladder
until multiple leak point pressures (LPP) obtained, patient
expresses strong desire to catheterize or maximum bladder
volume obtained.
ii. Mark each leak point pressure (LPP), if present.
iii. Document artifact of movement, crying, etc.
n. Stop testing and empty bladder with either 60 mL or 10 mL syringe to determine
residual urine volume or determine remaining urine by performing a bladder scan.
o. Repeat the test.
5. Post Test
a. Provide patient with post care instructions unless patient is being seen by provider
for follow up visit after testing.
b. Print test.
i. Provide one copy of test to be scanned into patient’s EMR.
ii. Provide second copy of test to provider to interpret.
c. Document procedure with .phrase: .pedsurourodynamics, print and give to
provider accompanied with test.
III. REVIEWED AND APPROVED BY

Clinical Nurse Specialist, Children’s Hospital Administration, Pediatrics Clinic
Ambulatory Policy and Procedure Committee
Clinics Administration

SIGNED BY

Karen Leimkuehler, RN, MS, Clinic Operations Director