/policies/,/policies/clinical/,/policies/clinical/uwhc-clinical/,/policies/clinical/uwhc-clinical/department-specific/,/policies/clinical/uwhc-clinical/department-specific/ambulatory/,/policies/clinical/uwhc-clinical/department-specific/ambulatory/clinic-specific/,

/policies/clinical/uwhc-clinical/department-specific/ambulatory/clinic-specific/1263.policy

201508237

page

100

UWHC,

Policies,Clinical,UWHC Clinical,Department Specific,Ambulatory,Clinic Specific

Video and Non-Video Urodynamic Testing (Adult) - Urology Clinic (12.63)

Video and Non-Video Urodynamic Testing (Adult) - Urology Clinic (12.63) - Policies, Clinical, UWHC Clinical, Department Specific, Ambulatory, Clinic Specific

12.63

12.63 Video and Non-Video Urodynamic Testing (Adult) - Urology Clinic
Category:

UWHC Departmental Policy

Policy Number:

12.63

Effective Date:

April 18, 2012 (extended expiration date to December 31, 2015)

Version:

Revision

Manual:

Ambulatory

Section:

Clinic Specific (Ambulatory)

I. PURPOSE

To establish a process for Urology clinical staff who have received in-clinic training to perform video and non-video
urodynamics including set-up and testing.

II. POLICY

This applies to Registered Nurses (RNs) and Medical Assistants (MAs) who have been trained and demonstrated
competence in performing Urodynamic tests and have a valid physician/nurse practitioner/physician assistant order.

III. PRE-PROCEDURE
A. At the time of scheduling, the patient will be screened using the Urodynamic Screening Sheet.
B. The RN will activate Ambulatory Protocol 19 - Antibiotic Therapy Protocol for Urodynamics Testing – Urology Clinic,
prior to testing. If an MA is performing the testing, the MA will defer this step to the RN.
IV. PROCEDURE
A. Equipment/Supplies
1. Foley catheter tray
2. Urodynamic bladder catheter
3. Urodynamic abdominal catheter
4. MMS pump tubing
5. Transducers and appropriate connections
6. 60ml syringe
7. 4X4 gauzes
8. Alcohol wipe
9. Urine dipstick
10. 250ml bottle of iothalamate meglumine contrast (video only)
11. 1 liter bag of sterile water (non-video only)
B. Preparation
1. Prepare Urodynamic computer system
a. Power on computer, monitor, and printer.
b. Enter patient information (if patient is not in database).
c. Choose adult protocol in the Urodynamic computer software.
2. Prepare room
a. Hang a 1 liter bag of sterile water for non-video testing or a bottle of contrast for video testing on
the lead cell pump with pump tubing attached. Flush tubing and place in roller pump in direction of
arrows.

b. Prepare transducers.
c. Prepare catheters.
d. Connect EMG pads to electrodes.
e. Prepare flow meter and commode.
3. Prepare patient
a. Explain procedure to patient.
b. Document in patient’s electronic medical record (EMR) specific rooming process.
c. Answer any patient questions.
d. Instruct patient to undress from the waist down.
C. Testing
1. Perform an initial uroflow (Ambulatory Policy 12.55 - Uroflow Procedure in Clinics), if patient is able to void
spontaneously.
2. Position patient on the testing table.
3. Place abdominal urodynamic catheter rectally or vaginally using clean technique.
4. Place urodynamic bladder catheter in bladder using sterile technique.
5. Prior to urodynamic testing, obtain a urine sample per Ambulatory Policy 12.58 – Obtaining Urine
Specimens on Day of Visit Policy.
a. Test urine sample with dipstick for leukocytes and nitrates.
b. If urine is positive for leukocytes but negative for nitrates, perform microscopy. If no bacteria are
present, the urodynamic testing will be performed. If bacteria are present, urodynamic testing will
not be performed.
c. If urine is positive for both leukocytes and nitrates urodynamic testing will not be performed. The
urine will be sent for culture. Testing will be rescheduled.
6. Remove all urine from the bladder with a 60ml syringe and record volume.
7. Connect catheters to transducers.
8. Connect pump tubing to catheter.
9. Choose the appropriate test on the computer.
a. Cystometrogram
b. Pressure flow study
c. Video-Urodynamics
10. Ask patient to cough and/or gently press on the patient’s abdomen above the bladder to check that
pressures are being sensed appropriately.
11. Tape the catheters to the patient and move to the appropriate testing position (if test is non-video proceed
to #13).
12. (Videourodynamics Only) After taping catheters, move the fluoroscopy table to a standing position or tilt
table until patient is able to urinate into the flow meter with the use of a saddle. When the test is ready to
begin, page the provider.
13. Start the pump at 50ml/minute unless otherwise indicated.
a. Instruct the patient to identify when they feel the first sensation of filling, the first desire to void, a
normal desire to void, and a strong desire to void. Mark each response on the testing print out.
b. Document artifact, leakage, or pain.
14. Instruct patient to void when they have indicated a strong desire to urinate or they indicate they are unable
to hold any more fluid.
15. Determine the patient’s residual urine by emptying the bladder with a syringe or performing an ultrasound
bladder scan. Enter data.
16. Print test results.
17. Repeat the test beginning at #13.
18. Provide verbal and written discharge instruction (HFFY 5914 - Urodynamic Testing).
19. Document procedure results, patient tolerance and teaching in patient’s EMR.
V. REFERENCES


Ambulatory Policy 12.55 - Uroflow Procedure in Clinics
Ambulatory Protocol 19 - Antibiotic Therapy Protocol for Adult Urodynamic Testing - Urology Clinic
Ambulatory Policy 12.58 – Obtaining Urine Specimens on Day of Visit Policy
Practical Urodynamics by Victor W. Nitti, MD (June 15, 1998)

VI. REVIEWED AND APPROVED BY

Urology Clinic Manager
Urology Registered Nurse
Clinics Administration
Ambulatory Policy and Procedure Committee

SIGNED BY

Deborah D. Tinker, RN, MS, Director, Ambulatory Nursing