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Urodynamic Complex Cystometrogram (CMG) Leakpoint and Pressures (102.143)

Urodynamic Complex Cystometrogram (CMG) Leakpoint and Pressures (102.143) - Policies, Clinical, UWMF Clinical, UWMF-wide, Clinical Policies and Procedures, Urologic

102.143

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UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
CLINICAL POLICY AND PROCEDURE

TITLE: URODYNAMIC
COMPLEX CYSTOMETROGRAM (CMG), LEAKPOINT AND PRESSURES

Effective Date: January. 2005 Approval: See Authorization
Supersedes Protocol: None Contact: Clinical Staff Education

Reviewed November 2007 April 2010 March 2012


PURPOSE: To provide guidelines for preparation and follow-up for patient undergoing a Complex
Cystometrogram at UWMF Clinics.

DEFINITION: A Urodynamic Complex Cystometrogram is a urologic procedure to measure bladder
function, compliance, stability, ability to work, and capacity. This procedure is used to screen for and diagnose
urinary incontinence or hypotonic bladder.

POLICY: The clinical staff will utilize the following guidelines to prepare a patient for a Complex
Cystometrogram.

SUPPLIES: Provider’s order, Patient’s record
Stand with Bard 4 channel urodynamic monitor, Mayo stand
Bard red rubber introducer or Bard pediatric introducer
Bard pump tubing, 2 fiber optic sensors (10 uses each)
Bard infusion adapter set, 16 Fr Foley catheter
10cc syringe with 5cc sterile water, 1,000 cc sterile water bag
Sterile specimen container, Betadine swabs, Lubricating jelly, Tape
Sterile gloves, 3 pair for nurse, 1 pair for provider, 1 green sterile towel
Consent for Urodynamic Complex Cystometrogram (CMG)

PROCEDURES

Machine Set-up

1. Verify provider order.

2. Wash hands and gather equipment.

3. Turn machine on.
NOTE: The machine will need 15 minutes to warm up.

4. Create a sterile field on Mayo stand.
Using sterile technique, place introducer, pump tubing, sterile water bag, sterile specimen
container, sensor, infusion adapter, water filled syringe and catheter on sterile field.

5. Install fiber optic sensor (marked P1) into P1 key, vacuum and fiber outlet on machine.

6. Do the same step with the fiber optic sensor (marked P2).

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7. Put on sterile gloves.

8. Insert infusion adapter into end of 16 fr Foley catheter and insert P2 sensor into catheter until metal
tip is at catheter eye.

9. Spike water bag with tubing and install tubing into back of machine.

10. When machine is ready, press “jog pump” until water has primed through tubing.

11. Press “Complex CMG/ LPP”.

12. Press “proceed”.

13. Place small amount of sterile lubricating jelly on sterile field.

14. Remove sterile gloves and wash hands.

Preparing the Patient

1. Room patient using standard Urology Clinic procedure.

2. Identify the patient, including date of birth; explain procedure and purpose and answer questions.

3. Verify patient allergies, specifically to betadine

4. Following the provider’s discussion with patient, have patient sign Consent for Procedure and sign
consent form as a witness.

5. Ask patient to void prior to test.

6. Assist patient onto table in dorsal lithotomy and position with legs in stirrups.

7. Using sterile gloves or corner of the towel - Pull out tray and place sterile towel over drain site.

Assisting with CMG

 If physician is performing procedure:

1. Wash hands.

2. Open betadine swabs (provider will take swabs using sterile technique).
NOTE: provider will prep patient. If patient allergic to iodine, use 4% chlorhexidine gluconate
solution for cleansing.

3. Put on sterile gloves.

4. Assist provider by handing introducer lubricated with jelly.

5. Catch urine with sterile container.


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6. As directed or when needed hand physician:
Tubing
P1 fiber optic sensor
Strip of tape to adhere tubing to leg
Lubricated 16 Fr catheter with P2 sensor
Water filled syringe

 If nurse is performing CMG:

1. Wash hands.

2. Using sterile technique drop swabs onto tray.

3. Put on sterile gloves.

4. Clean labial folds and meatus with swabs.
Clean labial folds and meatus from top to bottom.

5. Insert lubricated introducer into meatus.

6. Drain urine into sterile container and note residual.

7. Attach luer lock connector on tubing to infusion port on introducer.

8. Insert P1 sensor into introducer to the black mark on the sensor.

9. Tape tubing to patient’s thigh.

10. Insert lubricated 16 Fr catheter and P2 sensor into patient’s rectum - NOTE: just past anal sphincter.

11. Inflate rectal catheter balloon with 5cc sterile water.

12. Press “re-zero” to calibrate machine.

13. Press “print”, then press “pump”.

14. After 50cc instilled ask patient to cough to check for consistency.

15. Ask patient to tell you when they feel:
1st sensation (when patient feels fluid in bladder)
1st desire to void (feeling the need to void but can wait)
2nd desire to or urgency to void (when pt. would normally void)
capacity (when bladder feels full)

16. Mark each event on the remote event marker by pushing red button. NOTE: Clear peaks by flipping
black toggle

17. When completed, turn off “pump and printer” and press “report”.


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After procedure (either physician or nurse)

1. Provider will remove introducer and rectal catheter.

2. Assist patient to sitting position, offer bathroom and dressing (if needed) NOTE: may need to measure
output with hat.

3. Place printout with patient label onto patient’s record.

4. Discard tubing, introducer, catheter, adaptor and water bag.

5. Clean fiber optic sensors in Metrizyme. NOTE: Do not allow key end of sensors to come in contact
with water.

6. Soak above items in Metricide for 20 minutes.

7. Rinse in sterile water tray and wrap in sterile towels.
NOTE: May throw sensor away if over 10 uses.

Procedure With Leak Point Pressures (Directly after CMG performed)

1. Wash hands and gather equipment.

2. Put on sterile gloves.

3. Complete CMG portion of exam using above technique.

4. While leaving fiber optic sensor in place - remove introducer.

5. Press “re-zero”.

6. Tape sensor to patient’s thigh.

7. Press printer.

8. Ask patient to cough and perform valsalva to check for leaks.
If leak observed press red button on event marker
Repeat as needed.
NOTE: Patient may need to be placed in standing position.
Turn off printer, and then press “Print Report”.

After procedure (either physician or nurse; same for CMG with or without Leak Point Pressure)

1. Provider/nurse will remove introducer and rectal catheter.

2. Assist patient to sitting position, offer bathroom and dressing (if needed) NOTE: may need to measure
output with hat.

3. Send labeled printout for scanning into patient’s record.

4. Discard tubing, introducer, catheter, adaptor and water bag.

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5. Clean fiber optic sensors in Metrizyme. NOTE: Do not allow key end of sensors to come in contact
with water.

6. Soak above items in Metricide for 20 minutes.

7. Rinse in sterile water tray and wrap in sterile towels.
NOTE: May throw sensor away if over 10 uses.

8. Discharge instructions:
Provider will discuss results and treatment options after the test is completed.
No restrictions.
Patient may experience urinary frequency, urgency, and dysuria from catheter for 1-2 days.
Call if symptoms worsen, or with fever >101.

9. Assist with follow-up appointment (if needed)

10. Documentation (in Progress Notes section of HealthLink) in the patient’s record:
Patient education
the procedure performed, date & time completed
name and amount of any medications given (using SmartPhrase: .medinclinic)
how patient tolerated procedure
discharge instructions
follow-up appointment (if any)


WRITTEN BY: Deb Brausen, R.N., Manager, Department of Urology
Tracy Ancheta R.N., Department of Urology
Theresa Hollnagel R.N., Department of Urology
Gail Jahnke, R.N., N.P., Department of Urology

REVIEWED BY: Donnette Kelly, R.N., Department of Urology, 2012
Carol Decker, RN, MSN, Clinical Staff Educator, 2012

AUTHORIZATION:


Department of Surgery, Urology Date


Medical Director Date