Published online January 3, 2005
PEDIATRICS Vol. 115 No. 1 January 2005, pp. 108-111 (doi:10.1542/10.1542/peds.2004-0738)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via ISI Web of Science (15)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Chen, L.
Right arrow Articles by Santucci, K. A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Chen, L.
Right arrow Articles by Santucci, K. A.
Related Collections
Right arrow Genitourinary Tract
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Facebook   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?

Utility of Bedside Bladder Ultrasound Before Urethral Catheterization in Young Children

Lei Chen, MD*, Allen L. Hsiao, MD*, Christopher L. Moore, MD{ddagger}, James D. Dziura, PhD§ and Karen A. Santucci, MD*

* Department of Pediatric Emergency Medicine
{ddagger} Department of Emergency Medicine
§ General Clinical Research Center, Yale University School of Medicine, New Haven, Connecticut

Background. Urethral catheterization is the method of choice for obtaining samples for urine culture and urine analysis in infants. Before the procedure, there is little certainty of the presence or amount of urine in the bladder. Consequently, this relatively invasive and uncomfortable procedure often needs to be repeated. The newly available technology of portable ultrasound may be useful in reducing the number of unsuccessful procedures.

Objective. To investigate the utility of bedside ultrasound of the bladder performed by pediatric emergency medicine physicians before catheterization in reducing the number of unsuccessful attempts.

Methods. A prospective, 2-phase study was performed in the setting of an urban pediatric emergency department from August 2003 to February 2004. Children who were between the ages of 0 and 24 months were enrolled. During the observation phase, the amount of urine obtained during the first catheterization was recorded for each patient. During the intervention period, a rapid bedside ultrasound of the bladder was performed by a pediatric emergency medicine physician immediately before urethral catheterization. When a sufficient amount of urine was seen, catheterization was conducted as usual. Otherwise, catheterization was deferred and repeated ultrasound was performed at 30-minute intervals until sufficient urine was identified. The amount of urine obtained was recorded.

Results. During the observation phase, 136 infants underwent urethral catheterization. Overall, the rate of success during the first attempt, defined as obtaining >2 mL of urine, sufficient for culture and other routine studies, was 72% (95% confidence interval: 66%–78%). A total of 112 subjects were enrolled during the intervention phase. Sufficient urine was identified on the first ultrasound in 76% (n = 85) of the patients. Among these, 98% (n = 83) underwent successful urethral catheterization during the first attempt. Among those in whom insufficient urine was identified initially (n = 27; 24%), subsequent ultrasound revealed sufficient amount in all patients within 90 minutes. Among these, 93% (n = 25) underwent successful urethral catheterization during the first attempt. Overall rate of success of initial urethral catheterization during the intervention phase was 96% (95% confidence interval: 93%–99%). Compared with the success rate during the observation phase, the differences were statistically significant. The results were consistent after being adjusted for gender.

Conclusion. A rapid bedside ultrasound of the bladder performed by pediatric emergency physicians led to an increased success rate of urethral catheterization in children who were younger than 2 years. We were able to avoid repeated invasive testing with a simple noninvasive procedure.

Key Words: infant • ultrasound • urinary tract infections

Abbreviations: UTI, urinary tract infection • CI, confidence interval

Accepted Jul 1, 2004.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Facebook Facebook   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


This article has been cited by other articles:


Home page
 PediatricsHome page
J. A. Levy and V. E. Noble
Bedside Ultrasound in Pediatric Emergency Medicine
Pediatrics, May 1, 2008; 121(5): e1404 - e1412.
[Abstract] [Full Text] [PDF]

Home page
 CLIN PEDIATRHome page
Wm. L. M. Robson, A. K. C. Leung, and M. A. Thomason
Catheterization of the Bladder in Infants and Children
Clinical Pediatrics, November 1, 2006; 45(9): 795 - 800.
[Abstract] [PDF]

Home page
 PediatricsHome page
J. Graf
Efficient Bladder Ultrasonography
Pediatrics, September 1, 2005; 116(3): 797 - 797.
[Full Text] [PDF]

Home page
 Arch. Dis. Child.Home page
Journal Watch
Arch. Dis. Child., June 1, 2005; 90(6): 651 - 652.
[Full Text] [PDF]

Home page
 JWatch PediatricsHome page
Bladder Ultrasound Before Urethral Catheterization
Journal Watch Pediatrics and Adolescent Medicine, February 28, 2005; 2005(228): 2 - 2.
[Full Text]

Home page
 JWatch Emergency Med.Home page
US Increases Success of Pediatric Urinary Catheterization
Journal Watch Emergency Medicine, February 16, 2005; 2005(216): 3 - 3.
[Full Text]