For Performance By: Rn, Lpn

FOR PERFORMANCE BY: RN, LPN

POLICY STATEMENT The Ultrasound Bladder Scanner (BladderScan) will be used by RNs and LPNs with documented competency to measure a reasonable estimate of urinary bladder volume.

SUPPORTIVE DATA The BVI 3000 computes the volume of the urinary bladder based upon twelve, cross-sectional ultrasound images. For maximum accuracy, the scanhead must be held motionless while scanning.

Indications for BladderScan include: Patients with urinary retention Monitoring urinary output Verification of an empty bladder Measurement of post-void residual (PVR) bladder volume Verification that a Foley catheter is draining properly Determination of need to catheterize following the discontinuation of a Foley catheter or during an intermittent catheterization schedule Checking for bladder overdistention Monitoring patients' hydration status

Urinary catheters, scar tissue, sutures, incisions, surgical staples, bandages and fluid-filled cysts may interfere with the accuracy of the BladderScan measurement. Patients should be assessed on an individual basis and scanned beside, above or below the suture/bandage to obtain an accurate measurement. Do not use the BladderScan on patients with open skin or wounds in the suprapubic region.

BladderScan is contraindicated for fetal use and pregnant patients.

The device will reside on J2. Sign out the instrument when it is removed from J2, and return to J2.

EQUIPMENT BladderScan device Paper roll (Special order via manager) Ultrasound Gel Spare battery (Recharge in ?? J2) Alcohol wipe Spare Ultrasound Gel tube (Distribution)

PROCEDURE I. Bladder Volume Measurement

1. Place patient in supine position. Don gloves. The most accurate measurements are obtained when the patient rests quietly in the supine position. Standard Precautions.

2. Turn the BladderScan instrument ON by pressing the ON/OFF button.

3. Press the SCAN button from the main menu screen.

4. Then press the Gender button to select the appropriate setting. The female setting excludes the uterus from the measurement and should only be used for women who have NOT had a hysterectomy. For all other patients, select the "male" option. The LCD screen shows a male or female figure to indicate the gender selected.

5. Palpate the patient's symphysis pubis (pubic bone). Apply a generous amount of ultrasonic gel to scanner head.

6. Locate the Patient Icon on the scanhead and make sure that when the scanhead is placed on the patient's abdomen 1 inch above symphysis pubis, the head of the icon will point toward the head of the patient. Place the rounded end of the scanhead on the abdomen and aim it toward the expected location of the bladder. For most patients, this means angling the scanhead slightly toward the patient's coccyx.

7. Press and release the Scan button on the scanhead. Hold the scanhead steady during the scan. When you hear a beep, the scan is complete.

8. Verify that the scanhead was aimed properly by using the target-shaped Aiming icon, located on the right side of the LCD screen. The light area represents the bladder and indicates the position of the bladder relative to the scanhead. The scan is accurate when the bladder image is centered on the crosshairs of the aiming icon. If the bladder image is not centered, re-aim the scanhead and rescan the patient. To help you aim properly, visualize ultrasound waves being projected out of the scanhead toward the patient's body. If the bladder is located on the left side of the icon, re-aim the scanhead so that it projects ultrasound waves further to the left.

9. When the scan is accurate, press the Done button to view the Scan Results screen. Verify that the light colored bladder image was completely contained in both the vertical and horizontal scan planes. If the bladder image overlaps the edge of one of the scan planes or appears to be cut off, press the Scan button to return to the Scanning screen. Then rescan your patient.

10. When you have achieved an accurate measurement, press the Print button twice to print the exam result.

11. Documentation: Document assessment findings in patient care notes.

II. Installing the Battery

1. To remove the discharged battery, push the battery release button located on the left side of the machine. Batteries may require recharging every 3 days, depending on use.

2. Install fully charged battery into battery pack. Battery icon indicates power status of the battery currently installed in the instrument.

3. Return the used battery into charger to properly recharge the battery. a. A solid green light indicates fast charging mode (2-3 hours). b. A quick blinking green light indicates the battery has reached 80% of its charge level and the charger "tops off" the charge. Battery recharger is located ?? (J2) Medication Room. c. The battery that is not in use is stored in the charger so that it remains fully charged. There is no danger of overcharging the battery. d. Fully charging the battery may take up to 6 hours. e. Plugging and unplugging the charger while batteries are inserted causes no damage.

III. Installing Paper 1. Open the paper well door at the top of the instrument. 2. Insert the end of a new paper roll, with the thermal side down into the paper input slot. The machine senses the presence of the paper and feeds automatically. To verify loading the paper with the thermal side down, flick your nail over the paper. If a black mark appears, this is the thermal side.

3. Close the paper well door.

IV. TROUBLESHOOTING

ALARM 1. Inaccurate measurements or changes in performance. a. Assess aim, scanhead, ultrasound gel. Increase gel Scanhead motionless Scanhead directed toward bladder (coccyx).

b. Assess patient variables. Patient supine, not moving, not talking, abdomen not rigid Assess for excessive amounts of body hair, abdomen spasming, obesity Reduce environment distractions, CPM off. Increase amount of ultrasound gel.

c. Verify accuracy with equation: Pre-scan = Void + Post-Scan or PVR or SC See Safety Features/Monthly Accuracy Check, below

d. If inaccuracy validated, discontinue use and notify your manager.

2. Instrument does not turn ON. Check battery icon in the upper-right corner of the LCD screen. If the battery icon is clear (empty), replace the battery.

3. BATTERY RECHARGE message. Battery charge is too low to allow normal operation. Replace battery with a charged one. The charger brings the battery to a full charge in 6 hours or less.

4. NO SCANHEAD message. Scanhead is not connected. Reconnect scanhead to control unit scanhead input socket. 5. NO PAPER. Printer is out of paper. Load new paper roll. Notify your manager if there is no paper in the tray pocket.

6. DISENGAGED PRINT HEAD. Reposition the print head lever up as far as it can go.

7. TOO HOT. Print head is overheating. Turn machine off. Check for paper jam.

8. PAPER JAM. Turn off instrument. Lower printhead release lever (located adjacent to the paper advance thumb wheel). Gently pull the paper backward, while moving the thumb wheel counterclockwise. To avoid paper jams, never fold the end of the paper, roll, or cut it diagonally or to a point.

9. CALIBRATION DUE The instrument is calibrated yearly and the calibration due date has passed. Press OK to continue. The machine will continue to accurately scan measurements of bladder volume. Notify your manager to arrange for calibration.

10. Contact Precautions/Isolation To create a barrier between the patient skin and the scanhead a. Place gel on scanhead b. Apply a clean glove onto scanhead c. Apply gel over glove d. Continue procedure and scan

11. Cleansing Instrument Cleanse instrument with hospital approved disinfectant.

REFERENCES

BladderScan BVI 3000 Operator's Manual. 1998-2000.

Phillips, J. (2000). Integrating Bladder Ultrasound. AJN. March 2000. pp. 3-14.

Lehman & Owen. (2001). Bladder Scanner Accuracy During Everyday Use on an Acute Rehabilitation Unit. Clinical Nursing 18(2), pp. 87-92.

Borrie, Campbell, Arcese, et al. (2001). Urinary Retention in Patients in a Geriatric Rehabilitation Unit: Prevalence, Risk Factors, and Validity of Bladder Scan Evaluation Rehabilitation Nursing, 26(5), pp. 187-191.

STORAGE, RETENTION AND DESTRUCTION A. Policy stored in P/P: Nursing, Patient Care B. Policy will be reviewed every three years C. Previous versions of policy are stored in Retired Med Surg