CLINICAL PROCEDURE FOR BLADDER SCANNING
Issue History
New
Issue Version
1
Purpose of Issue/Description of Change
To inform staff of the fundamental principles for measuring urinary bladder volume
Planned Review Date
August 2015
Named Responsible Officer:-
Approved by
Date
Wirral Integrated Continence Service Lead
Quality, Patient Experience and Risk Group
August 2012
Target Audience Section: - CP58
Clinical staff directly employed by the Trust, who are required to carry out this procedure
UNLESS THIS VERSION HAS BEEN TAKEN DIRECTLY FROM TRUST WEB SITE THERE IS NO ASSURANCE THIS IS THE CORRECT VERSION
CONTROL RECORD Title Purpose Author Equality Assessment Subject Experts Document Librarian Groups consulted with :Infection Control Approved Date formally approved by Risk and Governance Group Method of distribution Archived Access
Clinical Procedure for Bladder Scanning To inform staff of the fundamental principles for measuring urinary bladder volume Quality and Governance Service (QGS) Yes No Integrated into procedure Wirral Integrated Continence Service QGS Medicines Management Group or Clinical Policies and Procedures Group Yes July 2012 Email √ Date 18/07/2012 Via QGS
VERSION CONTROL RECORD Version Number Author Status Version 1 Wirral N Integrated Continence Service
Intranet √ Location:- S Drive QGS
Changes / Comments New clinical procedure
Status – New / Revised / Trust Change
CLINICAL PROCEDURE FOR BLADDER SCANNING 2 of 7
C L INIC AL P R OC E DUR E F OR B L ADDE R S C ANNING INT R ODUC T ION Ultrasound Bladder Scanning is a non – invasive procedure that measures urinary bladder volume. It should be performed as part of a routine continence assessment or if urinary retention is suspected. (Getliffe & Dolman, 2007; NICE, 2006, Good practice in continence guidelines, 2000,) T AR G E T G R OUP This procedure applies to all clinical staff directly employed by the Trust, who are required to carry out this procedure. T R AINING All clinical staff who are required to carry out bladder scanning will receive bladder scan training from Wirral Integrated Continence Service. They will receive formal theoretical and practical training based on a competency framework. R E L AT E D P OL IC IE S Please refer to relevant Trust policies and procedures INDIC AT IONS • • • • •
To assess for urinary retention Suspected voiding dysfunction To monitor residual urine for patients with Neurological conditions To assess the ability to void following a trial without catheter Recurrent Urinary tract infections
C ONT R AINDIC AT IONS • • •
If patient has wound where the scanner probe would normally be placed If the patient was pregnant If the patient does not give consent
C ONS E NT Valid consent must be given voluntarily by an appropriately informed person prior to any procedure or intervention. No one can give consent on behalf of another adult who is deemed to lack capacity regardless of whether the impairment is temporary or permanent. However CLINICAL PROCEDURE FOR BLADDER SCANNING 3 of 7
such patients can be treated if it is deemed to be within their best interest. This must be recorded within the patient’s health records with a clear rationale stated at all times. Refer to Trust Consent Policy for further information and guidance. E QUIP ME NT • • • • • • •
Bladder Scanner with head connection Ultrasound transmission gel Trust approved cleaning wipe Paper towels (single use only) Single use disposable apron if required Single use disposable non-sterile gloves if required A charged battery
P R OC E DUR E AC T ION
R AT IONAL E
Verbally confirm the identity of the patient by asking for their full name and date of birth. If client unable to confirm, check identity with family/carer Introduce yourself as a staff member and any colleagues involved at the contact Wear identity badge which includes name status and designation Ensure verbal consent for the presence of any other third party is obtained and documented. Explain procedure to patient including risks and benefits and gain valid consent.
To avoid mistaken identity
Follow the Trust’s Consent Policy if unable to gain consent, complete consent form 4 to demonstrate treatment is in patients best interests Clarify if the patient requires a formal chaperone
Needs to be in discussion with other members of the team, carers, G.P
Ensure that the patient is in the supine or semi- prone position and is comfortable
To promote mutual respect and put client at their ease For patients to know who they are seeing and to promote mutual respect Students for example, as the client has the choice to refuse To ensure client understands procedure and relevant risks
It is the patient’s choice to have a chaperone if wanted. Discuss with line manger if nurse considers a chaperone is needed as part of risk assessment. If chaperone is refused document this discussion. For patient comfort and good access to the abdomen
CLINICAL PROCEDURE FOR BLADDER SCANNING 4 of 7
Prepare equipment and clean scan head with Trust approved cleaning wipe
To ensure equipment is available and ready for use
Decontaminate hands prior to procedure
To reduce the risk of transfer of microorganisms on the healthcare workers hands
If indicated apply single use disposable apron
To protect clothing or uniform from contamination and potential transfer of micro-organisms To protect hands from contamination with organic matter and transfer of micro organisms To maintain privacy and dignity
If indicated apply single use disposable non sterile gloves Expose area above the pubic bone, ensure exposure is kept to a minimum Clean the skin if visibly dirty or soiled with soap and water
To ensure a clean surface area for the procedure to take place
If appropriate set scanner to male/ female
To allow scanner to adjust calibration to reflect accurate reading
Apply a small amount of gel on the scanner head or on the area above the pubic bone
To aid ultrasound transmission
Press the scan head into this area at a downwards angle towards the bladder, ensuring the scan head is in the correct position (according to manufacturer’s instructions). For live scanners both transverse and saggital readings are required for accuracy Press the button on the scan head/ scanner and wait for the reading to display
To ensure an accurate reading
Repeat the procedure 3-4 times with minor adjustment of the scan head
To ensure the highest volume is detected
To obtain accurate reading
Use paper towel to remove excess gel Inform patient that procedure is finished and allow them to fix clothing
To ensure privacy and dignity
Clean scan head with approved Trust cleaning wipe in line with manufacturers instructions after each use If worn on completion of procedure remove and dispose of PPE to comply with waste management policy
Decontamination of medical equipment is essential for the effective delivery of patient care To prevent cross infection and environmental contamination
CLINICAL PROCEDURE FOR BLADDER SCANNING 5 of 7
Decontaminate hands following procedure/removal of PPE
Detach bladder scan print out and label it with patients’ name, date of birth and ensure date and time of scan is recorded on print out. Attach to patients notes. Clean equipment in line with Trust policy and manufacturers instructions Decontaminate hands
Discuss findings with the patient Record information in patients health records, this should include:• Valid consent • If a chaperone was required • Reason for procedure • Date and time • Review date if required • Report any comments/ concerns made by the patient
To remove any accumulation of transient and resident skin flora that may have built up under gloves and possible contamination following removal of PPE To ensure that the results are permanently recorded in the correct patient’ notes
Decontamination of medical equipment is essential for the effective delivery of patient care To remove residual cleaning product from hands and prevent potential transfer of micro-organisms To agree plan of care To record patient care given, provide seamless care and comply with health records policy
Additional notes for: Primary Care Assessment Unit only: To avoid mistaken identity Check identity of patient both verbally and by checking name band Use examination room to carry out the procedure When recording findings, ensure results are inputted into patient notes and discharge letter. Refer to Wirral Integrated Continence Service or community nurses as appropriate. Any urgent concerns to contact on-call Urologist
To maintain privacy and dignity
To ensure appropriate plan of care is implemented To ensure any emergencies are acted upon as soon as possible.
CLINICAL PROCEDURE FOR BLADDER SCANNING 6 of 7
E QUIP ME NT Bladder Scanners are calibrated yearly. A designated member of the administration team is responsible to monitor that the scanners are calibrated in sequence and dispatched timely to ensure continuity of service and availability of equipment. This is recorded on the computer system within the service. WHE R E T O G E T ADV IC E F R OM Trust staff undertaking this role should obtain advice from the Wirral Integrated Continence Service. INC IDE NT R E P OR T ING Clinical incidents or near misses must be reported and a Trust Incident Form must be completed using the Trust’s incident reporting system. S AF E G UA R DING In any situation where staff may consider the patient to be a vulnerable adult, they need to follow the Trust Safeguarding Adult Policy and discuss with their line manager and document outcomes. R E F E R R AL S Any referrals to health professionals, therapists or other specialist services must be followed up and all professional advice or guidance documented in the patients health records. E QUAL IT Y AS S E S S ME NT During the development of this procedure the Trust has considered the clinical needs of each protected characteristic (age, disability, gender, gender reassignment, pregnancy and maternity, race, religion or belief, sexual orientation). There is no evidence of exclusion of these named groups. If staff become aware of any clinical exclusions that impact on the delivery of care a Trust Incident form would need to be completed using the Trust’s incident reporting system and an appropriate action plan put in place. R E F E R E NC E S Dougherty, L., Lister, S. (2008) The Royal Marsden Manual of Clinical Nursing Procedures. 7th Ed. London: Wiley Blackwell. National Institute of Clinical Excellence, (2006). Urinary incontinence.: The management of urinary incontinence in women. London: DH. Department of Health, (2000). Good practice in Continence Services. London: DH Getliffe, K., Dolman, M. (2007). Promoting Continence. 3rd ed. Oxford: Balliere Tindall. CLINICAL PROCEDURE FOR BLADDER SCANNING 7 of 7
