Bladder ultrasound increases catheterization success in pediatric patients

To determine whether volumetric bladder ultrasound (VBUS) determinations improve the rate of successful pediatric catheterizations and caregiver satisfaction.

This randomized controlled trial was conducted at an urban academic emergency department. Patients younger than 36 months requiring diagnostic urine samples were randomized into one of two groups: VBUS or conventional catheterization (CC). Patients were excluded if they were critically ill or had genitourinary abnormalities. VBUS catheterizations were postponed for 30 minutes if the transverse bladder diameter was <2 cm. Data included demographics, number of catheterizations required for success (>/=2.5 mL urine) (SucC), and the number of postponed catheterizations. Caregiver satisfaction scores using a ten-point Likert scale (1 = poor, 10 = excellent) were obtained for time to SucC, physical handling of child (PhysH), and overall satisfaction. Descriptive statistics, chi-square tests, t-tests, and correlation coefficients were used where appropriate.

Of 64 patients, 33 underwent VBUS-guided catheterization. The groups did not differ regarding gender (39% male) and age (mean age: CC, 9.4 months, SD = 7.8; VBUS, 7.7 months, SD = 5.5; p = 0.33). SucC occurred in 94% (VBUS) versus 68% (CC) of patients (p = 0.007). The two groups did not differ on any of the caregiver satisfaction indices (time to SucC: VBUS = 8.9 vs. CC = 8.1; PhysH: VBUS = 9.3 vs. CC = 8.6; overall satisfaction: VBUS = 9.3 vs. CC = 8.5; all p > 0.15).

Although there was no significant difference in caregiver satisfaction between the VBUS and CC groups, implementation of VBUS greatly improved the success rates of pediatric emergency department catheterizations. This improvement is achieved with a rapid and easily mastered VBUS technique.