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Bladder Stimulation for Clean Catch Urine Collection: Improved Parent and Provider Satisfaction
Yagnaram Ravichandran1, Sarah Parker1, Ahmad Farooqi2
1From the Division of Pediatric Emergency Medicine, Department of Pediatrics.
Insights
Bladder stimulation technique (BST) for clean catch urine (CCU) collection in infants is well-tolerated and feasible for routine pediatric emergency department (PED) care. This method reduces infant discomfort and improves parent and provider satisfaction compared to catheterization.
Area of Science:
- Pediatric Emergency Medicine
- Urology
- Clinical Practice Implementation
Background:
- Clean catch urine (CCU) collection in infants is crucial for diagnosing urinary tract infections.
- Traditional methods like urethral catheterization can be invasive and cause distress.
- Previous studies suggest fluid intake combined with massage aids CCU collection.
Purpose of the Study:
- To investigate the acceptability and feasibility of integrating bladder stimulation technique (BST) into routine pediatric emergency department (PED) care for CCU collection.
- To compare BST with urethral catheterization regarding success rates, contamination, patient distress, and satisfaction.
Main Methods:
- Prospective cohort study involving infants under 6 months requiring urinalysis/urine culture.
- Standardized training for nurses and technicians on BST.
- Comparison of BST outcomes (success, contamination, distress, satisfaction) with urethral catheterization.
Main Results:
- BST was successful in 38% of cases, with higher success rates in infants <90 days old.
- No significant difference in urinary tract infection rates between BST (2%) and catheterization (7%).
- BST resulted in significantly less patient discomfort (2/10 vs 6/10) and higher parent (98% vs 58%) and provider (98%) satisfaction.
Conclusions:
- Bladder stimulation technique (BST) for CCU collection is a well-tolerated and well-received approach.
- BST can be easily implemented into clinical practice with minimal training.
- BST offers a less distressing and more satisfactory alternative to catheterization for infant urine collection.
Objectives:
Previous studies have demonstrated the efficacy of fluid intake with suprapubic and lumbar paravertebral massage for clean catch urine (CCU) collection in infants. We investigated the acceptability and feasibility of integrating this bladder stimulation technique (BST) into routine care in the pediatric emergency department (PED).
Methods:
This was a prospective cohort study. Infants less than 6 months of age requiring a urinalysis and urine culture as part of their PED visit were recruited. All PED nurses and technicians received a standardized training outlining the BST using a video module and print materials. Success rates, bacterial contamination, parental perception of patient distress, and parent and provider satisfaction with the BST for CCU collection were compared with urethral catheterization.
Results:
A total of 124 patients were recruited. The BST was successful in 38% (47/124) with a median time to void of 73 seconds (interquartile range: 19, 151). The BST was more likely to be successful in infants less than 90 days (53%; 95% confidence interval, 0.075-0.046; P = 0.005). A urinary tract infection was diagnosed in 4% of patients, with no significant differences between BST (1/47; 2%) and catheterization (4/59; 7%; P = 0.65). Patients experienced less discomfort during the BST compared with catheterization (mean numeric rating scale score, 2/10 vs 6/10; P < 0.001), and the BST was viewed positively by both parents and providers. Compared with catheterization, parents were significantly more satisfied with the BST (BST, 98%; catheterization, 58%; P < 0.001) and were more likely to consent to the BST in the future (BST, 98%; catheterization, 69%; P < 0.001). Most providers reported that the BST was well tolerated by participants (46/47; 98%), and providers felt that the BST improved parental satisfaction with the clinical encounter (46/47; 98%).
Conclusion:
The BST for CCU collection is a well-tolerated and well-received approach that can easily be implemented into clinical practice with minimal training.
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