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United Kingdom
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Sunday, March 14, 2010
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Elderly Care
Bladder dysfunction and incontinence are common occurrences in elderly patients. Residual urine in elderly patients can be seen to be of major significance in its association with voiding dysfunction, incontinence and the aetiology of urinary tract infection. Through the use of BladderScan® diagnostic catheterisation is not necessary and so the patient can avoid the physical and emotional trauma associated with urethral catheterisation. BladderScan® is a key tool for allowing users to evaluate bladder function without invasive and repeated catheterisations. BladderScan® will improve the quality of life for patients in the elderly care setting and provides a beneficial, inexpensive, non-invasive method for diagnosing urinary incontinence in elderly patients.
Indications / Applications
Indications for the use of the BladderScan® within Geriatrics are;
- Patient with a risk of urinary retention
- Patient who hasn't been able to void spontaneously for some time
- Patient after removing an indwelling catheter
- Patient who is confused and restless
- Patient who isn't been able to tell you if he or she has been able to void
- Patient who requires bladder re-training following surgery or bladder dysfunction
- Patient with M.S.
- Patient with Parkinson disease
Benefits for the user of BaldderScan® include;
- Reduces use of unnecessary catheterisations
- Reduces use of unnecessary disposables
- Non-invasive
- Reduces incidence of urinary tract infection and associated costs
- Easy to use
- Saves staff time
- Cost-effective
- Eliminates unnecessary trauma to patients
- Non-real time allows focussed scanning
- In house product training is aligned to KSF requirements
- Can be used by any healthcare practitioner and applied to their clinical environment
- All products, accessories and consumables can be purchased through NHS Logistics On-Line
Cost Analysis
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Key Clinical Messages
Resnick B. ( 1995 Rehabilitation Nursing Vol 20:4)
A BladderScan trial in Geriatric Rehabilitation
The sample size of this study was 16 patients from either Geriatric rehabilitation or acute rehabilitation units. It shows that 8 patients were catheterised and 8 patients received BladderScan assessments. (5 of which were unable to void naturally). BladderScan facilitated bladder retraining by allowing the nurses to evaluate bladder function without invasive and repeated catherisations. In addition, 8 out of 16 patients had UTI's at the time of admission. However at the time of discharge, only 2 patients were still being treated for UTI.
Shah P.J.R. (2000 Diagnostic Ultrasound UK Ltd publication)
Bladder Dysfunction in the Elderly
This paper uses a sample of 948 Geriatric patients with urinary incontinence. It shows that of the 948 patients, 56.4% suffered with urge incontinence. 29.9% had bladder instability 18.6% had outlet obstruction. 14% suffered with stress incontinence. The conclusion to the study demonstrates that by using a portable ultrasound scanner on every ward will certainly improve the quality of life for the patient and provides a beneficial, inexpensive, non-invasive method for diagnosing urinary incontinence in elderly patients
Ouslander J.G. (1994 JAGS 42: 1189-1192)
Use of a portable ultrasound device to measure post-void residual volume among incontinent nursing home residents
Results: The ultrasound demonstrated excellent test-retest and interrater reliability. For low PVRs, the device was highly sensitive (.90 for PVR<50 ml and .95 for PVR <100 ml). For PVRs of more than 200 ml. (n = 26), the ultrasound had a sensitivity of .69 and a specificity of .99. Conclusion. The portable ultrasound we used was reliable and reasonable accurate for assessing PVR in a representative sample of incontinent NH residents. Discussion: Ultrasonic measurement of PVR volume is being used increasingly in the office practice of urology, inpatient rehabilitation units, and in acute hospitals.
Granier P. et.al. (2002 et al Ann Readaption Med Phys 45:166-172)
Portable ultrasonographic device and bladder dysfunction management in stroke patients
A study of 33 patients showed that 10 were admitted with urinary retention. Determination of bladder volume was performed with a BladderScan™ BVI 3000 portable ultrasonographic device. Retention was resolved for 7 of these patients by the time they were discharged. The portable ultrasonographic device is a simple and non-invasive tool, useful for diagnosis, follow up and therapy guidance of urinary retention after stroke.
Campbell K. et.al. (1999 study Institution Parkwood Hospital, London Ontario, Canada)
Screening for urinary retention on a geriatric rehabilitation unit using a portable ultrasound bladderscan: a prospective case-control study.
The BladderScan provides conservative and reliable estimates of PVR prevalent among 10% of frail elderly persons. Intermittent catheterization and alpha blocking medication may quickly resolve UR in almost 70% of affected patients.
Newman D.K. et.al. (1999 Ostomy/Wound Management 1999: 45(12):32-50)
Incontinence and PPS: A New Era
Urinary incontinence (UI) is a prevalent and costly problem in nursing homes. Staff education remains an ongoing issue, as caregivers must be aware of attitudes and beliefs about the aging process and its impact on the genitourinary system in order to provide effective care. Under the Prospective Payment System, nursing homes need to change business as usual and remain abreast of new innovations and research in different behavioral interventions and continence technology.
Ouslander J.G. et.al. (1995 International Medicine Vol. 122: No. 6. 15 March )
Incontinence in the Nursing Home
Urinary and fecal incontinence are prevalent, disruptive and expensive health problems in the nursing home population. Nursing home residents who are incontinent of urine shoud have a basis diagnostic assessment including a determination of postvoid residual urine volume done by catherization or ultrasonography.
Palmer M.H. (1996 Nurs Home Med: 4:260)
Incontinence: A Major Problem for Patients, A Major Concern for OKRA.
Incontinence is considered a negative outcome, and the Omnibus Budger Reconciliation Act of 1987 (OBRA '87) states that the maintenance of as much normal function as possible is the responsibility of the nursing home. Nursing homes are now required to demonstrate that any deterioration in a resident's activities of daily living, such as toileting, are clinically unavoidable. Therefore, activitites to promote and protect continence, interventions to effectively treat incontinence, and documentation of these activities and interventions have assumed even greater prominence.
Smith N.K.C. et.al. (1999 summary)
A propspective Study of Urinary Retention and Risk of Death after Proximal Femoral Fracture.
Of the 309 patients, 244 (79%) had readings of post-void residual volume taken on admission: 90/244 (37%) had retention pre-operatively, 122/216 (56% post-operatively and 40/183 (22%) in the recovery phase. One year after operation 305 patients were traced and median follow-up was 2 years. Older age, cognitive impairment, polypharmacy, impaired mobility and urinary retention on admission and during recovery were associated with a higher fatality in the first post-operative year. Pre-operative urinary retention is common among older women with proximal femoral fracture and affects over half post-operatively. Retention is one of several factors associated with higher fatality.
Sueppel C. et.al. (1996 Urol.Nurse:no.16: pp 14-19)
A Comprehensive Screening Program for Urinary Dysfunction in Older Adults
Incontinence in the elderly population ranges from 8% to 51% overall and from 15% to 30% for community-dwelling persons. Tests that assist in delineating urinary incontinence include postvoid residual (PVR) volume by catherization or pelvic volume by catheterization of pelvic ultrasonography and stress testing. Bladder ultrasonography can noninvasively detect urine volumes of greater than 100 ml with a sensitivity of 77% to 90% and a specificity of 81%.2. It can be a valuable adjunct to the basic screening methods already mentioned. The potential advantages of bladder ultrasonography over catheterization are (1) little practice is needed for correct operation, (2) calculations are not required, (3) it is a noninvasive technique, eliminating risk of infection, and (4) the patient is not subjected to an uncomfortable procedure.
Omli R. ,Sykehuser Namsos, Namsos, Norway (2003 Nordic Urology Forum Beyen)
Incontinence, lower urinary tract infections and post-voiding residual urine volume in the elderly. A study among patients in nursing homes in Norway.
Prevalence of incontinence was 73% (n=133). 5% (n=10) used catheterization. 22% (n=40) was continent. 133 patients had PRUV >50 ml (mean 99ml, max 638 ml). The prevalence of PRUV was high to patients with LUTS, but no significance was shown.