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United Kingdom
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Wednesday, March 17, 2010
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Orthopaedics
Retention of urine and voiding difficulty are common occurances in patients undergoing orthopaedic surgery. A number of factors can be seent that are associated with an increased risk of retention of urine such as age, immobility, type of anaesthesia, and type of analgesia. The use of the BladderScan® offers the opportunity to diagnose retention of urine and enables its management such that the consequences of voiding difficulty and urinary infection can be reduced.
Indications / Applications
Indications for the use of the BladderScan® within Orthopaedics;
- Patient with a risk of urinary retention
- Patient after removal of an indwelling foley catheter
- Patient after removal of a Super Pubic catheter.
- Patient with a possible obstruction of the urinary tract
- Patient after spinal/epidural/general anesthesia
- Patient post-operative
- Patient who requires bladder re-training following surgery or bladder dysfunction
- Patient after Stroke
- Patient with a slipped disc
Benefits for the user of BaldderScan® include;o:p>
- The use of the BaldderScan eliminates unnecessary catheterisation
- Ability to recognise urine retention in time
- Performing the a scan using the BladderScan® takes less time than catheterising a patient
- Reduced use of disposables
- Minimises risk of urinary tract infection and associated costs
- Non-invasive
- Easy to use
- Saves staff time
- BladderScan® improves the patients quality of life
Cost Analysis
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Key Clinical Messages
Pavlin J. et.al. (1999 Aneath Analg , 89:90-7)
Voiding in Patients Managed With or Without Ultrasound Monitoring of Bladder Volume After Outpatient Surgery
BS ultrasound monitoring facilitated determining when to catheterise patients at high risk of retention (hernia/anal surgery, spinal/epidural anesthesia). Categories of patient risk groups are presented.
Slappendel R. et.al. (1999 European Society of Anaesthesiology)
Non-invasive measurement of bladder volume as an indication for bladder catheterisation after orthopaedic surgery and its effect on urinary tract infections.
Over a 4 month period, 1920 patients had bladder catheterisations where there was no spontaneous void 8 hours after surgery. Similarly over a 4 month period, 2196 patients bladder volume was measured with BladderScan, 8 hours after surgery, when catheterisations were performed if bladder volume was greater that 800ml. This demonstrated that there was a decrease of 50% of disposables used throughout the 4 month duration, also 18 urinary tract infections occurred in the first group compared to only 5 in the second group.
Bugter M. et.al. (2000 ESA Vienna)
Non-invasive bladder volume measurement is mandatory in every patient at the recovery room
Careful management of the renal function should be an important aspect during the recovery period. Therefore urine output is monitored by urinary catheterisation. 500 consecutive patients scheduled for minor orthopaedic surgical procedures participated in this study. In all 500 patients bladder volume measurement was possible. At the end of the recovery period in 12% of the patients a bladder volume of less than 50 ml was measured. In 25,2% of the patients the bladder content was more than 400ml urine, and in 8,4% of the patients more than 700 ml. Our results indicate that routinely measurements of the bladder volume (in a non-invasive way) during the recovery period is mandatory for having information about the bladder and kidneys, even after minor and short surgical procedures.
Rosseland L.A. (2002 Acta Anaesthesiologica Scandinavica,;46:279-282)
Detecting postoperative urinary retention with an ultrasound scanner
Patients undergoing orthopaedic procedures with spinal anaesthesia were monitored for retention by use of an ultrasound scanner. A reliability test was performed on an ultrasound scanner to compare scanned and catheterised volumes. The study confirms a good correlation between the two and suggests that the routine use of a scanner should be considered to prevent the consequences of undiagnosed post-operative urinary retention and the risk of infection imposed by an indwelling catheter.
Plowman E. et.al. (2000, Central Public Health Laboratory, Department of Health, London)
"The socio-economic burden of hospital acquired infection"
Urinary Tract Infections are the most expensive single site infection and cost the NHS £124 million a year. The cost per patient episode of Urinary Tract Infection is £1327 Patients spend on average 2.5 times longer in hospital when they contract a Hospital Acquired Infection