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FRANCE
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jeudi 29 juillet 2010
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Geriatric Medicine & Nursing Homes
Geriatric Units are geared toward the problems associated with aging. The percentage of patients suffering Urinary Incontinence increases with age. The BladderScan® has an obvious advantage in the care and management of these patients' urinary symptoms. The ability to easily and quickly evaluate and document the bladder volume not only provides the patient with assessment and therapy, it also promotes better care delivery by the unit staff. As bladder volume determination with the BladderScan® reduces time required to ascertain the etiology of the problem, it translates into more enthusiasm by the unit staff for investigating the bladder complaint.
Indications / Applications
Indications for the use of the BladderScan® at Geriatrics
- Patient with a risk of urinary retention Patient with a risk of urinary residue
- Patient who hasn't been able to urinate spontaneously for some time
- At a patient after removing an indwelling catheter
- Patient with incontinency problems
- Patient who is confused and restless
- Patient who isn't been able to tell if he has to urinate
- Patient who get a training for a good bladderfunction
- Patient after C.V.A.
- Patient with M.S.
- Patient with Parkinson disease
Experiences of the nursing staff in practice
- The use of the BaldderScan® eliminates unnecessary catheterization
- We are able to recognize urine retention in time
- A Bladder scan takes less time than a catheterization
- Less unnecessary use of disposables
- Always knowledge of the contents of the bladder
- Less deliberation about the necessity of catheterization
- Minimize risk of urinary tract infection and thus antibiotic use
- Use of the BladderScan® is more friendly to the patient than catheterization
- The BladderScan® contributes to the quality of care of the patient
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 Verathon Medical 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.