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FRANCE
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dimanche 5 septembre 2010
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Orthopedic Medicine
Orthopedic patients are usually recuperating from orthopedic procedures and may also be receiving physical therapy and rehabilitation. Many patients also suffer from multiple acute or chronic medical conditions. Many patients are initially catheterized during surgery and then have the catheter removed in the immediate postoperative period. Postoperative pain, limited mobility, and a debilitated state may exacerbate voiding difficulties. Urinary retention is not uncommon with symptoms including urinary frequency, urgency and incontinence. The BladderScan® is very helpful in expediting the correct diagnosis and thus implementing of the correct therapy.
Indications / Applications
Indications for the use of the BladderScan at Orthopedics
- 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
- Patient after removal of an indwelling catheter
- Patient with a possible obstruction of the urinary tract
- Patient after spinal/epidural/general anaesthesia
- Patient post-operative
- Patient who is confused and restless
- Patient who isn't been able to tell if he has to urinate
- Patient who has to lay down completely
Experiences of the nursing staff in practice
- The use of the BaldderScan eliminates unnecessary catheterization
- We are able to recognize urine retention in time
- The making of a measurement with the BladderScan 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
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