Measuring Bladder Volumes Scanning in the ICU
Condition: Urinary Retention; Acute Kidney Injury
MeSH terms: Acute Kidney Injury; Urinary Retention
Study type: Observational

Summary: 
      ICU patients are at risk for catheter associated urinary tract infection. Frequently patients
      can't tell clinicians if they need to void if the catheter is removed. If clinicians know
      that an accurate volume measurement s of urine volume in the bladder can be obtained when the
      catheter is removed, catheters could be removed earlier and more frequently and thus possibly
      avoid an infection. For this study, measures with ultrasound (directly visualizing the
      bladder to measure), bladder scanner (partially blind measure with placement of scanner over
      the expected bladder location on the skin) and urine catheterized volume will be obtained.
      The investigators also want to know if the technology is user dependent. The study will
      include 2 levels of nurses RN and advanced practice RN (APRN) perform the bladder scanner. An
      APRN and MD will conduct the ultrasound. Ultrasound is technology primarily used by
      physicians but APRNs are using the technology technology more frequently. After these 4
      measurements, the patient's nurse will perform an intermittent straight catheterization
      (catheter inserted, urine drained, and catheter removed) as the gold standard comparison.
    

Detailed description: 
      The purpose of this correlational descriptive study is to compare measured bladder volumes
      with a bladder scanner (Verathon Prime), 3D ultrasound (Sono-Site II) and straight
      catheterization in ICU patients with low urine output receiving dialysis and in ICU patients
      unable to void.

      Upon consent of patient or LAR, patient's age, gender and BMI with the assigned study code
      number will be recorded on enrollment log. Study code number, patient initials and unit will
      be written on bedside data collection sheet.

      Sequence of 4 non-invasive (1-4) measurement will vary from day to day (see below)

        1. MD performs bladder ultrasound and records volume on data collection sheet and places in
           envelope

        2. APRN performs bladder scanner and records volume on data collection sheet and places in
           envelope.

        3. APRN performs bladder ultrasound and records volume on data collection sheet and places
           in envelope

        4. Bedside RN performs bladder scanner and records volume on data collection sheet and
           places in envelope

        5. The study team will record the data from the straight catheterization that is performed
           as part of clinical care.

        6. APRN or research nurse will retrieve catheterization urine volume measurement from RN or
           from chart and record on data collection sheet

      Each enrolled patient will have these 4 measurements performed only on one day. Each
      clinician research team member will record their result on a data collection form with the
      study number, patient initials, day of week, clinician initials, observation of abdominal
      fluid, and comment section for any other observations. The clinician research team member
      will place the completed form for their measurement in an envelope with the study number on
      the outside while the next clinician is in the room obtaining the next measure.

      Data collection is complete after catheter volume is recorded.
    

Intervention name(s): Bladder Volume Measurement bladder scanner RN; Bladder Volume Measurement Ultrasound APRN; Bladder Volume Measurement bladder scanner APRN; Bladder Volume Measurement Ultrasound MD; Intermittent Straight Catheterization
Intervention type(s): Other; Other; Other; Other; Other
Intervention description(s): Measure Urine Volume with Bladder Scanner by RN; Measure Urine Volume with Point of Care Ultrasound by APRN; Measure Urine Volume with Bladder Scanner by APRN; Measure Urine Volume with Point of Care Ultrasound by MD; Measure Urine Volume with Intermittent Straight Catheterization
Other intervention name(s): Bladder Scanner; Ultrasound APRN; Bladder Scanner APRN; Ultrasound MD
Observational model: Case-Only
Time perspective: Other
Sampling method: Non-Probability Sample
Study population: 
        ICU patients with low urine output due to new acute kidney injury or patients unable to
        void, secondary to surgical procedure, change in level of consciousness, or neurological
        alteration