Measuring Bladder Volumes Scanning in the ICU

Study Overview
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Brief Summary
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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
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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) MD performs bladder ultrasound and records volume on data collection sheet and places in envelope APRN performs bladder scanner and records volume on data collection sheet and places in envelope. APRN performs bladder ultrasound and records volume on data collection sheet and places in envelope Bedside RN performs bladder scanner and records volume on data collection sheet and places in envelope The study team will record the data from the straight catheterization that is performed as part of clinical care. 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.

Official Title
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Measuring Bladder Volumes With Ultrasound and Bladder Scanning in the ICU

Conditions
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Urinary Retention, Acute Kidney Injury

Intervention / Treatment
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* Other: Bladder Volume Measurement bladder scanner RN
* Other: Bladder Volume Measurement Ultrasound APRN
* Other: Bladder Volume Measurement bladder scanner APRN
* Other: Bladder Volume Measurement Ultrasound MD
* Other: Intermittent Straight Catheterization


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ICU dialysis patients who have their catheter removed per ICU medical team ICU patients without an indwelling urinary catheter and inability to void 6 hours post urinary catheter removal or 6 hours after admission Exclusion Criteria: Pregnant women Prisoners

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 90 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| ICU patient unable to void for 6 hours<br>ICU patients unable to void after 6 hours after a indwelling urinary catheter is removed or since time of admission | Other: Bladder Volume Measurement bladder scanner RN<br>* Measure Urine Volume with Bladder Scanner by RN<br>* Other names: Bladder Scanner;Other: Bladder Volume Measurement Ultrasound APRN<br>* Measure Urine Volume with Point of Care Ultrasound by APRN<br>* Other names: Ultrasound APRN;Other: Bladder Volume Measurement bladder scanner APRN<br>* Measure Urine Volume with Bladder Scanner by APRN<br>* Other names: Bladder Scanner APRN;Other: Bladder Volume Measurement Ultrasound MD<br>* Measure Urine Volume with Point of Care Ultrasound by MD<br>* Other names: Ultrasound MD;Other: Intermittent Straight Catheterization<br>* Measure Urine Volume with Intermittent Straight Catheterization<br>|
| renal failure with low urine volume<br>ICU patients with renal failure, acute kidney injury or acute on chronic with minimal urine output without an indwelling urinary catheter | Other: Bladder Volume Measurement bladder scanner RN<br>* Measure Urine Volume with Bladder Scanner by RN<br>* Other names: Bladder Scanner;Other: Bladder Volume Measurement Ultrasound APRN<br>* Measure Urine Volume with Point of Care Ultrasound by APRN<br>* Other names: Ultrasound APRN;Other: Bladder Volume Measurement bladder scanner APRN<br>* Measure Urine Volume with Bladder Scanner by APRN<br>* Other names: Bladder Scanner APRN;Other: Bladder Volume Measurement Ultrasound MD<br>* Measure Urine Volume with Point of Care Ultrasound by MD<br>* Other names: Ultrasound MD;Other: Intermittent Straight Catheterization<br>* Measure Urine Volume with Intermittent Straight Catheterization<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Intermittent Straight Catheterization Volume Compared to Bladder Scan Measurement Volume | Comparison of the two measurements of bladder volume will be analyzed | At time of enrollment, one point in time | 
| Intermittent Straight Catheterization Volume Compared to Point of Care Ultrasound Measurement Volume | Comparison of the two measurements of bladder volume will be analyzed | At time of enrollment, one point in time | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Clinician Level Measurements with Bladder Scanner and Point of Care Ultrasound | Comparison of the two measurements between clinicians 1. Bladder Scan measurement by bedside RN compared to APRN bladder scan measurement) and 2. APRN Ultrasound compared to MD US will be analyzed | At time of enrollment, one point in time |