STARES WEEK 1
Women's Health Prac

SITUATION
I was seeing a young male patient with a continence problem. One of the things I needed to assess was if he was emptying his bladder completely when going to the toilet. It is important information for me to know. If he is not emptying completely then there will be a residual volume, which means less urine can then be stored in the bladder. To look at his bladder (and see how much urine is in there) real time ultrasound (RTUS) can be used.

TASK
I had to use the RTUS to look at the patient’s bladder pre and post void to see how much urine was being stored in there and if he was completely emptying it when going to the toilet.

ACTION
I asked the patient to lie on the plinth then I prepared him with the paper towels in place to stop the gel getting on his clothes. He had done this before with my supervisor so was used to the procedure. I then prepared the ultrasound head with gel and placed it over his bladder. It was quite easy to identify it on the screen as he had a moderate amount of urine in there (the fuller the bladder the easier to see it by ultrasound). After using the RTUS machine to measure the size of the bladder I asked the patient to go to the toilet. After this we did the whole process again and I needed to re-measure the size of his bladder.

RESULT
The second time I could not find his bladder using RTUS, which means he had emptied it properly. I did have my supervisor check as well, just in case I had made an error when trying to find it. She could not find it either, so we came to the conclusion that it had been completely emptied.

EVALUATION
Overall I felt that I used the RTUS effectively. I could find the patient’s bladder but needed to be shown how to measure the size of it. I was worried when I could not find it the second time, but was reassured it was because it had been emptied, not because I had the ultrasound head in the wrong spot. One thing I could improve on is how I was set up. My supervisor is left handed, so she had the machine set up to hold the ultrasound head in her left hand and use her right hand on the controls (to measure the bladder). I left it set up in this way, which made it a bit awkward when I had to use my left hand to hold the ultrasound head. I would have been more comfortable to have it in my right hand.

STRATEGIES
I should make sure I am prepared before jumping into a procedure with the RTUS. Next time I should position the machine on my left, instead of my right, so I can use my dominant hand. The machine sits on a trolley with wheels so it would be very easy to move (I would just have to be careful of cords that need to be plugged into the wall). Having had this experience, I think I will be more prepared for next time I use the RTUS but can apply this lesson to all things: be completely prepared before starting a procedure!