Written by Shannon Markus
Spoon Feed
In children under 2 years old, nurse-performed bladder POCUS to confirm presence of adequate urine volume significantly reduced dry catheterizations and improved caregiver satisfaction without increasing procedural time.
Small bladders, big benefits
Dry bladder catheterizations in pediatric patients often necessitate multiple attempts, causing distress for children and caregivers and increasing the risk of pain, urethral trauma, and infection. Because bladder scanners are less accurate in children under 3, POCUS is the preferred modality for assessing bladder volume. This single-center randomized controlled trial evaluated nurse-performed point-of-care ultrasound (POCUS) prior to bladder catheterization (BC) in children ≤24 months at a pediatric hospital. 180 participants were analyzed (85 POCUS, 95 standard). Nurses received a ~20-minute US training session, and ≥2 cm bladder dimension was the minimum measurement to proceed with BC. Dry BCs occurred significantly less often in the POCUS group (4.7% vs 16.8%, p=0.009). First-attempt success was non-significantly higher with POCUS (87% vs 77%, p=0.077), and time from BC order to attempt did not differ. Caregiver satisfaction was significantly higher with POCUS across multiple domains. Although it was a relatively small study performed only at a single center, findings support the feasibility and clinical benefit of nurse-performed POCUS in reducing unsuccessful BCs without delaying care.
How does this change my practice?
POCUS does not need to be physician-performed to provide value, as nurses can be trained quickly, allowing them to both assess the appropriateness of catheterization and proceed with it themselves. Since nurses already perform the majority of bladder catheterizations, empowering them to perform POCUS can streamline workflow, reduce my workload, and free my time for higher-acuity patients. I am all about teamwork, patient comfort, and parent satisfaction. Given the intervention does not delay care, it seems like a no-brainer to involve nursing staff in this quick bedside assessment that improves the patient experience.
Source
Nurse-Performed Bladder Ultrasound Effect on Pediatric Bladder Catheterization Success. Pediatr Emerg Care. 2025 Aug 7. doi: 10.1097/PEC.0000000000003461. Epub ahead of print. PMID: 40770366.
