1. VCUG - Catheterization: A simple approach for a simple procedure
A PREVIEW FOR NURSES

2. What is a VCUG?
A VCUG (Voiding Cystourethrogram): is an x- ray examination of a child's bladder and lower urinary tract that uses a special form of x-ray called fluoroscopy and a contrast material.

3. What are the common uses of the procedure?
A VCUG enables a radiologist, a physician specifically trained to supervise and interpret radiology examinations, to detect abnormalities in the flow of urine through the urinary tract.
This examination is often recommended after a urinary tract infection to check for a condition known as vesicoureteral (VU) reflux.

4. Reasons for the procedure:
Urine is produced in the kidneys and flows through the ureter, the tube that carries urine from each kidney to the bladder. A valve mechanism prevents urine from backing up into the kidneys as the bladder gets full. Urine leaves the bladder through the urethra and is eliminated from the body during urination.

5. Reasons for the procedure: (Continued)
In some children, an abnormality in the valve or the ureters allows urine to flow backwards, a condition called VU reflux. In mild cases urine backs up into the lower ureter. In severe cases it can back up into a swollen kidney. Usually, children with this condition are born with it. Other causes include:
blockage to the bladder
abnormal urination with very high pressure within the bladder
incomplete emptying of the bladder
urinary tract infections.

6. Nurse’s role for the procedure
The nurse plays an important role in the VCUG procedure. The nurse performs a sterile catheterization procedure so the catheter can be hooked up to the special contrast dye that will be instilled into the bladder. Steps for catheterization to follow.

7. How should we prepare?
You should inform your physician of any medications the child is taking and if he or she has any allergies, especially to contrast materials. Also inform the doctor about recent illnesses or other medical conditions.
Child life specialists play an especially important role in the Radiology suite because they often can eliminate the need for children to be sedated during a procedure. The specialists also help parents by modeling ways to talk about the scans to their children. And they teach technicians to explain the procedures in ways kids can understand. A child life specialist will be there with the child when you arrive to perform the procedure.

8. How should we prepare? (continued)
Supplies:
Have all supplies in room before starting catheterization. Normal Saline (0.9%) cc
Foley catheter French (peds)
Feeding tube (infant size)
Betadine solution (1 bottle) or
4 x 4 gauze pads (6)
2 x 2 gauze pads (2)
Xylocaine Jelly 0.1 %
Tape (cut in ~ 6 inch strips)
Sterile gloves (determine size)
Absorbent pads
Connector/Adaptor
Emesis basin

9. What should you expect during the examination?
The nurse will explain the procedure to the parent and child. The bladder will be catheterized for this exam. The child will need to lay on the x-ray table with his/her legs in a “Frog Position” or “Butterfly Position.” 

10. What should you expect during the examination? (continued)
As a relaxation technique during this process, we will ask the child to “blow out birthday candles”, or to take in big deep breaths. Once the catheter is placed we will secure the tube to the child's leg with a piece or two of tape and the exam will begin.

11. Steps for the procedure
1. Gather equipment
2. Open catheterization kit and catheter
3. Cut 3-4 pieces of tape into 6 inch strips
4. Prepare sterile field, apply sterile gloves
5. Generously coat the distal portion (2-5 cm) of the catheter with lubricant
6. Apply sterile drape
7. If female, separate labia using non-dominant hand. If male, hold the penis with the non- dominant hand.
8. Using dominant hand to handle forceps, cleanse peri-urethral mucosa with cleansing solution. Cleanse anterior to posterior, inner to outer, one swipe per swab, discard swab away from sterile field.
9. Pick up catheter with gloved (and still sterile) dominant hand. Hold end of catheter loosely coiled in palm of dominant hand.
10. In the male, lift the penis to a position perpendicular to patient's body and apply light upward traction (with non-dominant hand)
11. Identify the urinary meatus and gently insert until 1 to 2 inches beyond where urine is noted
12. Connect catheter to IV system to instill special contrast Secure catheter to abdomen or thigh, without tension on tubing
14. Evaluate catheter function and amount, color, odor, and quality of urine
15. Remove gloves, dispose of equipment appropriately, wash hands
16. Document size of catheter inserted, patient's response to procedure, and assessment of urine