Portable Bladder Scanner Use

Procedure
(BVI 3000/Cubescan 700)

(Continence Manual)

DOCUMENT CONTROL:
Version: 1
Ratified by: Clinical Policies Review and Approval Group
Date ratified: 2 April 2019
Name of originator/author: Senior Continence Specialist Sister
Name of responsible Clinical Policies Review and Approval Group
committee/individual:
Date issued: 17 April 2019
Review date: April 2022
Target Audience All Clinical Staff
 CONTENTS

Section Page No

1. Aim 3
2. Scope 3
3. LINK TO OVERARCHING POLICY 3
4. REFERENCES/FURTHER READING 3
5. Procedure 4
5.1 Clinical Indications for use of Bladder Scanner 4
5.2 Urinary Retention
5.3 Signs and Symptoms of Urinary Retention
5.4 Contraindications for use
5.5 False Readings
5.6 Care of the CUBEscan 700 and the Verathone BVI 3000/
BVI 9400
5.7 Methods
5.8 Performing the procedure
6 Training Implications
7 Appendices
Appendix 3 – Flow Chart for Bladder Scanning To access/
download
appendix
please see
Continence
Manual
homepage

Page 2 of 8
1. AIM

To provide staff with best practice guidelines for performing ultrasound

bladder scans.

Ultrasound Bladder scanning is a non-invasive procedure that measures

urinary bladder volume. Bladder scanning should be used in preference to
using an indwelling catheter to measure urinary residuals on the grounds of
acceptability and low incidence of adverse effects (NICE 2015)

Appropriate and timely use of the scanner can prevent unnecessary

catheterisation, assist in the managing of incontinence and help diagnose
urinary and bladder dysfunction

2. SCOPE

This procedure applies to all staff, whether in a direct or indirect patient care
role.

Adherence to the procedure is the responsibility of all Trust staff, including

agency, locum and bank staff.

3. LINK TO OVERARCHING POLICY

Continence Manual’s Policy

4. REFERENCES/FURTHER READING

Addison, R. (2000) A guide to bladder ultrasound. Nursing Times Vol 96, No

40Department of Health (DoH) (2001) Reference Guide to Consent to the
Procedure. London, Crown

Department of Health (DoH) (2005) Essence of care. Benchmarking for

Privacy and Dignity, Record Keeping, Continence and Bladder and Bowel
Care.

Department of Health (DoH) Essential Steps to Safe Clean Care (2007)

Preventing the Spread of Infection

National Institute for Health and Care Excellence (NICE) (2015) Urinary
Incontinence. The Management of Urinary Incontinence in Women.

NMC (2015) Code of Professional Conduct, NMC, London

5. PROCEDURE

The bladder scanner will only be used by a trained healthcare practitioner i.e.
Qualified nurse, Health care assistants within the Specialist Continence
Service and also by some Healthcare Assistants on in-patient wards who
have received training and are competent in the procedure.

Page 3 of 8
5.1 Clinical Indications for use of Bladder Scanner

 To check for retention of urine, if symptoms suggest incomplete bladder

emptying
 To check for retention of urine prior to commencing Anticholinergic
Therapy. Residuals over 100mls should not be commenced on
Anticholinergic therapy
 To monitor urine output in those patients commenced on Anticholinergic
therapy to ensure bladder function has not been compromised
 Assessing the degree of retention before catheterisation
 Assessing volume of urine in bladder if catheter appears to be blocked or
not draining
 After a trial without catheter, evaluation of whether a patient is able to void
and to what degree
 Patients with neurogenic bladder should have regular bladder scanning to
monitor residual urine e.g. for patients with progressive multiple sclerosis
 Intermittent self-catheterisation training aid
 Biofeedback mechanisms
 Aid bladder retraining

5.2 Urinary Retention

Urinary retention can occur for a variety of reasons including;

 A physical or neurological impediment which obstructs the flow of urine or

prevents the detrusor muscle from effective contraction
 Effects of medication including Anticholinergic drugs, opiates and epidural
analgesia
 Psychological effects
 Functional ability i.e. not being able to sit on the toilet properly to empty
properly
 Effects of surgery

5.3 Signs and Symptoms of Urinary Retention

 Hesitancy
 Nocturia
 Straining to void
 Sensation of incomplete emptying of the bladder
 Post micturition dribble
 Urinary Tract Infection
 Prostatic symptoms
 Palpable bladder

Page 4 of 8
  Frequency
 Urgency
 Dysuria

5.4 Contraindications for use

 If the patient has a wound where the scanner head would usually be
placed
 If the patient withholds consent

5.5 False Readings

 Anxiety about the procedure

 Foley catheter
 Intravesical mass
 Obesity
 Fluid filled cyst
 Patient on their side during the procedure
 Pregnancy
 Volumes over 1000mls
 Volumes under 100mls
 Anatomical anomalies

5.6 Care of the CUBEscan 700 and the Verathone BVI 3000 / BVI 9400

 Storage – The scanner will be stored in the supplied case in a cool dry
place. It is especially important to protect the probe head.

 Handling – When the machine is in use place it on a steady surface.

For the BVI 3000, always rest the probe on the rubber part of the
handle.

 Cleaning of the scanner and the probe – The scanner and probe must
be cleaned in accordance with both manufacturers’ guidelines and in
line with Infection Prevention and Control recommended practice. The
Trust uses antimicrobial wipes e.g. Clinell Universal wipes. The
equipment must be dry before being used on the next patient

 Each locality will have a designated base for their bladder scanner. This
base is to have a designated member of staff who will be responsible for
ensuring the maintenance of the scanner is carried out according to the
maintenance contract. When the scanner is due for calibration, or if the
scanner is not working properly contact the Specialist Continence
Service who will arrange the bladder scanner to be serviced.

Page 5 of 8
 The bladder scanners will be annually serviced by De Smit Medical

 BVI 3000 Always ensure that you have a spare battery fully charged
with the. When charging the battery, ensure that the battery is removed
from the charging unit when fully charged to prevent battery damage.

The Cubescan 700 has a built in battery, when the unit is on charge the
green and orange lights signal the battery is having a bulk charge to
increase the batter’s capacity fast. Once the orange light has gone out it
is important to keep the scanner on charge for a further 2 hours as the
battery will still be charging but at a slower rate. (Green light
permanently on). Should the battery appear to lose its charge quickly
then operate the bladder scan by the mains and when possible charge
the unit overnight.

 Ensure the printer paper is loaded properly in the scanner.

 A supply of cleaning dry wipes and ultrasound gel should to be kept with
the scanner.

 All manufacturer’s instructions must be adhered to and care taken to

prevent damage to the equipment. Should any part of the equipment be
damaged, this should be reported immediately.

 Please note that in transit the temperature may fall and the scanner
can become too cold. If the unit does not switch on after holding
the power button down for two seconds or the screen ‘flickers’ put
the scanner in a warm environment for approximately 30 minutes
before retrying.

5.7 Methods

There are four accepted methods of carrying out the scan procedure (Addison
2000):

1. A bladder scan is performed before and after voiding to assess the

residual volume.

2. The patient is asked to void and then a scan is taken within 10 minutes.

3. The bladder scan is performed first and if any urine is present the patient
is asked to void into a jug which is then measured. The difference
between the volume in the bladder according to the scan and the
volume of the voided urine gives the residual volume.

4. The patient is given large amounts of fluid to drink. When they

experience the urge to void a scan is taken. The patient is then asked to
void. After voiding a second scan is taken to give the post void residual.

Page 6 of 8
5.9 Performing the procedure

The steps for performing Bladder scanning are as follows:

 Explain the procedure to the patient and gain consent

 Ensure privacy

 Decontaminate hands

 Assemble the bladder scanner according to the manufactures instructions,

switch the scan on and set the scanner for the appropriate gender /
condition

 Assist the patient into a supine position with head raised

 Adjust clothing to expose the lower abdomen

 Place an ample quantity of ultrasound gel on the probe head. Palpate the
patient’s pubic bone and place the probe midline on the patient’s
abdomen, approximately one inch (3 fingers above the pubic bone)

 Standing at the patient’s right side, place the probe on the gel and aim
towards the expected location of the bladder. For most people this means
tilting the probe slightly towards the patient’s coccyx

 Press the SCAN button located on the probe. As the scan progresses,
sections of the bladder will appear on the console screen. When you hear
the end-tone, the scan is complete. When you have 3 consistent readings
and a clear image through scanner press print or take a photo of the scan
image and results and download into the patients notes

 At the end of the procedure the scanner head should be wiped free of gel
and cleaned with a detergent wipe

 Remove the remaining gel from the patient’s abdomen using wipes and
allow the patient to redress

 Ensure all waste is disposed of in line with RDaSH policy

 Decontaminate hands

 Explain the results to the patient

 If bladder contains a residual of urine under 200mls, teach bladder

emptying techniques. If residual greater than 200ml, check U&E’s and
rescan in 7 days. If residual remains above 200mls contact Specialist
Continence Service or Urology for further advice (See appendix 3 Flow
chart for bladder scanning)

Page 7 of 8
6. Training Implications

Bladder Scan Training

Staff groups How often Length Delivery Training Where are

requiring should this of method delivered by the records
training be training whom of
undertaken attendance
held?
Community Every other Half day Presentation Specialist Electronic
Nurses- Planned year Practical Continence Staff Record
/Unplanned Sisters system (ESR)

Qualified
Care Home
Staff

Qualified
Staff TRH

7 Appendices
Appendix 3 – Flow Chart for Bladder Scanning To access/
download
appendix
please see
Continence
Manual
homepage

Page 8 of 8