VCUG’s are hands-down one of the worst procedures. Depending on the age of the patient, the way you provide preparation/how much time you have to prepare, and how much the parents prepared the patient at home throughout the week leading up to the procedure (this is SUPER important) can make all the difference. However, even when all of these things are put in place and done well, sometimes the procedure still just blows.
Imagine being four-years-old and not totally understanding the procedure to begin with and next thing you know, there’s a tube being inserted right where you go potty! OUCH!
A VCUG (voiding cystourethrogram) is a test that utilizes a special x-ray to take pictures of the bladder and urinary tract. This test is usually necessary for those suffering from frequent urinary tract infections and helps to diagnose vesicoureteral reflux which is when urine flows the wrong way back to the kidneys.
The ROUGH ages are the 18-months to 3-year-olds. They struggle to follow directions and may view this test as a punishment due to not being able to understand why the test is happening in the first place.
I would say the “sweet-spot” age for this procedure are the 4 to 7-year-olds. They’re old enough that they can engage in the preparation, ask appropriate questions and usually follow directions well if prepared in advance.
I usually provide the preparation using my Aladdin doll since he’s plastic and easy to clean after each use.
I recently heard about utilizing a shadow buddy instead! This person used a shadow buddy and created a hole where the catheter can actually be placed into the doll so the patient can see exactly how that procedure works, place a catheter in the shadow buddy themselves prior to the procedure and also keep it for further education at home with their parents post-procedure. That is something I will be adopting as my new method from now on!
I love when I learn a new way of prepping!
The very first thing I make sure to clarify with the parents prior to procedure education with the patient is two things:
- What do they call their child’s private parts (because you’ll want to use the same language throughout your preparation – and trust me, I’ve heard everything)
- That during the preparation, you (as the CCLS) will specify that the patient’s mommy or daddy gave permission to the doctors and nurses to look at the patient down there, and that is the ONLY reason this is okay. No one should be touching or looking down there unless mommy or daddy says it is okay. I’ll let the parents know ahead of time that I’ll be asking them (the parents) during the preparation, “is it okay with you that the doctors and nurses look at Sally’s privates during this doctor visit?” to which they’ll answer, “yes,” so that the child understands the verbal consent given.
Inserting the catheter, for any age, is extremely difficult. I try to have my patients either blow out slowly as the catheter is being placed or blow bubbles for the younger patients who don’t understand why blowing out is necessary. This allows their muscles to relax down there so that there’s not any resistance when placing the catheter. If they’re nervous or tense, the catheter won’t be able to be placed or if it is able to be placed, it will be extremely painful due to the resistance.
I like to use an ISpy book or the iPad for distraction because it also blocks the child’s view as to what’s going on down there. And if the team is good and follows along with One Voice, I’m usually the person telling the patient exactly what is about to happen (if the patient is at an appropriate age for that).
“Okay, you’ll feel the nurse touch and something cold on your pee-pee. Remember that’s the cotton balls we did on Aladdin before the tube?”
“Okay, remember we want your tiny pee hole to be as big as possible. Do you want to blow out while I count to 10 or would you like to blow bubbles instead?”
Choices are always important – no matter what the procedure is!
One of the hardest things for the 2 to 3-year-olds to grasp is that once the hard part is over (inserting the catheter), they’ll then have their bladder filled with fluid and be asked to pee (while still laying on the table underneath the x-ray). This age is critical for learning how to pee in the toilet. They’ve just gotten out of diapers and now someone says it’s okay for them to pee on the table? That doesn’t sound right. But with all the fluid in their bladder, they so badly need to go potty and they’re struggling with the conflict of peeing on the table like the doctor says, or holding it and waiting for a toilet like their parent has always said.
This is where I usually have the parents take the lead and talk about how “mommy says it’s okay,” and maaaaybe some bribes in there: “if you pee on the table like the doctor says, we’ll get some McDonald’s on the way home” – works every time. Then we usually have a mini celebration when they start peeing and give ALL the congratulations to the child because it’s a super vulnerable thing to do (no matter what age) to pee in front of four strangers in the same room and on a table, no less.
This is a procedure I don’t get called for very often as it’s not a very common procedure where I’m located on the Pediatric and Pediatric Intensive Care Units, but sometimes I’ll have a patient that needs one. It’s something that even during my prep, I continually find new ways and better ways to prepare and support a child. It’s definitely a procedure I continually feel challenged by and don’t know what to expect going in to it so I always have an open mind.
Sometimes we get stuck in our “sales pitch” or “spiel” for each procedure that we forget something that may make a prep even better. Never be afraid to adjust the way you prep!
Never stop learning.