Should You Skip the Dip? A VCUG Performance Improvement Project

Abstract

A child undergoing a fluoroscopic voiding cystourethrogram (VCUG) can be at an increased risk for a kidney infection (pyelonephritis) or disseminated infection (urosepsis). Nurses responsible for the required catheterization are obligated to provide care according to best practice. Radiology nurses practicing in the fluoroscopy department at the Division of Diagnostic Imaging & Radiology of the Children's National Health System, located in Washington, DC, designed and implemented a performance improvement project. The goal of this project was to determine if it is best practice to perform a point-of-care dipstick urinalysis for all specimens before a VCUG or only for those that were suspicious for a urinary tract infection (UTI) based on the assessment of the patient's urine and clinical history. During a 5-month study period between May 1, 2015 and September 30, 2015, nurses collected data on patients undergoing a VCUG. Urine specimens collected before VCUG were assessed for color, clarity, and odor. The time since last fever was also determined. Point-of-care testing (POCT) for urine dipsticks was used in suspected cases of active UTI based on the urine and fever assessments. A partnership with our urology clinic was created to help secure a pathway to POCT for urine dipsticks. The data were displayed on a performance board within the department to keep the nursing team apprised of monthly findings. Of 266 VCUG examinations performed in a 5-month study period, three urine specimens were tested, and of those, two were positive for UTI. Of the two positive dipsticks, one examination was cancelled and the other was completed at the request of urology. Based on our findings, the fluoroscopy team determined that because of a low occurrence of positive urine dipsticks, performing a dipstick only on suspicious specimens as opposed to every specimen is best nursing practice.