Replies to This Discussion

Permalink Reply by Jason T Nomura MD, RDMS on May 6, 2010 at 11:16pm

If I am attempting to visualize pelvic structures and pathology I will tend to only fill the bladder if it is a young non-sexually active patient. If I am attempting to fill the bladder then I use IV fluids if there is an IV, if not then PO fluids.

I will attempt transabdominal views, but assume they will be limited without the acoustic window of a filled bladder. The time to fill the bladder is not an efficient use for the information I recieve from transabdominal views in the emergent or acute care patient.

If there is concern I usually perform an EV study as part of the pelvic exam after the bladder is cleared to help both with the EV views and the pelvic exam.

If the patient is going to the radiology dept for an pelvic US our sonographers usually request the nurse to have patient drink water and not void prior to being sent over.

I think filling the bladder is important for the transabdominal views, but if an EV is planned then I don't see much point in the emergency and acute care patient.

Permalink Reply by Dr MM Nurus shafi on May 7, 2010 at 2:12am

A very important & relevant topic. I face this dilemma a lot of times particularly with the patients of ectopic preg etc who come with out an IV line .Most of these patients have dehydration & some in shock. they can neither take or retain fluid.And without a TVS probe you are particularly in a precarious position. Some time a whole morning or evening is consumed to fill the bladder which is so frutrating when the patient is having frank PV bleeding in front of you , with the referring Doctor calling frequently to have the diagnosis .
I try to give some IV fluid & if fail then I have no alternative but to try the oral route.

Some times I send back the patient to the Hosp & ask to send again with a full bladder.

I would love to do a TVS in these situations.

Regarding a foley catheter , in my small out door clinic, I will not like the idea.

In other , not so acute cases, I would certainly prefer the oral route & wait.

Some times , I hear that nurses in some of the busy hospitals put diuretic tablets orally which I consider unethical & very horrible.

Permalink Reply by ZENAB.A.KHAIR on May 10, 2010 at 6:04pm

We must do TA &TV scan ,so pt must be full UB ,some times we give iv diuretics to accelerate filling .

Permalink Reply by Phil Andrus on May 24, 2010 at 12:56pm

The main indication for ED Pelvic ultrasound is the first trimester woman with abdominal pain or bleeding, where the concern is IUP vs. Ectopic vs. threatened miscarriage. For this exam, we normally perform a transabdominal exam first, and if there is no definitive IUP, we follow up with a transvaginal exam. In this instance we do not fill the bladder. If it is full at the time of transabdominal exam, we ask our patients to empty their bladder prior to transvaginal ultrasound.

Permalink Reply by Kimberley Ellen Oliver on February 22, 2011 at 4:56pm

We must do TA & TV also.  We request a foley.  If the pt. refuses the foley we make a note of that on the exam sheet.

If we absolutely can not get their bladder full for the TA exam we note on the exam sheet that the exam is LIMITED and   the reasons why.   A TA exam is considered  very important at our Immediate Care Facility.  A complete Pelvic exam has both TA and TV exams.  If only one exam is done it is considered a LIMITED  study.

    TA= Full bladder

    TV= Empty bladder

  I  think a Pelvic Complete study offers more information than just a TV or TA.  I absolutely hate dealing with the bladder prep problem.  I wish I didn't think it was important.....but, it is and I continue to deal with the "hub bub" of getting a pt bladder full.

Permalink Reply by Bashir H Samma;MD,PGD&C,SrMAIUM on April 8, 2011 at 4:58pm

If I'm satisfied with TA exam, I do not bother going for TVS. TA is extremely important to get a "panoramic view" before one gets closer by TVS. In case of urgency, I think an IV line and a safe diuretic are indicated.....alternatively as said, distending the mighty bladder with  a Foley's