I had the privilege to shadow the child life specialist in our Radiology department. I can tell you it was an honor because her ability to calm children is apparent. She's had many years of experience and I loved being able to gain the knowledge of how to support kiddos in Radiology in order to cover for her when she's out. The procedure that caught my attention was a VCUG. I have had some experience with this procedure but I can't recall a time I shadowed a CCLS in their own area where this procedure was done. I was so glad I did because it was a phenomenal approach and a successful procedure.
First of all a VCUG is a Voiding CystoUrethroGram and typically occurs when a patient has multiple UTI's (Urinary Tract Infection) and they're looking to see if they're caused by reflux.
I'll give you a "quick" rundown of how we prepped/provided support for the procedure with our 6 year old patient:
1. Entered the room and introduced services. Asked if the patient understood why she was in the hospital today. She stated no. We went on to explain that she was here for a VCUG and it's a test to see why she has been having some problems with going to the bathroom/having UTIs. Mom confirmed she had UTI's and they were checking to see if there were any issues.
2. We introduced our puppet "Molly" who has anatomically correct parts to provide an explanation of what was going to happen. Molly was going to show our patient what a VCUG is and why our patient needed one. We laid Molly down the same way our patient would be expected to when the test started. We explained that Molly was going to need help filling her bladder today and would have pictures taken with the camera. We showed the patient the camera and how it came across her body kind of like a tunnel, but the camera wouldn't touch her and it wouldn't hurt to take her picture. We also explained that her job would be to lay her legs like a butterfly or frog legs to make it
3. We explained to the patient that sometimes kids get infections because germs crawl up their urethra or their "pee hole". It's important to use the correct terminology but also relate it to something they know as well. We showed her where Molly's urethra is as well as how sometimes germs go up the urethra, through the ureters and can make their way to kids bladders or kidneys and cause kids to be very sick. Today the patient would be having to a test to see if the patient's body isn't able to block those germs from getting to those parts of her body.
4. We explained that the techs are going to come in and have her lay down just like Molly and then clean her vagina or "private area" with brown soap 3 times. We do this because we want to make sure that no germs get up her pee hole and cause any infections today. We explained it would feel wet and looks funny because it kind of looks like chocolate ice cream. We then explained the tech will squirt some cold water to wash off the soap and it also feels cold but it's just to make sure all the brown soap comes off. We imitated this with Molly to show how it would be and this patient didn't want to do it but it can be offered that the patient imitates for better understanding.
5. Next we explained the tech would take a tiny bendy straw (showing the catheter at the same time) called a catheter and insert it into the urethra or their "pee hole" in order to put xray water in that will show up on the pictures. Their job while the straw goes in is to take deep breaths and most kids like to blow into a kazoo/whistle to remind them to take breaths. We will tell her when she has to do this. We let her pick what color kazoo she wanted at this time and she was excited she would be able to take it home. We reiterated how important it was to take deep breaths because her urethra is a muscle. We showed our hand as an example. We made a fist and said "It's like your hand, if you clench your hand up the straw can't fit through"and we showed how it couldn't go in. We said "If you take deep breaths then your pee hole or urethra muscle will open up and allow the straw to go through." We showed how we took a deep breath and opened our hand so the straw could go through. We explained that if she didn't take deep breaths and clenched that muscle then it may feel like a pinch, but if she can relax and blow into the kazoo when we ask then it wouldn't hurt.
6. We said that after that they will take 2 soft pieces of tape and tape the tube down because we didn't want it to fall out until after the xray water was put into her bladder. We explained this part wouldn't hurt but she would feel like she has to pee because her bladder would be filling. We said she could watch on the screen while they take pictures to see how much xray water was inside. This patient was excited to watch so we knew that could be her distraction during the procedure.
7. Next the doctor would take pictures and when the patients bladder was completely full they would be able to let the patient go pee. **This part is sometimes hard for kids that are toddlers/school aged because they don't know how to pee anywhere but the toilet since they're recently potty trained** We explained we could put a cup down there to catch her pee if that would be easier to pee into (instead of on a towel on the table). A lot of kids that are having this procedure have previously had a UTI and are used to peeing in cups at the doctors so this is an easier way to get them to go to the bathroom. She agreed she would like that.
8. We also told the patient that when it's time to pee they will take the tape off but it's soft so it shouldn't pull too much and she can say if it hurts so they can go slow. Then it would be her job to go to the bathroom and we could watch as her bladder empties.
9. We asked if she had any questions. This patient said no and we explained we would be there the whole time to explain what was happening and remind her what comes next.
10. The techs came in and the procedure began.
During the procedure this patient did amazingly! She had some difficulty relaxing her legs "like a butterfly" but with guidance she did really well. Some takeaways I had:
1. SUPER IMPORTANT to have them take deep breaths when they catheter is inserted. Remind them to "blow their whistle" or use whatever other device is utilized for reminding them to breathe. This CCLS did not encourage bubbles as it's more difficult for them to hold still when they're trying to reach the wand.
2. The hardest part for these procedures tends to be when they have to pee. Really encouraging them, having them visualize their own bathroom at home, putting a cup by where they pee or playing the app "koi pond live" to hear little drips - all of these can help. Fortunately they did for our patient! She did cry because it hurts when your bladder gets that full! So we reminded her that's why it hurt but if she continued trying to pee she would feel much better after.
3. We also spoke to the importance of not allowing anyone else to touch her vagina other than mommy or someone mommy says is okay. She was old enough to understand this as she was 6. You can gauge how appropriate it is based on the patient but definitely something to consider!
That's all I got! It was a really great procedure but not all of them go that well. The CCLS I was shadowing clearly knew what she was doing and had done these daily as she was very well rehearsed and did an excellent job with procedural support. I was very fortunate to be able to witness her talent.
Let me know if you have any questions regarding the VCUG procedure. I have 4 dates in June coming up that I'll be filling in, in radiology and can't wait to share my experience with you all!
