Automated bladder scan urine volumes are not reliable in complex neonatal cases.

PURPOSE: We investigate the accuracy of urine volumes obtained by an automated bladder scan in complex neonatal cases. MATERIALS AND METHODS: Automated bladder scan determinations of urine volumes were obtained by neonatal intensive care unit nursing staff in 10 patients with myelodysplasia and cloacal exstrophy. Urine volumes were then immediately obtained by straight catheterization. Correlation between the scan and catheter volumes was then evaluated across and within cases. RESULTS: There was low correlation between automated bladder scan volume and catheter volume across and within cases (0.037 +/- 0.37) and (0.188 +/- 0.12), respectively. Using a cutoff of 20 cc 25% of significant volumes were missed. The 95% confidence interval from these data indicates that a significant volume is missed 7% to 25% of the time. CONCLUSIONS: We urge clinicians to exercise caution in the use of automated bladder scanners for determination of urine volumes in complex neonatal intensive care unit cases.

Patients' behavior at the time of injury: effect on nurses' perception of pain level and subsequent treatment.

This study examined whether nurses who currently provide direct patient care would perceive and treat pain differently in patients whose pain resulted from activities involving different levels of socially acceptable behavior. Clinical vignettes (differing only with respect to information provided about the patient's behavior at the time of injury) were randomly distributed to all medical/surgical, critical care, and emergency room nurses at this institution. Nurses were asked to record their perception of the patient's pain level and to indicate how much morphine should be given. Nurses (n = 167) did not differ significantly in their mean pain ratings (p =.86) or in the average amount of morphine (p =.80) given to the 2 patients. However, medical/surgical nurses indicated that they would give significantly less morphine to the patient who was presented as engaging in less socially acceptable behavior at the time of injury (p =.03). Overall, significantly more nurses correctly increased the next dose of morphine for the patient who was presented as having injured him or herself while participating in more socially acceptable behavior (p =.003). Thus, although the level of social acceptability of the patient's behavior at the time of injury did not significantly affect the average pain rating or morphine dose that the nurse would have reportedly given, there is evidence that the nurses would have been less aggressive in ensuring adequate pain treatment in the patient exhibiting less socially acceptable behavior.