Monday, August 10, 2015

VCUG tips!

VCUG 9:00 AM...I see it staring at me in my agenda.

For me, the voiding cystourethrogram (VCUG) is one of the most intimidating procedures that I take part in as a Child Life Specialist. Some go awesome and others, simply do not. I thought I would just share a few of the tips that work for me, and I would love to hear some of your tips in the comments (I always like to add to my bag of tricks).

1. Pre-call- 
This is the most important step in my opinion. No one knows their child better than their parents. Calling the parents the day before, explaining your role, clarifying the procedure, and answering their questions can give you an insight to how the procedure is going to go. (If your radiology department generally does this call, then you can ask for this information from them.)

2. Prep

Once you meet and assess each child, you can decide if they would benefit from prepping before the procedure or if stress point preparation will work best. In my prep box, put together by my genius co-worker, we have:
  • a shadow buddy with a hole cut where the catheter goes in
  • sample jelly
  • brown soap (be careful with this as it can stain)
  • the catheter
  • the pad that the child will be laying on. 
On our iPad we have a prep book that includes pictures of the room, the bed, the TV screen, and the big camera. The most important part of any prep is giving the child choices (do you want to look at my iPad or an I Spy book) and jobs (frog legs, pencil legs, staying still like a statue) to do throughout the exam.

3. Getting kids to relax their muscles. To get kids to understand what relax their muscles means I like to use this trick. Make one of your hands into a fist; squeeze your hand shut as tight as you can. Now, with your other hand, try to push a finger in-between the fingers making the fist. It’s not easy, is it!! Next, loosely hold your hand in a fist (your muscles are more relaxed this way). See if your finger fits between more easily this way. 

Then we talk about way to get them to relax most include deep breathing some kids like to blow bubbles, or blow on a pinwheel and other kids just like to take deep breaths and maybe even sing. 

4. Pocket Pond app
If you have never seen a VCUG before, the last step is getting the child to void the contrast onto the table. This can be embarrassing to older children, and confusing to recently potty-trained kids. My favorite app is called Pocket Pond. It's essentially a pond with fish, but when you touch the screen the water moves and makes a splashing sound. The splashing sound can aid the child to void. (Extra tip: *you can also have one of the technologists pour some warm water over the child, or run water into the sink*)

5. Kool-aid powder-
Now this trick works really well, but you have to clear it first with your radiology team since it can make a bit of a mess. Pouring a bit of Kool-aid powder (I recommend green or blue) on the pad where the child is going to eventually void the contrast on can turn urinating into a game. Who doesn't think green or blue pee is cool?

6. Be Prepared for Anything- Obviously go into each procedure with a positive attitude, but if none of your interventions are working, don't beat yourself up. This is a very invasive procedure and not all of them are going to be picture perfect. If your patient screams the whole time it is okay, just keep saying calming, caring words and provide praise and a prize at the end. You did your best and so did they!

7.Tips from Caroline-
I was once called for a VCUG at the last minute. There was no time for preparation or developing a coping plan. When I walked in the door, the parents were holding the child down on the table, and she was crying. Using a calm tone and my internship supervisor's fantastic idea of calling it a balloon, we supported the 6-year-old through the procedure. We watched the "balloon" aka the bladder fill up on the ultrasound machine. By focusing on the balloon, it took the attention away from the fact that she felt like everyone was looking at her. When it came time for her to urinate on the table, we empowered her to choose who she wanted to stay by the table (with the exception of the tech). We then worked to "push the air out of the balloon." Although there were intermittent tears, she coped well with the procedure, and hopefully we modeled to the parents that holding their daughter down was not necessary to complete the procedure!

               Please leave your tips and tricks for VCUG's in the  comments below! I can't wait to try them out!



Anonymous said...

My parents tricked me into having mine by simply keeping me in the dark about it until it was happening.

I screamed the whole time, but no one seemed to care. I have nightmares to this day.

If there were child life specialists in the early 90s, my parents didn't care to employ one.

No one helped me through.

Today, id rather get cancer that go through something as simple as a Pap smear.

Oh the glory of childhood trauma.

Carolyn said...

I just saw my daughter urologist today. We attempted to have a VCUG today, but my 11 year old had a complete panic attack. The child life person we had didn’t really help. At one point it seemed like she was pushing us to force her to do the procedure and she would have other staff members hold her down. At this point I said we’re done. We have rescheduled her test for March. My daughter is selective mute and has severe anxiety. I don’t want her to be traumatized by this. Do you have any suggestions for me to help front load her? I know talkinking to her about the procedure will help. I’ve been through the VCUG test a few time between my 11 year old and her sister both having kidney reflux. Any suggestions would be appreciated.

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