Pediatric VCUG PRINT

Pediatric VCUG Protocol

I. Equipment

    • Sterile towels
    • Plastic tape
    • Cotton balls
    • Urinal for males, bedpan for females
    • KY gel (not lidocaine gel)
    • Spotlight
    • Soap (Hibiclens)
    • Urologic contrast bottle w/ extension tubing
    • Catheter adapter (REF 2219) (small blue tree)
    • 5F feeding tube (boys under 1 month), 8F feeding tube (boys and girls older than 1 month)
      Example: Argyle Feeding Tube (REF 460802)

II. Personnel

a. Pediatric radiologist/RA

i. Responsible for imaging

b. Technologist at head

i. Responsible for holding patients’ hands above the abdomen
ii. Parent may substitute

c. Technologist at feet

i. Responsible for holding legs of patient
ii. Turns contrast on and off
iii. Removes tape and catheter when told by the person performing the study

III. Procedure

a. Patient supine on table
b. Scrub genital region x3
c. Insert catheter and affix with single piece of tape (continue to insert even after urine flows; tape onto labia/penis)
d. Attach contrast tubing to urethral catheter
e. Run contrast in under gravity drip
f. Take appropriate images
g. When patient is uncomfortable full, place in urinating position

i. Females on bedpan if old enough
ii. Males rotated to left with urinal if old enough

h. Loosen tape to prepare for catheter removal- remove catheter when told by radiologist/RA

IV. Required Images

a. Scout of abdomen with pubic symphysis visible at bottom of image/ up to 12th rib
b. AP early bladder filling
c. Full bladder- The patient must be filled to their Estimated Bladder Capacity, to ensure they are assessed adequately for reflux, using the following formulas:

i. If less than 1 year old = 7 x weight in kg
ii. If greater than 1 year old = (age in years +2) x 30

d. Right and left obliques of bladder including bladder base and proximal urethral region
e. Voiding with contrast filled urethra
f. Images with maximum reflux (oblique to show vesicoureteral junction) (kidneys w/ max reflux)
g. Post void of bladder and kidneys (bladder does not need to completely empty)

V. Special considerations

a. Infants younger than 12 months of age REQUIRE 2-3 cycles of voiding
b. Young females with fused labia may require steroid cream to open.
c. Uncircumcised age 5 and younger, do not pull back or force the foreskin. You can pull a little to try to expose the opening and then go “fishing” with the catheter. Per Dr. Casanova. (Pediatric Urologist)
d. DO NOT HAND INJECT CONTRAST