Child Life Corner
Preparing Children for a Voiding Cystourethrogram
By Kristine Murray, CCLS
A voiding cystourethrogram is one of those procedures that I wish there was a better way to find out if a child has urinary reflux. As we all know, it can be very traumatizing to the children and sometimes their parents.
VCUGs are managed differently throughout the country. Some programs offer mild to moderate sedation, others offer no sedation, while others offer general anesthesia for the foley placement. There are programs where there is a child life specialist to provide preparation and procedural support. Unfortunately not all programs have access to child life and many are stretched to provide the preparation that can be vital to the emotional well-being of the child and their family. When child life is not available, it is important for other medical team members to prepare the child and their family.
It is not uncommon for parents to not tell their child why they are going to the doctor because they don’t know how or that it will scare them. To make parents feel more comfortable giving their child information, I often approach them about how preparation is beneficial and the tools I have available to use (a preparation book with pictures, playing with medical equipment and practicing on a doll). I stress to them that their child will be assessed throughout the preparation for signs they are becoming overwhelmed or anxious. But I also ask for their help if they see their child has had enough information.
When preparing children for a VCUG, it is important to first identify how much information is needed or wanted. Some children need to know every detail and other children want to know very little. At the very least, a brief overview is encouraged addressing the foley catheter, the contrast for the pictures and the need to go to the bathroom on the x-ray table.
For those children who want more detail, tailoring the information to their developmental level, prepare to the senses and what we need them to do.
You may use a picture book and/or the medical equipment. Giving the child the opportunity to explore the equipment will help them gain control and mastery over what they will experience. For example, practice on a doll using a foley, the betadine, and the bed pan. Seeing the foley can be very reassuring to children as they visualize something much larger and harder or sharp. It may also help them void on the table to see the bed pan or urinal. I offer children the opportunity to create their own “special potty” by decorating it with stickers. I have found over the years that girls love to do this, even teenagers. Boys often think using a “bottle” is fun enough.
When preparing for the foley placement focus on:
The position of their legs for the foley placement, have them practice.
The cold and wiping of the soap and numbing gel.
Taking slow, deep, relaxing breaths with them to help the nurse place the tiny tube. I practice these with children as they don’t really understand “relaxing breaths”.
Describe the balloon on the end of the catheter as a “bubble” as it is the size of a bubble.
When preparing for the VCUG focus on:
The equipment that they’ll see in the room and its job.
The contrast “special water” and how it will make them feel.
Identify who will be in the room and their role.
Their jobs: to hold their legs still, to play if they’d like, to tell staff when they need to go to the bathroom and can’t hold it.
They should void the catheter out.
After preparing the child and answering questions, create a coping plan. This consists of identifying what the child wants to do during the procedure. For example playing on the iPad, looking at an I SPY Book and/or watching the pictures as they are being taken etc. This coping plan should also include identifying a support person. The support person should be someone that focuses only on the child throughout the procedure.
I hope this helps you when working with children having VCUGs. If you have questions, I would be happy to answer them.