Single arm study, where urine collection will be done via bladder stimulation and subsequently catheterization if they meet the eligibility criteria.

Urinary Tract Infections

The bladder stimulation technique is performed following genital cleaning with a 2% castile soap towelette, which is part of the sterile clean catch urine collection cup kit. For the technique, infants will be held under their armpits by a parent over the bed, with legs dangling in males and hips flexed in females. The nurse or technician will then alternate between bladder stimulation maneuvers: gentle tapping in the suprapubic area at a frequency of 100 taps per minute for 30 seconds followed by lumbar paravertebral massage maneuvers for 30 seconds. These two stimulation maneuvers will be repeated until micturition begins, or for a maximum of 300 seconds.

Bladder Stimulation technique

Children's Hospital of Michigan

Bladder Stimulation Technique for Clean Catch Urine Collection in Infants

Bladder Stimulation Technique for Clean Catch Urine Collection in Infants : Assessing Impact on Patients and Providers in a Pediatric Emergency Department

The technique will be performed following genital cleaning. Infants will be held under their armpits by a parent over the bed, with legs dangling in males and hips flexed in females followed by gentle tapping in the suprapubic area at a frequency of 100 taps per minute for 30 seconds followed by lumbar paravertebral massage maneuvers for 30 seconds. These two stimulation maneuvers will be repeated until micturition begins, or for a maximum of 300 seconds. Urine will be collected in a clean catch specimen container. The research assistant will time the procedure from the start of the stimulation techniques to the start of micturition using a stopwatch. Non nutritive sucking on a pacifier with/without sucrose will be provided as an optional comfort measure. A successful urine collection using the bladder stimulation techniques will be defined by onset of micturition within 300 seconds of bladder stimulation.

Contamination rates of urine cultures obtained using the bladder stimulation technique will be expressed in terms of proportion to the total sample size and this rate will be compared to the contamination rates of urine cultures obtained via catheterization.
The criteria for contamination will be determined per the AAP guidelines for positive urine culture versus contamination rates.
Laboratory definitions of a positive urinalysis and urine culture are defined based on definitions published by the American Academy of Pediatrics and previous authors investigating the bladder stimulation technique.
Three criteria are needed for each definition: Urinalysis result, number of organisms cultured and specific threshold for colony counts based on method of collection.
Positive urinalysis: Bacteriuria, positive leukocyte esterase test, positive nitrite test and/or >/= 10 white blood cells per micro liter; negative urinalysis: do not meet criteria for positive urinalysis

The investigators aim to evaluate the time required for successful urine collection using the bladder stimulation technique.
The research assistant will time the procedure from the start of the stimulation techniques to the start of micturition using a stopwatch. The timing will start from the time the bladder stimulation maneuvers start after the patient is positioned and cleaned till the onset of micturition or until 300 seconds, whichever is earlier. The investigators aim to assess the time taken for successful urine collection using bladder stimulation, especially since prior studies have reported onset of urination within 57 seconds. the ultimate goal is to show that this method of collection is easy, minimally invasive and quick.

The investigators also aim to evaluate the time required for successful urine collection for the entire bladder stimulation technique (initiation of feeding to start of voiding). The research associate will retrospectively review charts and look at the time feeding was initiated and the time taken till the onset of micturition. By doing this, the investigators aim to evaluate the total time of the procedure and thereby establish this as a potentially rapid and quick procedure as compared to catheterization with potential impact on the length of stay.

The investigators aim to evaluate patient distress during the bladder stimulation technique using the Numeric Rating Scale (NRS).
During the bladder stimulation technique, parental perception of pain will be assessed using the Numeric Rating Scale (NRS). The research assistant will administer the NRS to the parent immediately prior to the procedure (T0), during the bladder stimulation technique (T1), 1 minute after completion of the bladder stimulation technique (T2) and 5 minutes after completion of the bladder stimulation technique (T3). For infants undergoing catheterization, parental perception of pain will also be assessed using the NRS at similar time intervals.

The investigators aim to evaluate parent and provider satisfaction with urine collection using the bladder stimulation technique.
After collection of the urine sample using the stimulation technique (whether successful or not), the parent and the nurse will complete a brief questionnaire (administered by the research assistant). The parent questionnaire aims to evaluate parental perception of discomfort and their satisfaction with the stimulation technique. The provider questionnaire evaluates their comfort with the procedure and their perception of patient discomfort. Similar questionnaires will be distributed to the parent and the nurse following catheterization when this procedure is performed.

The investigators aim to evaluate the economic impact of the bladder stimulation technique.
The cost of the bladder stimulation technique will be based on cost of the urine collection cup and nursing time spent on the maneuver. This will be compared to the cost of a urine catheterization kit. Ultimate aim is to evaluate and establish bladder stimulation clean catch as a more cost effect method compared to catheterization.

Yagnaram Ravichandran, MBBS, MD, FAAP

Fellow, Pediatrics Emergency Medicine

Sarnaik Endowment Fund

CHMF Annual Fund

Blue Cross Blue Shield of Michigan Foundation

Each patient in the honey group (group 1) took oral honey in a dose of 5 ml/kg/day (with a maximum dose of 150 ml/day) for four weeks.

Each patient in the molasses (placebo) group (group 1) took molasses in a dose of 5 ml/kg/day (with a maximum dose of 150 ml/day) for four weeks.

Hepatitis A

Each patient in the intervention group (group 1) took oral honey in a dose of 5 ml/kg/day (with a maximum dose of 150 ml/day) for four weeks.

honey

Each patient in the molasses (placebo) group took 5 ml molasses/kg/day for four weeks, with a maximum of 150 ml/day

molasses

The Effects of Honey, as a Dietary Supplement in Children With Hepatitis A

mamdouh abdulmaksoud abdulrhman

professor

Ain Shams University

The routine care group will help us to quantify the routine amount of distress associated with catheterization.

A experimental group will include patients who will have 2% Lidocaine instilled into the urethra prior to catheterization. This group of subjects receiving routine care plus Lidocaine, will be evaluated during each of the four phases of the intervention.

This group will undergo catheterization utilizing routine care plus lubricant jelly instilled into the urethra. This placebo group will aid in discerning the effects of instillation into the urethra on pain and associated distress.

Fevers

Pain

Lubricant jelly instilled in urethra prior to catheterization

Lubricant Instillation

2% Lidocaine lubricant instillation prior to urethral catheterization

sucrose/fever

Bladder Stimulation Technique for Clean Catch Urine Collection in Infants

The Effects of Honey, as a Dietary Supplement in Children With Hepatitis A

Lidocaine Lubricant in Pediatric Urethral Catheterization

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