Sedation Reduces Distress for Children Needing Invasive VCUG Procedure

Children with urinary tract infections often undergo a radiological procedure known as a VCUG (voiding cystourethrogram) to check for a condition known as vesicoureteral reflux.


While quite helpful from a diagnostic perspective, the VCUG procedure - which requires insertion of a foley catheter into the child's urethra and filling of the child's bladder with saline - can be very distressful to a child and family. According to a recent study, 70 percent of all children (and 80 percent of children 6 months to 3 years) experience serious distress while undergoing a VCUG.


Sensing an opportunity to improve the VCUG experience for patients and families, American Family Children's Hospital began in 2007 to admit all children scheduled for a VCUG through the Pediatric Sedation Program prior to the procedure.


The Sedation Program provides a family-centered environment with care by pediatric nurses, child life staff and the opportunity for sedation, supplemented by preparation and distraction techniques that reduce anxiety. For families of children undergoing VCUG procedures, the results have been very positive.


"VCUG procedures have been done on children for years, usually without sedation," says Greg Hollman, MD, medical director of the Pediatric Sedation Program at American Family Children's Hospital. "After hearing reports and witnessing patients in obvious discomfort, however, we believe the time had come to reduce the stress and anxiety associated with this procedure for children and families."


Accordingly all patients since July 2007 whom are scheduled for a VCUG at American Family Children's Hospital are first admitted to the Pediatric Sedation Program and offered minimal sedation, usually midazolam. Of the 198 patients assessed from July 2007 through January 2009, the level of serious distress observed during the procedure was substantially less than reported in the literature (1.9 versus 3.3 on the Groningen Distress Rating Scale). Moreover, the vast majority of families (more than 80 percent) whose child had previously underwent a VCUG without sedation said having sedation was clearly preferable.


Gretchen Hasenzahl of Rockford, Illinois, whose daughter, Alannah, has undergone the VCUG procedure both with and without sedation, said the difference could not have been more striking.


During Alannah's first VCUG - performed at another hospital where sedation was not used - Gretchen watched in agony as hospital staff tried to catheterize her very distressed daughter.


"There were eight nurses in the room trying to keep Alannah down on the table, while she's screaming. It took more than an hour to get her catheterized. I stood there in tears, feeling totally helpless."


When Alannah was referred to American Family Children's Hospital and required another VCUG, mom and daughter left with nothing but pleasant memories.


"Having the sedation was such a positive for us," Gretchen says. "Even more important, everyone at American Family Children's Hospital knew how to interact with children. The nurses talked to my daughter in a way that made her feel comfortable and in control. They also got the catheter placed in a couple of seconds, with minimal anxiety."


Dr. Hollman, a pediatric critical care specialist who has led the Pediatric Sedation Program since 1991, says there is a great advantage of having all pediatric sedations - about 2,000 each year - in a centralized location.


"We are one of the few children's hospitals I know of that coordinates all sedation procedures under one roof," Hollman says. "Whether a child is scheduled for a bone marrow procedure, a lumbar puncture, an MRI scan or a VCUG, we recognize the anxiety related to each of these procedures and tailor each sedation in a way to minimize the pain and distress for each child."


Physicians and clinical staff are welcome to contact Dr. Hollman directly at (608) 263-8832 or the Pediatric Sedation Program office at (608) 262-4402.