O3292: Nursing-Performed Bladder Volume Assessment using Point-of-Care Ultrasound Artificial Intelligence

Background: Bladder catheterization (BC) is a common procedure performed in pediatric emergency departments across the country. Although BC it is a routine procedure most often performed by trained nurses, there is still a relatively high reported “unsuccessful” catheterization rate ranging from 22-33%, most often due to a bladder with insufficient urine volume. Point-of-care (POCUS) prior to a BC can confirm the presence of an adequate volume of urine (≥ 2.5-3 mL) and has shown to increase successful catheterization rates from 67-78% without POCUS to 92-95% with POCUS. This study assesses the ability of nurses in an urban pediatric emergency department (PED) to use POCUS to measure bladder volume using a POCUS artificial intelligence (AI) automated bladder volume tool after a brief educational intervention, and then evaluates knowledge and skill retention at 2 months and 4 months after the initial educational intervention.

Methods: This study was a prospective cohort study of a POCUS curriculum for PED nurses to assess bladder volume.  The study had 3 sessions which assessed nurses' ability to assess bladder volume on pediatric models using the AI POCUS tool. Session one included three outcome measures – a written test, Objective Structured Clinical Exam (OSCE), and a survey that included confidence rated on a Likert scale from 1 = not very confident to 4 = very confident–- pre-intervention and immediately after POCUS education.  Session two (two months post-education) and session three (four months post-education), repeated the three measures to assess for skill retention.  Continuous variables are presented as a mean with standard deviation. Paired-samples t-tests were used to compare the three outcomes from pre-intervention and post-session three.

Results: Twelve nurses attended the three testing sessions. Mean age was 35 years ± 10, 79% were female and mean number of years practicing as a pediatric nurse was six years ± five years. 86% felt that POCUS training was in the scope of a pediatric nurse. The mean OSCE score increased from 1.1±1.1 pre-intervention to 5.9±0.3 session three (p,.001). The mean written test score increased from 49%±18 pre-intervention to 96%±7 session three (p <.001). The mean confidence increased from 1.4±0.7 pre-intervention to 3.4±0.7 session three (p <.001).

Conclusion: This study shows that AI bladder ultrasound can be quickly and effectively taught to non-physician members of the health care team who have limited or even no prior ultrasound experience, with the aim of increasing bladder catheterization success rates. The use of AI ultrasound allows for image acquisition and image interpretation to be more accessible to novice users. Future study ideas include examining changes in bladder catheterization success rates when nurse-performed AI bladder ultrasounds are performed.