Why Are Wee Waiting?!

Why are wee waiting?

As anyone who has worked in an emergency department that caters for our younger patients knows, at any point during the day you can almost guarantee that there’s a parent somewhere, clasping a bowl to their child, waiting for them to wee.

The clock is ticking, the managers are on your back, and all the while you’re at the mercy of a tiny bladder.

Wouldn’t it be so much easier if there was some easy (and non-invasive!) way to just get that baby to pass urine quicker?

Published online at the EMJ last month, Jonathan Kaufman and team from the Children’s Hospital in Melbourne, Australia have designed and trialled a possible solution called the Quick-Wee method. This was developed through anecdotal reports of children voiding during perigenital cleaning, which the team hypothesised stimulates newborn cutaneous voiding reflexes. Their technique is to perform ten seconds of perigenital cleaning with sterile saline-soaked gauze, then rub saline-soaked gauze suprapubically in a circular motion for up to five minutes. It’s a technique that requires just a single member of staff, and one that they hope can decrease the time it takes to get a clean catch urine sample.

This was a single centre, feasibility study, and therefore all patients had the technique performed and there was no control group. Room temperature saline-soaked gauze was used in half the patients, with cold saline used for the remainder, as it was thought that temperature might have a role here too. The researchers looked at outcomes of voiding within five minutes, successful catch, and parent/clinician satisfaction on a five point Likert scale.

Previous studies have determined an average time to void of between 25 and 60 minutes, with only around 12% passing urine within five minutes. In this study, of 40 children aged between 1 and 24 months old, twelve children (30%) had successful voids in under five minutes, and all of those were under 12 months old. Cold gauze appeared more effective, but not significantly so, and all involved were reportedly satisfied with the technique.

This is a small study, but one that appears to show improvement compared with just waiting with a pot. It’s a technique that is technically easy, and could be performed by a parent or guardian rather than a healthcare professional. The protocol for their randomised controlled trial has already been published, and it will be great to see the results of this once the study is complete.

You can see Dr Kaufman present the team’s findings at the Australasian College of Emergency Medicine Annual Scientific Meeting 2015 here.

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Chris