SPHP

INDICATION: Bladder injury, Bladder trauma, Bladder rupture, Bladder laceration, Urine leak, Bladder fistula

SERIES

• 3mm Axial (pre, cysto, postvoid)
  
• 3mm Coronal (pre, cysto, postvoid)
  
• 3mm Sagittal (pre, cysto, postvoid)

NOTES:  

SUPPLIES:

500 mL IV bag normal saline

Cystogram connector tubing (high flow)

50 mL syringe

18 G needle

25 mL of IV contrast - Isovue 300

INSTRUCTIONS:

1) Remove and discard 25 mL of normal saline from 500 mL bag.

2) Place 25 mL of Isovue 300 contrast into 500 mL bag.

(This makes an overall solution of 5% dilution)

3) Shake bag to mix.

4) Insert cystogram connector tubing into IV bag port. Be sure that tubing is occluded first with flow control device to control leakage.

5) Fill connecting tubing with contrast mixture to expel air.

6) Insert cystogram connector tubing tip into Foley catheter securely. (Be sure that Foley has been to gravity drainage prior so the bladder is empty before beginning the exam, then disconnect the Foley bag from the catheter and insert the contrast bag connector into the same large lumen that the Foley bag was connected to. The second smaller Foley catheter lumen is for the balloon – do not connect here.) If after hours, tube connection can be performed by the ER nurse, PA or MD accompanying the trauma patient who has sustained significant injuries. If the patient is an inpatient, then can be performed by the patient's nurse or surgical physician assistant. 

7) Open flow control device on connector tubing to begin instillation. The nurse, PA or MD accompanying the patient should be present during the instillation of the contrast into the bladder.

8) Instill dilute contrast mixture by gravity into bladder. Continue instilling contrast until either 350 cc is instilled or the flow stops. (Do not ever inject with pressure or squeeze bag as bladder injury could occur or worsen.) Estimate the amount of fluid instilled and place the amount on the Radiology requisition for documentation in the official report.

9) Image through the pelvis from 2cm above the iliac crest to the pubic symphysis at 3mm contiguous axial images.

10) Disconnect the contrast tubing and hook back up to Foley bag and drain bladder to gravity.

11)  CT cystography should be performed after routine abdominal/pelvic CT and

renal images so dense extravasated contrast does not obscure other significant pathology

If this is performed in conjunction with a trauma CT A/P scan, no pre-cystogram/precontrast is performed (the portal venous phase images will serve as the pre-cystogram phase)