USE OF A PORTABLE ULTRASOUND DEVICE TO MEASURE POST-VOID RESIDUAL VOLUME AMONG INCONTINENT NURSING-HOME RESIDENTS

OBJECTIVE: To determine the accuracy of a portable ultrasound device f or the assessment of post-void residual (PVR) volume among incontinent nursing home (NH) residents. DESIGN: Prospective, clinical series. SE TTING: Seven community-based nursing homes. STUDY POPULATION: Two hund red one consecutively assessed incontinent NH residents who were parti cipating in a larger clinical trial. MEASUREMENTS: PVR volumes measure d by trained research associates using a portable ultrasound device an d by in-and-out catheterization were compared. The accuracy of the ult rasound was calculated using the volume obtained by catheterization as the gold standard. RESULTS: The ultrasound demonstrated excellent tes t-retest and interrater reliability. For low PVRs, the device was high ly sensitive (.90 for PVR <50 mL and .95 for PVR <100 mL) and moderate ly specific (.71 for PVR <50 mL and .63 for PVR < 100 mL). For PVRs of more than 200 mL (n = 26), the ultrasound had a sensitivity of .69 an d a specificity of .99. CONCLUSION: The portable ultrasound we used wa s reliable and reasonably accurate for assessing PVR in a representati ve sample of incontinent NH residents. Because the sensitivity for cli nically significant urinary retention (PVR >200 mL) was only .69, repe ated measurements may be necessary to exclude high PVR in individual N H residents. Recent changes in ultrasound design should improve its ea se of use and accuracy. Although measuring PVR by ultrasound is much e asier and more comfortable than catheterization for both NH residents and staff, the cost of the device may be a barrier to its widespread u se in the NH setting.