Introduction
Cystometrogram is a part of urodynamic testing used to measure bladder functions. It aids in diagnosing the cause of lower urinary tract symptoms. A filling medium is instilled into the bladder; the intravesical pressure is measured against volume. Bladder and rectal pressures can be tested with a transurethral and a separate rectal balloon catheter which is connected to an external transducer.
Definition
Cystometry, or CMG, is a series of tests used to examine the bladder capacity, detrusor contracting (neuromuscular) function, urethral pressures, and causes of bladder dysfunction.
Purposes
- To evaluate the bladder muscle activity (abdominal, bladder, and detrusor pressure).
- To identify bladder problems related to an overactive bladder, reduced bladder capacity, or incomplete emptying.
Phases of CMG
- Filling phase (first sensation-resting bladder pressure, detrusor function, bladder compliance, and capacity).
- Voiding phase on pressure flow study.
Indications
- UTI.
- Stress incontinence.
- Spinal cord injury.
- Bacterial prostatitis.
- Benign prostatic hyperplasia.
- Lower urinary tract dysfunction after pelvic radiation or radical pelvic surgery.
- Neurological conditions, such as multiple sclerosis or stroke.
Contraindication
- Acute urinary infection.
Articles
| Articles | Purpose |
| Cystometry with transducers | To assess bladder pressures. |
| Sterile tray with bowl and cotton | To clean around the urinary meatus. |
| Povidone-iodine solution | To disinfect the skin. |
| Lidocaine gel (local anesthetics) (For males to be taken in the 10-mL syringe) | To relieve pain and discomfort during insertion. |
| Foley catheter 14 or 16 Fr or intermittent catheter | To drain the urine. |
| Fine catheter with sensor | To fill the fluid and measure bladder pressure. |
| Rectal balloon catheter | To measure the abdomen pressure. |
| Adhesive tape | To secure the tube. |
| Kidney tray | For draining the fluid. |
| Intravesicular sterile fluid/normal saline 0.9% in a glass bottle held in IV pole, IV set with Luer lock and connecting tube. | To fill the bladder. |
| Sterile gauze | To clean the connecting tube. |
| Underpad | To prevent the soiling of the sheet. |
| Gown and drape | To prepare the patient and cover him or her. |
| Mask, sterile gloves | To minimize the transmission of infection. |
Procedure
| Nursing Action | Rationale | |
| 1. | Explain the procedure to the patient that a catheter will be inserted, the bladder will be filled with fluid, and during filling the patient should describe the first urge to void, and the sensation of being unable to delay urination any longer. | Allays anxiety and obtains cooperation from the patient |
| 2. | Obtain informed consent from the patient. | Serves as legal evidence. Prevents litigation of the staff. |
| 3. | Instruct the patient to change to a hospital gown and ensure the removal of all valuables. Ask the patient to empty his or her bladder before the procedure. Note: Usually uroflowmetry (to measure the rate of urine flow while urination) is performed before cystometry. | General preparation before the procedure. |
| 4. | Perform hand wash. | To prevent cross-infection. |
| 5. | Position the patient supine. | For insertion of the catheter. |
| 6. | Assist the physician in disinfecting the skin, draping the patient, and preparing the articles for the cystometrogram. | To aid in performing the procedure. |
| 7. | Assist the physician by providing lidocaine gel for inserting an intermittent catheter, the residual volume of urine is measured and a small amount of warm fluid is filled into the bladder. | To assess the residual urine, sensation of warmth, urge, pain, etc. |
| 8. | The fluid will be drained out through the catheter into the kidney tray. | To empty the bladder. |
| 9. | Assist the physician in inserting a fine catheter into the bladder which will be connected to a cystometry. | To assess the bladder emptying and filling properly. |
| 10. | Assist the physician in placing a soft rectal tube into the rectum and adhesive electrodes may be placed on either side of the anal opening. | To measure the abdomen pressure and muscle function. |
| 11. | Connect the bladder catheter to a filling solution, which is placed in the IV pole at least 3 feet above. | To aid the flow of the fluid under gravity. |
| 12. | Turn the regulator of the fluid. | To fill the bladder with the sterile fluid. |
| 13. | Ask the patient to cough and bear down during the procedure. | To test the bladder reaction. |
| 14. | Instruct the patient to describe when he or she has the sensation and urge to void. | To assess bladder capacity. |
| 15. | Ask the patient to void, when the bladder is full. | To assess the pressures during voiding. |
| 16. | Assist in removing the catheter post procedure. Dispose of PPE and waste in the bin. | To prevent the transmission of infection. |
| 17. | Replace the articles and perform hand wash. | |
| 18. | Monitor the patient for signs of complications such as UTI, autonomic reflex (severe headache, increased BP, lower heart rate, sweating, and flushing) in patients with SCI or lesions. | To intervene promptly. |
| 19. | Advise the patient to take more fluids and report if fever, abdominal pain, hematuria, or oliguria is present. | To report promptly for seeking medical support. |
| 20. | Document the procedure: Record the date, time, and patient’s response to the procedure. | Serves as legal evidence and prevents duplication of care. |
Special Consideration
- Educate patients on their specific replacement schedule and discourage overwear
- Patients with keratoconus, post-surgical corneas, or severe dry eye may use scleral or hybrid lenses these require advanced care protocols.
- Always wash hands with non-moisturizing soap and dry with a lint-free towel before handling lenses.
- Remove lenses before swimming, showering, or using hot tubs to prevent Acanthamoeba infection.
- Unless specifically prescribed, sleeping in lenses increases risk of microbial keratitis.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
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