Troubleshoot

Any Pressure sensor drifts downward during the study

• check to make sure leur-lock connection is tight
• Make sure that the urodynamic equipment is calibrated
• Change the pressure channel to another cable to make sure that the cable is working properly. If this straightens out the problem, send back the cable.
• If it drifts again then probably there is a leak in the catheter. Replace the catheter and send it back to the company for replacement and resolution of the problem.
• avoid over-insertion of catheter
• -females - insert no more than 8 - 10 cm, with the exception of large patient where length of insertion may be longer
• -males - insert no more than 8 - 10 cm, plus the length of the penis

(Enlargements temporarily disabled).

• use either a styleted catheter or place in a stylet.
• If necessary you can coude the stylet tip prior to insertion thus making the catheter a coude tip.
• Do not force, you may spin the catheter or reposition and replace.
• Straighten out prolapse before insertion
• Straighten out the penis before insertion

Securing catheters:

• use non-abrasive clear tape to secure catheters at desired position, i.e. 1/2" to 1" Blenderm 3M tape. Use of clear tape allows tester to see any kink in catheters that may develop during test
• If position change is required during procedure (i.e. sitting to standing), be sure that catheters have not have not bent/twisted since placement. If necessary resecure catheters at a desired testing position (tape catheters in place while patient is standing)
• male patient, tape should be secured on top at the tip of the penis (5cm from tip), follow with tape fold on to the catheter.
• avoid taping pump tubing channel close to the pressures recording channels (Pves & Pabd). This could result in artifacts on tracings due to movement created by the infusion pump. Tester could secure one pressure channel on one thigh, and the other channel on the other thigh.
• use of Velcro leg strap to secure cable will further stabilize catheter placement

Infusion

• check pump calibration
• infusion line can kink at infusion pump box or catheter sheath
• If infusion seems slow; catheter may be up against the bladder wall or due to bladder pathology (diverticula's adhesions/bridge, prolapse). Pull back and infuse 50 cc's then readjust urethral sensor once bladder is somewhat inflated.
• over insertion - please refer to catheter insertion in technique area
• If patient experiences severe pain on initial infusion (maybe accompanied by flank pain) stop immediately and reposition catheter. It probably was inadvertently placed into the ureter. This may be seen prior to infusion with peristalsis being seen on the Pves channel.

Abdominal Pressures

• check to ensure abdominal catheter is inserted far enough above the anal sphincter.
• -If questioning placement, have patient squeeze (contract) pelvic floor muscles, if pressure increases, insert catheter farther
• To prevent position change of the catheter after appropriate pressure transmission ratio is achieved, bend and kink wire in catheter and then tape in place. This is good for vaginal prolapse and rectal placement to maintain position during the test. This should not affect the abdominal pressure tracing.
• For patients with fecal impaction (Neuro Patients, patient with history of constipation) we recommend enema evacuation prior to procedure or use of a single sensor vesicle catheter(T-DOC-7FS) with the flow channel. After inserting to 8-19 cm's inject 5-10 cc's of saline (using a syringe via filling lumen) giving a protective pocket/environment to work within. This technique will give you more stable readings.
• Vaginal placement with uterus; may inadvertently place sensor through the cervical os. This will cause cramping and may see a contraction pattern. Just pull back catheter and reposition in the posterior formix of vagina or place rectally.

Negative or Dampened Detrussor (Pdet) Pressure

• catheters register true pressure and there are occasions that abdominal pressures can be higher than vesical pressures.
• -This can due to abdominal content or desease process
• check placement of vesical catheter - this can be accomplished by:
• -Ensuring catheter is not over inserted, please refer to catheter insertion in technique area
• If necessary, can be corrected by zeroing abdominal pressure