BULLET: Bladder Ultrasound Limits Length (of Time), Expedites Treatment

In this study, we will enroll female pediatric emergency department (ED) patients presenting
with a diagnosis of abdominal pain who may have a transabdominal pelvic ultrasound ordered by
their treating physician (or nurse practitioner). In order to maximize the visualization of
organs deep within the pelvis such as the ovaries and uterus, the patient's bladder must be
full. The current practice at our institution, as well as numerous others, is to have a
bladder catheter placed immediately when a transabdominal pelvic ultrasound is ordered, and
then to fill the bladder in a retrograde manner in order to provide enhanced visualization of
the pelvic structures. The process of inserting a bladder catheter into a pediatric patient
is an invasive procedure which can be traumatic and painful to the patient. Additionally, if
the patient's bladder is already full, this procedure may be unnecessary.

In this study, a point-of-care bladder ultrasound will be performed, upon enrollment of a
patient by a study bedside sonographer (our pediatric emergency department nurse
practitioners), to assess degree of bladder fullness. This measurement will then be repeated
serially while the patient is receiving hydration and the ultrasound will be performed when
the bladder is full. We hypothesize that this work flow will result in an equivalent time to
transabdominal pelvic ultrasound completion and will reduce the number of potentially
traumatic and painful, invasive urethral bladder catheterizations.

Inclusion Criteria:

- Age 8yr-18yrs

- Female

- Likely to have order placed for transabdominal pelvic ultrasound/ovarian ultrasound

- No history of pelvic or bladder reconstructive surgery

Exclusion Criteria:

- Pregnancy (known)

- Critically ill patients

- Patients with known renal or genitourinary structural abnormalities or prior
pelvic/genitorurinary surgery

- Chronic renal disease

- Patients presenting outside the defined treatment windows