Outpatient Treatment 5-7 day course of oral abx (amoxicillin, keflex, etc.)
Hoberman A, Charron M, Hickey RW, et al. Imaging studies aftera first febrile urinary tract infection in young children. NEngl J Med 2003;348:195202.
no benefit to imaging any child who has had a third trimester ultrasound
Use 3-Man Technique for Catheter Urinalysis
Here’s an easier way to obtain a catheter urinalysis on pediatric females when you need a very clean urine specimen, such as for a septic work-up on a small child, or you need to rule out a urinary tract infection.
“It’s a three-man procedure, but well worth the personnel because it’s quick and relatively nontraumatic,” says Teri Howick, RN, nurse educator for the ED at McKay Dee Hospital in Ogden, UT.
The first person, who can be the parent or caregiver, if he or she is willing, stands at the head, reaches over the patient and holds the legs bent in a frog-leg position, she explains. “This is best accomplished by grasping the leg just below the knee, and flexing the leg so it is bent and slightly spread laterally,” says Howick.
The second person stands below the patient, and with gloved hands, gently grasps each labia majora with a dry 2×2, then slightly pulls them out not to the side, she instructs.
“Pulling to the side, which seems like the most logical thing to do, puts undo tension on the fragile tissue of the perineum and actually can tear it,” says Howick. “The labia should be pulled toward the foot of the bed. By this simple maneuver, you will be amazed at how the anatomy just falls into place, like opening a curtain.”
The vaginal opening as well as the elusive urinary meatus are easily visualized in normal anatomy, says Howick. The third person does a quick cleaning, and with a small catheter, take care to aim toward the small of the back downward and at a 45-degree angle or more, instead of straight in as you would an adult female, she explains. “I have had overwhelming success with this technique,” says Howick.
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