Page 2176 - Cote clinical veterinary advisor dogs and cats 4th

Cystogram 1085.e5

• Mild surgical scrub solution and gauze/ Fill the bulb to the recommended level, and • The catheter is then gently advanced into
close the 3-way stopcock.
sponges for prepping the penis/vulva • After it is clear the bulb can hold air, release the urinary bladder (a stylet can be used
VetBooks.ir • Sterile catheter adapter (Christmas tree) the air from the bulb, leaving the air in the • Inflate the catheter bulb with air, and
with the Foley if necessary).
• Sterile 3-way stopcock
then close the stopcock to maintain infla-
• Enema bag/set
syringe.
• Sterile saline
tion.
• Attach the syringe filled with selected contrast
material to the 3-way stopcock (and fill the • Attach a syringe onto the stopcock, and open
Anticipated Time catheter with positive contrast material if the stopcock to this syringe.
Approximately 30 minutes performing a positive-contrast study). • Remove as much urine as possible from the
• Close the stopcock to the contrast material, bladder (repeat as necessary to allow total
Preparation: Important and open to the syringe filled with air for emptying).
Checkpoints bulb inflation. • Close stopcock to this syringe and discard
• Animal fasted 24 hours (water ad libitum) • In male cats, a sterile tomcat catheter is used. syringe.
• Enema given at least 2 hours before Contrast material is drawn into the syringe, • Turn stopcock open to the contrast medium,
study to remove fecal material from the and the syringe is attached directly to the and inject the dose of chosen agent.
colon, allowing visualization of the urinary catheter. • Palpate bladder periodically to ensure it is Procedures and Techniques
bladder not overdistended.
• Sterile gloves should be worn from this point Possible Complications and • Stop if back pressure is felt, if reflux is seen
forward. Common Errors to Avoid around the catheter, or if the bladder feels
• Positive-contrast cystogram • Urinary bladder rupture full.
○ Dilute positive contrast agent to 15%-30% • Cystitis: hemorrhagic, emphysematous ○ Positive-contrast study: after the contrast
with sterile saline. • Bacterial contamination: iatrogenic UTI material is in the bladder, images can be
○ Dosage of diluted contrast is 10 mL/kg. • Bladder or urethral trauma obtained.
○ Draw appropriate dose into a syringe. • Catheter kinking or knotting ○ Negative-contrast study: after the contrast
• Negative-contrast cystogram • Reaction to positive contrast media (rare) material is in the bladder, images can be
○ Use 10 mL/kg of chosen negative agent • Negative-contrast study: possibility of air obtained.
(cats: 4-50 mL generally adequate). embolism with severe mucosal disease (rare) ○ Double-contrast study: inject the posi-
○ Draw appropriate dose into a syringe. tive contrast, and then roll the animal to
• Double-contrast cystogram Procedure ensure good mucosal coating; follow this
○ Use 10 mL of undiluted positive contrast • Preliminary abdominal radiographs are made with injection of the negative contrast,
agent (cats: 2-4 mL). to determine adequate animal preparation and then images can be obtained.
○ Use 10 mL/kg of chosen negative contrast and set radiographic technique. ○ NOTE: If a double-contrast study is desired
agent (cats: 40-50 mL generally adequate). • The kilovoltage peak (kVp) should be set after a positive-contrast study, the majority
○ Draw appropriate doses into syringes. between 65 and 75 to maximize contrast. of the positive contrast is removed from
• Remove Foley catheter from packaging using • Milliampere seconds (mAs) may need to be the bladder, leaving only a small puddle;
aseptic technique. increased 25%-50% compared with settings then negative contrast is injected.
• Attach catheter adapter (Christmas tree) to for survey radiographs. • Ventrodorsal and lateral radiographs are made
Foley catheter. • The animal should be placed in left lateral immediately after injection.
• Attach 3-way stopcock to catheter adapter. recumbency.
• Draw appropriate amount of air into a • An assistant should extrude the penis in the Postprocedure
syringe to inflate the Foley bulb. male. • After the study is complete, the recoverable
• Attach syringe containing air to the 3-way • The penis/vulva should be prepped with mild volume (majority) of contrast is withdrawn
stopcock. surgical scrub solution. from the urinary bladder.
• Open 3-way stopcock to allow airflow into • Sterile lubricating jelly is placed on the Foley • Air should be removed from the catheter
the catheter bulb to ensure the bulb is intact. catheter. bulb before the catheter is withdrawn.

A B
CYSTOGRAM Positive-contrast cystogram, lateral projection. A, Normal study. B, Large filling defect along caudodorsal
aspect of urinary bladder (arrows), later diagnosed as transitional cell carcinoma.
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