Hi. I’m Dr. Chris Cooper. Catherization can be a frightful and painful procedure in children leaving them lasting traumatic memories. This video is going to demonstrate a technique to help decrease the pain and distress in your young patients. The video will cover both the preparation of the patient as well as positioning the patient and importantly the use of 2% lidocaine to anesthetize the urethra. In our study, published in the Journal of Urology, we demonstrated that the use of 2% lidocaine to anesthetize the urethra led to significantly decreased rates of pain and distress in children. In fact, when we compared it to KY jelly the pain scores went from 65 all the way down to 21. Now there are certain contraindications where you would not want to use lidocaine jelly. If the child or patient had urethral trauma or a history of severe cardiac disease or was allergic to the caine family drugs you should not use lidocaine jelly. Please join me now in watching this important procedure that should result in decreased discomfort and distress for your young patients. Thank you. Prior to the catheterization procedure, the child will be asked to change from his or her own clothing into a hospital gown. (We’re gonna have you get into a gown.) One person in the room, preferably a parent or someone with whom the child is familiar, should be designated as a child support person or coach. This person will help the child remain calm and cooperative by providing a focal point and using relaxation and distraction techniques. If available a Child Life Specialist should be involved. A Child Life Specialist is a certified staff member who focuses on the developmental and emotional needs of pediatric patients during uncomfortable and or stressful procedures. Let the child know that the coach is here to help. Explain to the child about the need to be still during the procedure. While supplies are being readied, it is essential for the coach to foster calm and relaxation. During the procedure some children respond well to the use of distraction, such as an interactive book, an interesting toy, or games on a tablet. Most children can practice relaxation techniques such as non force abdominal breathing. Instruct the child to breathe rhythmically with an easy breath in, filling the lungs, followed by gentle exhalation through pursed lips. Helpful prompts include blowing bubbles or blowing on a pinwheel. Both boys and girls should lie on their backs in the bed. Girls are helped to rest in a frog leg position with blankets or towels to support their knees. For privacy and warmth children will be covered with blankets as much as possible. Boys should have slightly bent knees supported by a towel. All children should be encouraged to keep their buttocks down on the bed or table to keep their muscles relaxed. Children often need to be reminded of this throughout the procedure. The child’s genital area will be cleaned with baby wipes or wash cloths. For older children the parent or child may help with this if that is more comfortable for the child. A numbing gel called lidocaine will be put on a cotton ball and placed on the child’s genital area. The child’s genital area will be sterile-ly cleaned by the medical staff. This might be a good time to hold the child’s hands to keep them out of the sterile area. Additional numbing gel will be placed in the child’s genital area and allowed to remain there for a few minutes. The catheter will then be inserted by the medical staff. It is important at this time to remind the child to breathe and remain as relaxed as possible. Once the catheter is placed the coach should continue to help the child either by use of distraction or by explaining what is happening. Support should continue until the child is allowed to leave the exam room. My interaction with a BCUG is to participate in helping the child be calm and to help apply lidocaine and help the physician catheterize the patient. So I see the difference with the patients who’ve had lidocaine and patients who haven’t had lidocaine. Patients that have lidocaine perform better with a catheterization. Sometimes they don’t even notice that it’s happening. With the use of lidocaine I feel with pediatric catheterization the patient’s experience is better. The discomfort level is lower and things tend to go more smoothly. If it were my child I would want lidocaine used. Research shows that the comfort level is far better with the use of lidocaine during a catheterization procedure. The use of lidocaine gel in pediatric catheterization has, we’ve learned that it’s very very important for three main reasons especially in pediatrics. First of all it numbs the urethra where the urinary catheter is placed and it also lubricates that area just due to the gel itself and then thirdly it actually helps the urethra relax and so it kind of opens up and helps us with the placement the catheter itself. Sometimes we have kids that come in that have had traumatizing experiences with a catheterization, whether it be at our institution before we’d incorporated lidocaine gel or at a local hospital, and they’re already flailing and fighting us when they get into a room. And we can talk with them about trusting us. Having child life in there to distract them during this procedure. We tell them exactly what’s going to happen. We tell them how the jelly feels, it feels a little cold and gooey, but it’s there to do, do work and we tell them exactly what it’s going to do and so when you get done with that procedure and they look at you and they’re like oh it’s done! You know that’s so fun and rewarding and you’re high-fiving and you’re just very grate… you’re very grateful as a medical person that you can do that because then we even talk to them about you know when you come back if you ever need this again number one if you’re not in our institution please ask for lidocaine gel but also we’ll do everything in our power not to have you endure pain because that’s not our goal at all. So it’s super rewarding to use it and really prove we believe the results and when actually our parents and our kids can see how it’s effective it’s just very very rewarding. We realized that many many institutions on a day-to-day basis when you put an extra step in a procedure or a plan for the day you may think it’s going to take extra time but what our research has actually found is that if you take the time to place the lidocaine gel, use child life, and do the distraction that’s appropriate, your procedure time is much much less and not only that is that it’s a painless procedure and the kids go away not afraid. You don’t want kids to have a negative thought about coming in to see the doctor or coming into the hospital so it’s a win-win altogether. From a medical standpoint you’re not using more time because it takes a lot more time and energy to fight with a patient. It’s very hard on your heart to have to do that with a pediatric patient so I would like to encourage you to all try lidocaine jelly and see for yourself that actually works. It’s important to give it enough time but your benefits will way out outweigh any time that you think it might take extra. For a physician that doesn’t think the lidocaine gel is necessary to use, is effective, I would actually ask them just come in the room with you and just watch one time and they will be amazed by the outcome because if they actually never see how lidocaine gel is used and see how it affects the child in such a positive manner they, they may not believe you but it’s going to be a one-and-done situation I can promise you that. If they see the benefits they will definitely use it time and time again.