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She laid up a trolley and was back by the cot minutes later.
‘Someone needs to hold her very firmly in the supine position,’ Andreas said calmly, using the ultrasound to check that the baby had a full bladder.
‘I’ll hold her,’ Libby said immediately, ‘and I know her mum will want to be with her. She’s just nipped to the phone to call home.’
At that moment Alison returned and Andreas quietly explained why they needed to aspirate the bladder.
‘Her temperature is going up and we need to obtain a sterile specimen of urine.’
Alison looked pale and tired. ‘Libby was trying to get a clean catch.’
‘I haven’t managed it,’ Libby said softly, ‘and we really, really need to see if she’s got bugs in her urine. In a child of this age this is the only reliable method and we need to send it to the lab before we start antibiotics.’
Alison nodded. ‘So do it.’ Her mouth tightened. ‘Can I stay with her?’
‘Do you want to?’ Andreas spoke gently and Alison sucked in a breath.
‘Yes. It’s upsetting but I couldn’t bear to think that I wasn’t there for her when she needed me.’
Andreas exchanged glances with Libby and then turned away to wash his hands, scrubbing them methodically.
Libby prepared the trolley and then held the child while he cleaned the area with alcohol and allowed it to dry.
She watched as he inserted the needle gently, aspirating as he advanced it into the bladder, speaking softly to the baby as he worked. It was obvious from the skill and speed of his fingers that he’d performed the procedure many times before.
When he had the sample he withdrew the needle and his gaze flickered to Libby.
‘Can you apply pressure to that site for about two minutes? Then cover it with a dressing.’ He placed the sample on the trolley and turned to Alison. ‘It’s possible that she will have a bit of blood in her urine for the next couple of days so if you notice that in the nappy don’t be alarmed. You can call Libby if you’re worried.’
Libby lifted the gauze and checked that the bleeding had stopped and then applied a dressing. Then she swiftly dressed the sobbing baby and handed her to her mother for a cuddle.
‘Just hold her for a bit and she should settle,’ she advised. ‘She’s had paracetamol and ibuprofen so hopefully her temperature should come down soon.’
Alison looked at her. ‘And the doctor really thinks that she has an infection in her bladder?’
‘Yes, he does. The reason he wants to treat it quickly is because it can spread to the kidneys and cause damage.’
‘But with treatment she should be OK?’
Libby nodded. ‘Dr Christakos will probably want to do more tests to check, but you brought her in straight away so the chances are we’ve caught it before the infection has had time to spread.’
Satisfied that Alison understood the explanation, Libby followed Andreas to the nurses’ station where he was tapping details into the computer.
‘What happens now?’
‘She’s dehydrated so I’m going to put a line in and get some fluid into her. I’m also going to start her on IV antibiotics. When she’s picked up a bit we can give her the rest of the course orally.’
‘You’re not going to wait for the results?’
He shook his head. ‘It’s important to treat her fast. If necessary we can change the antibiotics when the results come back. If the UTI is confirmed, we’ll need to do more tests.’ He didn’t lift his eyes from the screen. ‘All young children have to be investigated for vesicoureteric reflux.’
‘So will you do an ultrasound?’
‘Amongst other things.’ He looked up and smiled briefly. ‘Reflux and scarring can be missed by ultrasound in this age group so she will have to ha
ve cystography.’
‘And you’ll send her for a DMSA scan?’
