Catching Up With Clean Intermittent Catheterization: Guide to Products, Tips, and Tricks

Clean intermittent catheterization (CIC) is the gold standard for the management of urinary retention. Students with special healthcare needs who require CIC can be supported by school nurses who have knowledge and expertise in the management of CIC including an understanding of available products, reinforcement of proper technique, and resources available to promote student independence. This article will discuss the variety and unique features of CIC products and tips to overcoming barriers in bladder management.

Intermittent catheterisation

When an individual has voiding difficulties, the person may require a urinary catheter. Enabling the person to choose an appropriate method of catheterisation and supporting them can have an enormous impact on the individual's health and wellbeing. Indwelling urethral catheters are suitable for some people but for others they can affect a person's lifestyle and lead to depression. Intermittent catheterisation can work well for some people. Intermittent self-catheterisation has been used to manage urinary retention for over 3500 years. It remains the 'gold standard' in terms of bladder drainage, but it is under-used and indwelling catheters remain more common. This article examines the history of intermittent catheterisation, indications for self-catheterisation and how to support people to use self-catheterisation.

[Management of bladder retention in an elderly person]

A nurse clinician in urodynamics - advanced practice shares her experience in implementing self-bladder education sessions for bladder retention. The objective is to promote autonomy in the elderly person with bladder retention while developing collaborative work with the referring health care team to promote the transfer of knowledge. This requires a stance of listening and positive reinforcement in order to achieve a therapeutic collaboration with the patient and/or his or her entourage.

Meeting the Needs of the Complex Older Adult Patient with Urinary Retention: A Case Study

This article presents a case study of how a homebound older adult patient with urinary retention is managed by a patient-centered medical home/transitional care model. A description of how a root cause analysis can effectively improve outcomes is also provided.

Teach-Back for quality education and patient safety

Effective clinician-patient communication, a clear understanding of patient literacy, and use of the Teach-Back Method are useful tools in helping patients to better understand their own medical conditions. Educated patients are able to manage their medications, fully participate in their treatments, and follow protocols to achieve the goal of safe quality care. The end result is win-win: positive patient outcomes and increased patient satisfaction.

Post-operative urinary retention

Urinary retention is a common complication of surgery and anaesthesia. The risk of post-operative urinary retention is increased following certain surgical procedures and anaesthetic modalities, and with patients' advancing age. Patients at increased risk of post-operative urinary retention should be identified before surgery or the condition should be identified and treated in a timely manner following surgery. If conservative measures do not help the patient to pass urine, the bladder will need to be drained using either an intermittent catheter or an indwelling urethral catheter, which can result in catheter-associated urinary tract infections. This article provides an overview of normal bladder function, risk factors for developing post-operative urinary retention, and treatment options. Guidance drawn from the literature aims to assist nurses in identifying at-risk patients and inform patient care.

A hard mass discovered in the corpus spongiosum after difficult urethral catheterization: two case reports

Male urethral catheterization is a common procedure rarely causing complications. Difficult urethral catheterization, however, can be problematic for both clinician and patient, leading to unexpected complications. This article will present two unreported cases of urethral trauma during difficult catheterization that resulted in the development of a hard, tumor-like mass in the corpus spongiosum. This is a rare complication that if not recognized might lead to unnecessary invasive interventions for the patient.

Translating an evidence-based algorithm to decrease early post-operative urinary retention after urogynecologic surgery

The implementation of an evidence-based algorithm along with comprehensive nursing education supports effective clinical decision-making in the prevention of post-operative urinary retention and bladder distention for women who have undergone urogynecologic surgery.

Intermittent self-catheterisation: past, present and future

In the past, the only way to drain a bladder was to use intermittent catheterisation. For four millennia, intermittent self-catheterisation (ISC) was used to treat bladder dysfunction. That changed in the 20th century when Foley redesigned and improved on 19th century designs for an indwelling urethral catheter. While some patients benefit from indwelling catheters, long- and short-term indwelling catheters can increase infection risks and contribute to bladder dysfunction. NICE guidance on infection control recommends that intermittent catheterisation should be used in preference to an indwelling catheter if it is a clinically appropriate and practical option for the patient. NICE also recommends that patients should be offered a choice of either single-use hydrophilic or gel reservoir catheters for intermittent self-catheterisation. Voiding problems increase the risks of infection, bladder and renal dysfunction, and can impair quality of life. Individuals who have reasonable bladder capacity and sufficient dexterity and motivation can regain bladder control using ISC, which can make a huge difference to their health and wellbeing.

Traces: making sense of urodynamics testing--part 13: pediatric urodynamics

While the majority of urodynamics studies are performed in adults with stress, urge, and mixed urinary incontinence or urinary retention, urodynamic clinicians are also expected to evaluate special populations. Article 13 of the Traces series focuses on urodynamics testing techniques in infants and children, including children with neurogenic bladder dysfunction.

An evidence-based approach to decrease early post-operative urinary retention following urogynecologic surgery

The Johns Hopkins Nursing evidence-based practice model and guidelines were used to translate evidence into a practice algorithm for the prevention of urinary retention with bladder distention during hospitalization in women having undergone urogynecologic surgery.

Postpartum urinary symptoms

There are clear contributing factors during the antenatal and intrapartum period which increase the likelihood of women experiencing postpartum bladder dysfunction. Whilst, anecdotally, stress incontinence is often talked about and accepted by many women to be part of the post childbirth experience, postpartum bladder retention is not. Understanding both the risk factors and the potential short- and long term impact of bladder dysfunction are important elements in postnatal care. This understanding should guide appropriate management and early detection in the postnatal period, considered vital in avoiding long term sequelae.

Ins and outs of suprapubic catheters--a clinician's experience

In today's evolving health care field, outpatient procedures are becoming more commonplace. Many patients with suprapubic catheters are now being seen in outpatient or home care settings. Addressing the educational needs of patients, family members, and nursing staff is now more important than ever for successful patient suprapubic catheter management. A basic understanding of how these catheters are initially placed is essential for proper care and avoidance of possible complications. This review of initial placement of suprapubic catheters and post-insertion care is based on one clinician's experience and practice at a local hospital in Pennsylvania.

Predictors of acute urinary retention after transurethral resection of the prostate: a retrospective chart audit

A chart audit of patients who had undergone a transurethral resection of the prostate established that 15.4% of 156 patients had postoperative acute urinary retention (AUR). Pre-operative prostate size, clot retention, and pre-operative urinary tract infection distinguished men at risk for post-operative AUR.

'Have you had a wee yet?' Postpartum urinary retention

Physiological changes in the bladder that occur during pregnancy predispose women to develop symptomatic retention of urine during the first hours to days after birth (Saultz et al 1991, Lose et al 1992). A basic definition of postpartum urinary retention (PUR) is the lack of spontaneous micturition six hours after vaginal birth or after removing an indwelling catheter (Humburg 2008). PUR after vaginal birth is a relatively common event, with the reported incidence ranging from 1.7 per cent to 17.9 per cent (Carley et al 2002, Ching-Chung et al 2002, Glavind and Bjørk 2003, Yip et al 2004). When examining why PUR occurs following vaginal birth research often states that instrument-assisted birth and regional analgesia are both independently associated (MacLennan 2002, Groutz 2001,Teo et al 2007). Other common risk factors include primiparity, prolonged first and second stage, perineal damage and oxytocin use (MacLennan 2002, Glavind and Bjørk 2003, Humburg 2008, Groutz et al 2001, Teo et al 2007). Unrecognised urinary retention and mismanagement may lead to recurrent urinary tract infections, upper urinary tract damage and permanent voiding difficulties (Groutz et al 2001). Humburg (2008) suggests that, overall, the lack of guidelines is one of the major problems in treating women with PUR. Careful questioning and examination from the midwife should always be performed to avoid any complication.

Review of intermittent catheterization and current best practices

Intermittent catheterization is the insertion and removal of a catheter several times a day to empty the bladder. This type of catheterization Is used to drain urine from a bladder that is not emptying adequately or from a surgically created channel that connects the bladder with the abdominal surface (such as Mitrofanoff continent urinary diversion). Intermittent catheterization is widely advocated as an effective bladder management strategy for patients with incomplete bladder emptying due to idiopathic or neurogenic bladder dysfunction. Urologic nurses are at the forefront of educating and teaching patients how to self-catheterize. Catheterizations performed in institutions, such as acute and rehabilitation hospitals and nursing homes, are done aseptically. Historically, however, intermittent catheterization has been performed by the patient in the home environment using a clean technique involving the re-use of catheters. New guidelines released in the past three years have recommended changes to the practice of re-using catheters. Currently, nurses use their clinical judgment to determine which technique and type of catheter to use, in conjunction with patient preference. Differential costs and insurance coverage of catheters/echniques may also influence decision making. The authors provide an overview of the indications, use, and complications associated with intermittent catheterization, present current guidelines on self-catheterization and treatment of catheter-associated complications, detail types of catheters, and review clinical practice of intermittent catheterization.

Urinary tract infection rates associated with re-use of catheters in clean intermittent catheterization of male veterans

Clean intermittent catheterization used to manage urinary retention can be complicated by urinary tract infection (UTI). This retrospective study describes the frequency of antibiotic-treated UTI in patients undergoing intermittent catheterization. Most patients did not have UTI; this supports findings in previous studies.

False reading of retained urine from a bladder scan

This case study describes bladder scan findings in an 88-year-old female patient with heart failure and decreased level of consciousness who experienced decreased urinary output. The actions of the nurse demonstrate how gaps between assessment findings and expected outcomes must be investigated further. This case provides an example of the daily need for critical thinking by nurses to promote positive patient outcomes.

Using bladder ultrasound to detect urinary retention in patients

Bladder ultrasound is now considered a safer alternative to catheterisation in the diagnosis of urinary retention. This article outlines how bladder ultrasound works and its practical uses.

Postoperative voiding criteria for ambulatory surgery patients

The number and types of surgeries being performed in ambulatory surgery facilities have increased during the past several years. Many surgeries that were once performed on an inpatient basis routinely occur in outpatient settings today. Patients are required to meet certain discharge requirements and, occasionally, voiding is included in this criteria. Requiring patients to void postoperatively, however, can unnecessarily delay a patient's discharge and contribute to increased anxiety for the patient. This article provides a case study with discussion, a literature review regarding postoperative voiding and urinary retention in ambulatory surgery, and recommendations for future research regarding postoperative voiding criteria for low-risk outpatients.

Paruresis or shy bladder syndrome: an unknown urologic malady?

To date, shy bladder syndrome, or "paruresis," chiefly has been seen as a psychological problem; consequently, little attention has been focused on this debilitating condition. The best estimate is that 7% of the general population, or approximately 17 million people in the United States, suffer from paruresis. While much has been written about urologic topics, such as incontinence and the neurogenic bladder, urologic literature does not contain any articles that specifically refer to paruresis. Little is known about the underlying causes of paruresis, but research indicates that the condition may have a physiological basis in addition to the more obvious psychological factors. Paruresis is a complex medical condition of unknown origin. The lack of awareness among the medical, nursing, and therapeutic communities contributes to the significant unmet needs of patients suffering from paruresis and its related symptoms. Only with education and research, in addition to clarification and agreement of the terminology for this phenomenon, can progress be made in understanding and effectively treating paruresis.

Urinary elimination: Part 2--retention, incontinence and catheterization

In part two of this article, the nursing role in relation to the assessment and management of urinary retention, urinary incontinence and catheterization are considered using recent literature and best practice statements. Retention of urine and incontinence have a major detrimental impact on a person's life and nurses have an important role to play in supporting patients. Catheterization is often necessary for acute retention of urine but is the last resort for incontinence. However, when catheter use is appropriate, asepsis technique during insertion and continuing management can help to minimize associated problems. Urinary elimination problems are embarrassing and distressing and nurses need to deal with them with sensitivity and empathy.

Failing to take appropriate action when informed of a patient's condition

The importance of registered nurses taking into account what their junior members of staff are saying to them is well illustrated in the following case. The Don Hospital is an acute hospital with a continuing care ward accommodating 20 elderly patients suffering mainly with advanced dementia. Most, if not all, of the patients were entirely dependent on nursing staff for their physical needs.

Application of portable ultrasound scanners in the measurement of post-void residual urine

The aims of the present study were to investigate the impact of research subjects' characteristics on the accuracy of the BladderScan when the latter is used to measure post-void residual urine volume, and to evaluate differences between BladderScan and catheterization in terms of the expenditure of time and of human and material resources. Subjects in the present study were 71 patients undergoing inpatient or outpatient rehabilitation therapy. Post-void residual urine was measured with the BladderScan BVI 3000, followed by intermittent catheterization. Repeated- measures ANOVA revealed no statistically significant difference between the post-void residual urine volume measured by the bladder ultrasound and that of catheterization, or among the factors: sex, diagnosis, body position, thickness of abdominal fat, bladder shape, urine volume, and time intervals between operations. The BladderScan averaged 45 seconds (range=17-119 seconds), while catheterization averaged 293 seconds (range=136-664 seconds); the time required for catheterization was 3 to 8 times that for the BladderScan. The BladderScan gave accurate measurements of post-void residual urine volume for all of the subjects. Using the BladderScan first to measure post-void residual urine volume can reduce the frequency of catheterization, and can save medical human resources costs as well.

Management of postoperative urinary retention

Clinical governance has been described as 'the total of all factors that make the National Health Service, and the place in which you work, safe (Lilley, 1999). The term 'clinical governance' was used for the first time in the White Paper, The New NHS: modern, dependable (DoH, 1997), in which the government stated its commitment to giving the people of the United Kingdom a quality health service. Clinical governance is the framework for driving this quality service. It encompasses clinical effectiveness, risk management, fitness to practise and a patient-focused culture, all of which are underpinned by an organisation that supports the ethos.

Measure bladder volume without catheterization

Learn how noninvasive ultrasound scanning can save your patient discomfort and infection risk.

Producing catheterisation guidelines for patients who have oliguria

Little guidance is provided in the literature on whether and when to catheterise patients whose urine output is low. In response to this problem, one nurse in critical care developed an algorithm with a multidisciplinary group of colleagues that would provide a simple, step-by-step guide to reaching a decision on catheterisation in this group of patients.

Managing patients with a distended bladder

A distended bladder is a serious medical situation that requires prompt intervention to drain urine and promote patient comfort. The presence of suprapubic pain distinguishes acute urinary retention from chronic retention. After decompression of the bladder, patients must be monitored closely for post-decompression complications. Additional nursing management may include preparing patients for surgery or additional diagnostic tests.

Postoperative bladder distention: measurement with bladder ultrasonography

Bladder distention is a common postoperative occurrence. A process improvement project was conducted at a Midwestern Veteran Affairs Medical Center to determine whether a new method for detecting bladder distention, bladder ultrasonography, was more effective than manual palpation in the perianesthesia setting. Data were collected on 494 men over a 9-month period using bladder ultrasonography. Of those patients, 19.4% had postoperative bladder distention with greater than 400 mL of urine. This compared with 1.4% of patients who had bladder distention detected during the previous year using manual palpation. Data from the project supported the use of bladder ultrasonography as being more effective than manual palpation in the assessment of postoperative bladder distention in the PACU.

How is follow-up after transurethral prostatectomy best performed?

OBJECTIVE

To evaluate the role of the nurse practitioner (NP) in screening patients for potential discharge after routine transurethral prostatectomy (TURP) or bladder neck incision (BNI) where, although urologists continue to follow such patients, the trend is away from clinic attendance.

PATIENTS AND METHODS

The NP telephoned 70 patients 4 weeks after surgery; information about expected postoperative problems, change in symptoms and the need to visit their general practitioner (GP) was recorded. A doctor then saw all the patients in a clinic 3 months after TURP or BNI.

RESULTS

Complete records were available for 66 patients (TURP 56, BNI 10). Four weeks after their operation, 39 (59%) patients still had one or more significant symptoms but only nine (23%) had consulted their GP. After a telephone interview the NP considered that 38 of the 66 patients were fit to be discharged. At the 3-month outpatient appointment, 37 of these 38 patients were subsequently discharged. Of the remaining 29 patients, 15 (seven with carcinoma of the prostate and eight with significant symptoms) were given follow-up appointments.

CONCLUSIONS

The persistence of significant symptoms in 12% of patients 3 months after TURP justifies the follow-up of all patients. A telephone interview by the NP at one month is recommended. This could result in safe discharge of more than half the patients and allow follow-up of those who need specialist input.