Urinary Retention: Inability to pass urine despite the presence of urine in the bladder.

Transcription

1 FOCUS The assessment and treatment f acute urinary retentin thrugh perfrmance f straight intermittent catheterizatin. This guideline des nt refer t the nging management f urinary retentin. BACKGROUND Ratinale Urinary retentin can cause pain/discmfrt, infectin, lng term damage t the bladder r kidneys, r bladder rupture if left untreated. The Registered Nurses' (RN s) scpe f practice under the British Clumbia Health Prfessin s Act, authrizes RNs t diagnse and manage cnditins withut an rder frm anther health prfessinal (i.e. physician). The Cllege f Registered Nurses has established Standards f Practice: Acting withut an Order. These have been endrsed by BC Children's Hspital and includes an RN s ability t: make a nursing diagnsis identifying a cnditin (acute urinary retentin) as the cause f the signs r symptms f an individual. apply ultrasund fr the purpses f bladder vlume measurement permitting nurses t use ultrasund withut an rder t measure bladder vlume. fr the purpses f assessment r amelirating r reslving a cnditin identified thrugh the making f a nursing diagnsis (i.e. urinary retentin), put an instrument r a device (i.e. urinary catheter) beynd the pening f the urethra. This dcument standardizes the practice f assessment and treatment fr acute urinary retentin acrss BCCH based n the literature and expert evidence, and prvides decisin supprt resurces fr the RN t treat acute urinary retentin. DEFINITIONS Urinary Retentin: Inability t pass urine despite the presence f urine in the bladder. ASSESSMENT Clinical Assessment Patient has sudden inability t pass urine (indwelling/fley catheter nt insitu) Signs and Symptms Patient des nt vid fr 4-6 hurs and has a palpable bladder r cannt pass urine despite sensatin t vid is present Lwer abdminal pain/tenderness Frequent, small vids and /r incntinence/cntinuus leakage f urine Restlessness (with cgnitive impairment) Diaphresis Increased bld pressure in absence f pain r withut histry f hypertensin Prtable bladder ultrasund/scanner (if available) indicates bladder is at least ¼ full. Cntributing Factrs t Cnsider Histry f bladder, kidney, urinary tract abnrmalities, trauma r interventins Pst OR/anesthesia Opiid Infusin Fluid intake level (ral/iv/ng) Cgnitive r neurlgical impairment Medicatin histry (anesthetics, narctics, spinal anesthesia, antichlinergics, beta blckers, calcium channel blckers, tricyclic antidepressants, sympathmimetic drugs) Urea and Creatinine levels t measure fr kidney functin CC BC Children s Hspital Child & Yuth Health Plicy and Prcedure Manual Page 1 f 5

2 Bladder Vlumes Expected Bladder Vlume Patients age less than 2 years Expected Bladder Capacity (EBC) in children less than 2 can be estimated with the fllwing frmula: EBC (ml) = ([2 x age in years] + 2) x 30 Fr example: 6 mnth ld child EBC = ([2 x 0.5] + 2) x (30 ml) = 90 ml Patients age 2-12 years Expected Bladder Capacity (EBC) in children can be estimated with the fllwing frmula: EBC (ml) = (age (years) divided by 2 + 6) x 30 ml) Fr example: 3 year ld child EBC = ( ) x 30 = 225 ml Patients age greater than 12 years ml (urge t vid at 150 ml sense f fullness at 300mL) Abnrmal Bladder Vlume Equal t r greater than ¼ full (¼ f EBC) Equal t r greater than ¼ full (¼ f EBC) Equal t r greater than 400mL PRECAUTIONS / SPECIAL CONSIDERATIONS 1. Urinary catheterizatin can lead t infectin and trauma t the urethra and is assciated with increased length f hspital stay, mrbidity and mrtality. 2. There is a direct relatinship between the incidence f urinary tract infectin and length f time a urinary catheter is in place. 3. Intermittent urinary catheterizatin shuld be a last chice fr determining and treating urinary retentin and shuld nly be cnsidered nce all ther strategies have been exhausted. 4. A prtable bladder ultrasund/scanner is a nninvasive, prtable diagnstic device used t measure the capacity f the bladder and calculate urine vlume. Prtable bladder ultrasund can be used as an adjuvant fr assessment f urinary retentin (when available in the clinical setting). Hwever, prtable bladder ultrasund shuld nt replace clinical assessment. 5. Sme patient cnditins require indwelling catheters (which requires a prescriber s rder). Indicatrs fr use f an indwelling fley catheter include: Epidural analgesia Suspected spinal injuries until spinal x-rays cleared Acute head and spinal injuries Pelvic injuries Renal and urlgical surgery 6. Cntraindicatins: D nt catheterize the patient with trauma, abnrmality r recent interventin t the bladder, kidneys r urinary tract. Cnsult physician. D nt catheterize neutrpenic r thrmbcytpenic patients. These patients require a prescriber s CC BC Children s Hspital Child & Yuth Health Plicy and Prcedure Manual Page 2 f 5

3 rder and may require platelet transfusin prir t catheterizatin. INTERVENTIONS Ratinale 1. ASSESS patient fr signs and symptms f urinary Required data t make a nursing diagnsis. retentin if patient des nt vid fr 4-6 hurs and cnsider cntributing factrs as listed abve. 2. If patient assessment verifies urinary retentin (if Nn-invasive methds may encurage nrmal viding pssible, utilize a prtable bladder and avid need fr intermittent catheterizatin. ultrasund/scanner t verify if bladder is at least ¼ full), EMPLOY nn-invasive strategies t encurage nrmal viding such as: change in psitin (sitting/standing/use f cmmde) ambulatin ensuring pain management privacy the sund f running water r placing hand in warm water blw bubbles thrugh a straw sitz bath r shwer 3. Perfrm straight, intermittent catheterizatin if all ther strategies t encurage nrmal viding have failed t reslve urinary retentin. Ensure catheterizatin is nt cntraindicated. 4. MONITOR patient. If nrmal urinatin ccurs in 4-6 hurs, cntinue with rutine bladder/pericare. This initial treatment relieves the immediate distress f a full bladder and prevents permanent bladder damage. 5. If urinatin des nt ccur in 4-6 hurs, REASSESS Indwelling catheterizatin shuld be perfrmed nly if patient fr acute urinary retentin (if pssible, utilize straight intermittent catheterizatin is unsuccessful in bladder ultrasund/scanner t verify urinary reslving urinary retentin and a prlnged perid f retentin). bladder drainage is anticipated. 6. If patient reassessment indicates nging acute urinary retentin, and patient des nt respnd t strategies t encurage nrmal viding, REPEAT straight, intermittent catheterizatin (t a maximum f 3 catheterizatins in ttal). Cnsider any cntributing factrs t urinary retentin (e.g. piid administratin). Cnsult physician regarding pssible need fr indwelling catheter. DOCUMENTATION Length f time fr indwelling catheterizatin shuld be minimized as much as pssible t prevent increased risk f infectin. DOCUMENT in apprpriate recrds: Initial and nging assessment data (including accurate intake and utput data, use f prtable bladder ultrasund/scanner) Diagnsis f Acute Urinary Retentin Interventins emplyed t encurage nrmal viding Catheterizatin prcess Vlume f urine drained via catheterizatin Character f drainage Patient respnse t treatment Cnsultatin with physician r apprpriate health care prfessinal Other pertinent actins r bservatins CC BC Children s Hspital Child & Yuth Health Plicy and Prcedure Manual Page 3 f 5

4 REFERENCES Andersn, B. and Khadra, A. (2006). Acute urinary retentin: develping an A&E management pathway. British Jurnal f Nursing, 15(8): Baldini, G., Bagry, H., Aprikian, A., and Carli, F. (2009). Pstperative Urinary Retentin. Anesthesilgy, 110(5): Barrisfrd, G.W. and Steele, G.S. (2012). Acute Urinary Retentin. UpTDate Versin 12. Bray, L and Sanders, C. (2006). Nursing Management f paediatric urethral catheterizatin. Nursing Standard, 20(24):51-60 British Clumbia Children s Hspital. (2007). Pediatric Critical Care Prgram: Urinary Catheterizatin Decisin Making Tree. British Clumbia: Authr. British Clumbia Children s Hspital (2008). Creatin and implementatin f a care bundle t reduce catheter assciated urinary tract infectins. British Clumbia: Authr. Carringtn, F. (2005). Has nt passed urine but is the bladder full? British Jurnal f Pediatric Nursing, 15(11): Chi, S. and Awad, I. (2013). Maintaining micturitin in the periperative perid: strategies t avid urinary retentin. Current Opinin in Anesthesilgy, 26(3): Cllege f Registered Nurses f British Clumbia (2013). Scpe f Practice fr Registered Nurses: Standards, Limits, Cnditins. Publicatin Number 433. British Clumbia: Authr. Crpper, J and Llewellyn, N. (2003). Pst-perative retentin f urine in children. Paediatric Nursing, 15(7): Fernandes, M.B.C., da Csta, V.V. and Saraiva, R.A. (2007). Pstperative urinary retentin: evaluatin f patients using piids analgesic. Revista Latin-Americana de Enfermagem (RLAE), 15(2): Fitzpatrick, JM and Kirby, RS. (2006). Management f acute urinary retentin. British Jurnal f Urlgy, 97(S2): Guld, C et al and the Healthcare Infectin Cntrl Practices Advisry Cmmittee. (2009). Guideline fr the Preventin f Catheter Assciated Urinary Tract Infectins Centre fr Disease Cntrl and the Department f Health and Human Service, USA. Gray, M. (2011). Evaluatin f Bladder Filling/Strage Functins. Urlgy Nurse, 31(3): Kaefer, M., Zurakwski, D., Bauer, S.B., Retick, A.B., Peters, C.A., Atala, A. and Treves, S.T. (1997). Estimating Nrmal Bladder Capacity in Children. The Jurnal f Urlgy, 158: Kmen, E. et al (2002). Use f ultrasund bladder mnitring in children after caudal anaesthesia. Paediatric Anesthesia, 12: Mangnall, J. (2006). Intermittent catheterizatin: using a reflective framewrk. Nursing Standard, 20(43): O Farrell, B., Vandervrt, M.K., Bisnaire, D., Dyle-Pettypiece, P., Kpman, W.J. and McEwan, L. (2001). Evaluatin f prtable bladder ultrasund: accuracy and effect n nursing practice in an acute care neurscience unit. Jurnal f Neurscience Nursing, 33(6): Palese, A., Buchini, S., Derma, L. and Barbne F. (2010). The effectiveness f the ultrasund bladder scanner in reducing urinary tract infectins: a meta-analysis. Jurnal f Clinical Nursing, 19(21/22): Pellatt, G.C. (2007). Urinary eliminatin: part 2 retentin, incntinence and catheterizatin. British Jurnal f Nursing, 16(8): CC BC Children s Hspital Child & Yuth Health Plicy and Prcedure Manual Page 4 f 5

5 Rsseland, LA et al. (2005). Mnitring urinary bladder vlume and detecting pst-perative urinary retentin in children with an ultrasund scanner. ACTA Anaesthesilgica Scandinavica, 49: Sherburne, E. and Sawin, K. (2008). Investigating Time t Vid After Lwer-Extremity Orthpedic Surgery in a Pediatric Ppulatin. Jurnal fr Specialists in Pediatric Nursing, 13(1): Sparks, A., Gambrel, A., Jhnsn, J., Jhnsn, J., Daniels, C., Mattingly, H. and Palerm, D. (2004). The clinical benefits f the bladder scanner: a research synthesis. Jurnal f Nursing Care Quality, 19(3): Steggall, M.J. (2007). Acute urinary retentin: causes, clinical features and patient care. Nursing Standard, 21(29): CC BC Children s Hspital Child & Yuth Health Plicy and Prcedure Manual Page 5 f 5