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Pre-catheterisation
- Confirm appropriate indication
- Relief of acute or chronic urinary retention
- Need for accurate measurements of urinary output in critically ill patients
- Patient requires prolonged immobilisation (e.g potentially unstable traumatic injury)
- To improve comfort for end of life care
- Bladder scan & document result
- Appropriate consent from patient
Catheterisation
- Always insert catheter using aseptic technique
- Anticipate potential difficulties (e.g BPH) and use appropriate size catheter
- Only use 3-way /Coude tip catheter if prior experience
Post-catheterisation
- Always use Trust catheter insertion and management care plan on EPR to document the procedure
- Bladder scan if in doubt regarding correct placement
- Always remove catheter if not draining and there is ongoing doubt regarding correct placement
- Consider whether patient it as risk of post obstructive diuresis
- Ensure patients being discharged home with an indwelling urinary catheter have a Home discharge pack
- Ensure a referral to the district nursing team is completed for organisation of catheter supplies and/or TWOC
- Think about the cause (Neurological e.g. CES, Malignant, Infective, etc)
- Post Obstructive Diuresis (POD) can KILL
- POD – Risk factors
- Large residual volume: often quoted as 1500ml(but cases published with volumes above 800ml)
- Single Kidney
- AKI (reduced eGFR, elevated Creatanine or Urea)
- Oedema/fluid overload
- >200ml/hr urine: this is part of the definition of POD, will mean time of onset is 3hours but can be upto 27hours
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