Urinary Catheterisation in ED

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

Urinary Retention Guide: Click HERE 

  • 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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