- The patient to know the procedure of catheterisation and removal
- The nurse must educate the patient on what to expect during the process
- Require recording of the volume of the urine in the urine bag on the fluid balance chart
- Patent education on intake of fluid in required amount (Street et al., 2015)
- Give full support to the patient to increase confidence
- Educate the patient report discomfort immediately
- Nurse must stop fluid intake in case of discomfort
- Inform patient that the first urine may be blood stained (Ostaszkiewicz et al., 2016)
The nurse must explain the process of trial of void after the removal of IDC to the patients. The nurse Educate the patient on voiding urethrally using urinal or bed pan when having a desire to void and in case they become uncomfortable. Patent education is necessary to ensure the successful outcome. It will help them realise the importance of regular fluid intake.
Supporting patient is necessary to reduce anxiety and increase the confidence to challenge the bladder. It is safe for the patient to learn that that the discomfort may occur to avoid panic and anxiety.
Further nursing care involves
- Ensure that the patient maintains the fluid intake of 250 - /hour atleast when awake
- Educate the patient on voiding urethrally using urinal or bed pan when having a desire to
- Help patient in regular fluid intake to reduce the risk of disturbed sleep
- Frequent monitoring during the day for voided urine
- Nurse to ensure that the patent’s bladder capacity do not exceed 600mls (Widdall, 2015)
It is necessary that nurse ensures the bladder is filled overnight at the time of sleeping. It will help in increasing the volume of the first void in the morning. It is necessary to keep patient alert and wake to help intake of adequate fluid and voiding activity. Adequate fluid intake (1.5-2L) will help in enough urine output.
Considerations for nurses when a patient commences trial of void after removal of IDC
- Prior to removal of IDC the bladder must be empty
- Nurses need to measure the void volume
- Record the fluid volume each time of void on the fluid balance chart
- Reassessment or re-catheterisation required if the patient has not voided for 6-8 hours
- Require monitoring of the post void residual
- Prior to removal-Assessment (Lynch et al., 2016)
- Monitor and record the failure of trial of void
- Discuss the ongoing plan of care with the patient in an event of failure
Note- The nurse must consider the discomfort of the patients and recatheterise if the patient has not voided for 6-8 hours and must be followed by reassessment. It is necessary to consider the post void residual on atleast three subsequent voids. The nurse must ensure that before the removal of catheter the bladder is completely drained. Prior to removal the assessment should indicate that IDC can be removed. These steps are required because the trial is carried to determine the patient’s ability to successfully empty the bladder and then remove the IDC. Patient safety cannot be maintained if the clinical procedure is not maintained. These considerations are required as it will be easy to monitor and manage the complications when the trial fails.
Precaution at the time of the catheter removal includes the following:
- Nurse to ensure that the patient is not constipated prior to removal
- Collection of patient history before trial
- Assessment for patient symptoms such as nocturia, frequency and the functional bladder capacity
- To keep the option of urethral catheter reinserted in case of fail of trial (Daly et al., 2016)
It is necessary to ensure that the patient is not constipated as it will lead to retention of urine. It may appear that the trail has failed. Patient history is required to know the usual urine time. It will help in having the correct time of the trial of void. Some older patients may have large diuresis overnight and some patients may have large urine volume during day.
Daly, O., Coffey, K., Liberatore, R., Mendoza, C., Comeadow, M., Pohatu, H., & Dibella, V. (2016). Better postpartum bladder care through standardised documentation, screening voids, trial of void protocol and the use of automated bladder scanners. Australian & New Zealand Continence Journal, 22(4).
Lynch, G., Bell, K., Long, D., & Burmeister, L. (2016). Factors associated with the successful removal of indwelling urinary catheters post-operatively in the fragility hip fracture patient. International journal of orthopaedic and trauma nursing, 23, 25-31.
Ostaszkiewicz, J., Hutchinson, A., & Cull, E. (2016). Cleaning, containing and concealing incontinence in residential aged care facilities: staff members' constructions of quality continence care. Australian & New Zealand Continence Journal, 22(4).
Street, P., Thompson, J., & Bailey, M. (2015). Management of urinary catheters following hip fracture. Australasian journal on ageing, 34(4), 241-246.
Widdall, D. A. (2015). Considerations for determining a bladder scan protocol. Journal of the Australasian Rehabilitation Nurses Association, 18(3), 22.