Nurse Driven Protocol

1. Nurse Driven Protocol White River Medical Center Arkansas

2. Urinary Catheter Decision Flowchart • Criteria for insertion of a urinary catheter: • Acute urinary retention or obstruction • To aid in Surgical Procedure • To assist healing of open sacral or perineum wounds • Immobilization due to multiple trauma • Accurate I and O measurement for the critically ill • Comfort measure for end of life care • ******If patient is being followed by OB/GYN or Urologist call physician prior to removal Contact physician for clarification of continued need based on criteria No Physician order? Urinary Catheter in Place Yes Does the patient meet criteria? Contact charge nurse, clinical lead, or APN to assess for continued need Yes No Catheter needed? If urinary catheter placed by OB/GYN or urologist, call physician prior to removal. Urinary catheter remains in place Document reason Yes No Leave catheter in place Remove urinary catheter

3. Urinary Retention Nursing Protocol Urinary catheter discontinued or onset of urinary retention Able to void • Encourage PO fluids • Assist patient to BR every 2-4 hr • Consider Warm bath/shower • Turn on water in bathroom No Yes Able to void No Place indwelling urinary catheter and notify physician and request Flomax Yes Perform bladder scan • Assess presence of bladder distention • Assess patient’s discomfort/urgency Yes 250cc or greater urine in bladder Yes Bladder distended or discomfort/urgency present Intermittent cath No No No Able to void within 4-6 hours Reassess every 4 hours and PRN and follow protocol as necessary Yes

4. Urinary Retention Nurse Protocol • Once indwelling catheter is discontinued and or patient is experiencing urinary retention encourage fluids on the patient that is not NPO. • Get patient up to the bathroom every 2 to 4 hours to attempt to void. (May need to run water in the sink or pour warm water over the patient’s perineum) • If patient unable to void after 4-6 hours or complains of inability to void assess: • presence of bladder distention • patient’s discomfort and urgency to void • amount of urine in bladder using Bladder Scan and if greater than 250cc do in and out (intermittent catheterization) using sterile technique. • Document bladder scan results, patient assessment of need to void, your attempts to help the patient void, and amount of urine obtained from in and out catheterization • Continue to take patient to the bathroom every 2 to 4 hours • If in 4-6 hours patient still unable to void, may repeat in and out cath. Leave catheter in place on 2nd in/out cath and contact physician of urinary retention • Consider Flomax References: Nazarko, L. (2009). Managing bladder dysfunction using intermittent self-catheterization. British Journal of Nursing, Vol.18, No 2, pp. 110-115.