1. Urologic Procedure Pelvic Surgery
PILOT - Algorithm for Early Removal of Urinary Catheters Applies to - Elective Total Hip Arthroplasty (May 15 – Jun )
EXCLUSION Criteria
Urologic Procedure Pelvic Surgery
Pre‐admission permanent indwelling catheter
Bladder outlet obstruction (urology is consulted)
Continuous bladder irrigation for gross hematuria
Stage 3 or 4 sacral ulcer in incontinent female patient
Comfort care, end of life
Physician order for strict ins/outs
Does the patient meet any of the EXCLUSION Criteria for leaving the urinary catheter in beyond POD #1 0600hr No
Yes
Remove urinary catheter
Daily assessment of Urinary Catheter requirement
Box 1
Re-assess patient in 4 hours
Does the Pt. still require a Urinary Catheter?
Box 2
Is Patient able to void?
Bladder Scan
Yes No
Less than 400 mLs
Greater than 400 mLs
Assess causes for decrease in output. Encourage oral hydration. Re-assess in 2 hours
Return to Box (2)
Mobilize patient
Does the patient have discomfort, urgency or incontinence?
Does patient complain of Urgency or discomfort?
Yes No
Does Pt. complain of Urgency or discomfort?
If 6 hrs has passed and patient has less than 400 mLs in bladder post, bladder scan and notify MRP
Perform Bladder Scan
Yes No
In/Out Catheterization, then re-assess. Return to Box (1)
Re-assess in 2 hours (perform bladder scan
If volume greater than 600 mLs, perform in/out catheterization
Re-assess in 2 hrs.
Return to Box (2)
If bladder scan mLs re-assess next void
Return to box (1)
If bladder scan less than 100 mLs X 2 consecutive voids
Discontinue Monitoring
If In/Out Catheterization continues after 24 hrs, notify MRP