1. Nurse Driven Protocol White River Medical Center Arkansas

2. Urinary Catheter in Place Physician order? Yes No Does the patient meet criteria? YesNo Urinary catheter remains in place Contact charge nurse, clinical lead, or APN to assess for continued need Catheter needed? YesNo Leave catheter in place Remove urinary catheter Contact physician for clarification of continued need based on criteria 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 Urinary Catheter Decision Flowchart If urinary catheter placed by OB/GYN or urologist, call physician prior to removal. Document reason

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

4. Urinary Retention Nurse Protocol 1.Once indwelling catheter is discontinued and or patient is experiencing urinary retention encourage fluids on the patient that is not NPO. 2.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) 3.If patient unable to void after 4-6 hours or complains of inability to void assess: a)presence of bladder distention b)patient’s discomfort and urgency to void c)amount of urine in bladder using Bladder Scan and if greater than 250cc do in and out (intermittent catheterization) using sterile technique. 4.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 5.Continue to take patient to the bathroom every 2 to 4 hours 6.If in 4-6 hours patient still unable to void, may repeat in and out cath. Leave catheter in place on 2 nd in/out cath and contact physician of urinary retention 7.Consider Flomax References: Nazarko, L. (2009). Managing bladder dysfunction using intermittent self-catheterization. British Journal of Nursing, Vol.18, No 2, pp. 110-115.