Revista de Enfermagem em Cuidados Intensivos Perioperatórios e Críticos
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Implementing a New Postoperative Urinary Retention Protocol Using the Individual Maximum Bladder Capacity as Threshold for the Maximum Bladder Volume: A Clinical Observational Study

Brouwer TA, Weiland S, van Roon EN, Kalkman CJ, Veeger N

Background: In three different sized hospitals we investigated the feasibility of implementing a new postoperative urinary retention (POUR) protocol. We used the individual maximum bladder capacity (MBC) as a threshold for bladder catheterization, instead of a fixed bladder volume limit of 500mL. The implementation was stated to be successful when over 80% of the eligible and participating patients were treated following this protocol.

Method: General surgical patients were included if they were between 18 to 60 years old and operated under spinal or general anesthesia without an indwelling urinary catheter. Consenting patients measured their maximum bladder capacity at home, which was recorded in the Electronic Health Record. Postoperatively, patients were intended to be treated according to the new POUR-protocol. The nursing staff was informed by personal information sessions, classical lessons and e-mail.

Results: Of the 338 eligible patients 210 gave informed consent. At the Post Anaesthesia Care Unit 170 patients had measured and registered their maximum bladder capacity. Finally, 114 patients followed the new POUR-protocol (67%). The primary outcome in the largest hospital was 100%, for the medium sized hospital this was 60% and for the smallest hospital this was 58%.

Conclusion: The implementation was successful for the largest hospital (>80%) but not in the other two hospitals. For successfully implementing a new POUR-protocol many barriers need to be addressed. The most important barriers were (1) to achieve commitment from surgical patients who are not aware of POUR, and (2) to achieve commitment from all involved health providers to adhere to a postoperative urinary retention protocol. Anesthesiologists, surgeons and nurses should be aware of their role in preventing POUR and how their actions can influence the quality of care for their patients.