We are having a big push to not use catheters in their pts from a number of ortho surgeons. While this is, in my opinion, inifinitely safer in terms of infection reduction and provides motivation to pts to get out of bed w after surgery or face using the pan, we inevitably have the older gentlemen who just cannot seem to pee within 6-8 hours after surgery and wind up with bladder scans of 450+, get straight cathed or have a foley placed for 24 hours.
I just had lunch with a friend who had knee surgery, male, 60+ yrs old, who said no catheter and he was prescribed Flomax (tamsulosin) for three days post surgery when the opioid pain medications would be most highly used, and no problems peeing.
Anybody else seen this push for no catheters and/or the use of the med? I read more on the drug literature and could see possible blood pressure problems if a pt is volume depleted post surgery, but maybe this has merit as the drug actually has effect on the smooth muscle of the the bladder sphincter?
Jun 8, '12
This is most likely about reimbursement . The CMS put into effect new reimbursement guidelines that were effective in Oct of2008. They would no longer pay for catheter associated UTIs . The same applies for CVCs. For years I have been studying and preaching on how to reduce central line infections but once it was tied to reimbursement everyone is now interested and a flood of products have come onto the market. Too bad it took this.The same will happen for catheter associated urinary tract infections. IMO a risk benefit analysis must be done and not cookie cutter medicine. I work in a hospital that aim to have the urinray catheter discontinued 24 hours post op but I know there are case when it must be left in place or reinserted.
Jun 8, '12
Yep, we follow SCIP guidelines and have goals to discontinue foleys POD#1. I'm just wondering if anyone has seen docs trying tamsulosin in the older gents to stave off the "I can't pee" problems....I'd love to not have foleys in the post op pts at all, but it seems more often than not that we wind up straight cathing.......