Continuous Urine Monitoring

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    Recently we have been involved in a number of cases where had urine output been more thoroughly monitored, symptoms could have been more readily detected, more focused treatment would have been applied to the patient and therefore better care would have been given in the ER/ICU/OP/Trauma unit.


    Has anyone else had this experience?
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  3. 14 Comments so far...

  4. 0
    As all onco patients are supposed to have accurate I/O checks, the issue is already addressed with my patients.

    The vast majority of inpatients here in the states generally are on I/O. It tends to be a routine admission order.
  5. 0
    Quote from caroladybelle
    As all onco patients are supposed to have accurate I/O checks, the issue is already addressed with my patients.

    The vast majority of inpatients here in the states generally are on I/O. It tends to be a routine admission order.

    We only have problems with the ambulatory onco patients and the majority of inpatients here are on I/O too. Unfortunately you have missed my point. Haven't you ever been in a situation where an attending physician left instructions for urine output to be monitored and if the level falls below say 30 cc/h, to contact them, but as the day goes it turns out that you never get the chance to measure the urine output on an hourly basis? In addition, the business of getting down under the bed, attempting to take a reading - that's no fun.

    I have just been thrust into this urine output monitoring mess, in order to find a better way. Personally I have this gut feeling that urine output really is a vital sign, but there are just no tools available to show it.
  6. 4
    Quote from Ashman
    Haven't you ever been in a situation where an attending physician left instructions for urine output to be monitored and if the level falls below say 30 cc/h, to contact them, but as the day goes it turns out that you never get the chance to measure the urine output on an hourly basis? In addition, the business of getting down under the bed, attempting to take a reading - that's no fun.
    In our ICU, measuring hourly urine is our standard of practice. If anyone were to complain that it wasn't convienent for them to perform this measurement, they wouldn't find much sympathy among the people I work with, myself included. We have foley bags with urometers, so all one has to do is look at the number, and dump the urine in the bag. It takes about 3 seconds. If someone has UOP<30cc/hour for a couple hours , I'm going to call the doc, even if he didn't specifically order me to do so.

    Not checking hourly urine output on critical patients would be like not ever checking blood pressure or neuro status. You can't just ignore a whole system!
  7. 0
    Quote from sway
    In our ICU, measuring hourly urine is our standard of practice. If anyone were to complain that it wasn't convienent for them to perform this measurement, they wouldn't find much sympathy among the people I work with, myself included. We have foley bags with urometers, so all one has to do is look at the number, and dump the urine in the bag. It takes about 3 seconds. If someone has UOP<30cc/hour for a couple hours , I'm going to call the doc, even if he didn't specifically order me to do so.

    Not checking hourly urine output on critical patients would be like not ever checking blood pressure or neuro status. You can't just ignore a whole system!
    Exactly. Some of the mds do not worry unless output falls below 30cc for two hours other mds will flip if they are not notified immediately.
  8. 0
    Our standard protocol is q2h on everybody. This doesn't always happen since we often have pts w/o foleys. We do hourly on immediate post-ops, or if otherwise indicated or ordered d/t diuretic gtts or whatever.
  9. 2
    Quote from sway
    In our ICU, measuring hourly urine is our standard of practice. If anyone were to complain that it wasn't convienent for them to perform this measurement, they wouldn't find much sympathy among the people I work with, myself included. We have foley bags with urometers, so all one has to do is look at the number, and dump the urine in the bag. It takes about 3 seconds. If someone has UOP<30cc/hour for a couple hours , I'm going to call the doc, even if he didn't specifically order me to do so.

    Not checking hourly urine output on critical patients would be like not ever checking blood pressure or neuro status. You can't just ignore a whole system!
    You are by all means correct, these are our standard practices too. On the other hand, we are not talking about SOP's here and evidently we are not alone. In my effort to find an alternative method/procedure to ensure that what sometimes occurs, never happens again, I came across the following blurb (one of many):

    Postoperative retention of urine

    Following a nerve root decompression and L4-S1 posterior spinal fusion, Mr L experienced difficulty passing urine. His urinary output was nevertheless reasonable until the fourth postoperative day, when at midday nurses noted a distended abdomen and suspected urinary retention.

    They notified the house officer, but apparently no further action was taken. Mr Lís fluid balance chart had been discontinued that morning, but it does not appear to have been re-instituted. Mr B, the consultant orthopaedic surgeon, was told about Mr Lís distended abdomen on his ward round early that evening, and he asked that a urologist be brought in, but did not himself examine Mr Lís abdomen.

    It seems that no further action was taken until the urologist came to see Mr L more than 24 hours later. He diagnosed urinary retention and Mr L was then catheterised. Unfortunately, by then the delay had already done its damage. When Mr L was examined three years later, he was still suffering from overflow incontinence despite self-catheterising several times a day.

    We settled Mr Lís claim on the basis of expert opinion which concluded that he had suffered a permanent disability caused by the delay in recognising and treating urinary retention. In the opinion of an expert in orthopaedic surgery, it was not necessary to catheterise a patient prior to a spinal fusion, but Ďit is necessary that the house staff and nursing staff should take early measures if acute retention of urine is suspectedí.

    The consultant was also held to bear much of the reponsibility for his failure to examine Mr L during his ward round.

    Comment

    Postoperative ward rounds are not just courtesy calls. If the patient appears to be suffering a complication it is encumbent on all healthcare professionals involved to ensure the matter is investigated and action taken to correct the problem.

    Good communication between all members of the healthcare team is fundamental to the quality of a patientís care and this needs to be addressed by both the medical and nursing staff on the ward.

    International Casebook 16, February 2002


    Unfortunately I do not remember exactly where I found this, but I think it was a malpractice/negligence site I ran into.

    As I mentioned previously I really feel that UO is a vital sign, but there are no tools (or studies for that matter) to prove it. Unfortunately the problem exists and we need to face it head on and solve it - for the good of our patients.
    CrabbyPatty and WalkieTalkie like this.
  10. 0
    Quote from pricklypear
    Our standard protocol is q2h on everybody. This doesn't always happen since we often have pts w/o foleys. We do hourly on immediate post-ops, or if otherwise indicated or ordered d/t diuretic gtts or whatever.
    Unfortunately what I am finding, in my research to find a solution, is that the problem is more rampant than anyone is willing to concede. We also have SOP's of q2h and definitely hourly in post-ops. However what I am saying is that UO has been the most ignored vital sign there is. Imagine today being in a position where you to monitor a pulse rate: 1) you would use the watch on your wrist, 2) manually count heartbeats, 3) manually record the pulse rate and it would be a different person who took the heart rate every hour - in immediate post-op recovery, otherwise it could be 2 hours or more. It would be ludicrous in the 21st century.

    Today however that is what we are doing with urine output - another vital sign. UO is such a great indicator of so many conditions, as well as a general indicator of a problem, but it has been wholly ignored as a vital sign!
  11. 0
    Quote from hollyster
    Exactly. Some of the mds do not worry unless output falls below 30cc for two hours other mds will flip if they are not notified immediately.
    What I am finding is that some of the mds after they are notified also take 24 hrs to get there. Who is the worse for it - the patient no?
  12. 0
    Quote from Ashman
    What I am finding is that some of the mds after they are notified also take 24 hrs to get there. Who is the worse for it - the patient no?
    Exactally, the patient takes the hit. It sounds like more of an MD problem where you work. If they want urine monitored closely, they need to order a foley. Almost every patient I work with has a foley, and if I felt like a patient needed one, I would certainly ask for an order pronto...or maybe just put one in sans order depending on the MD. The case of urinary retention is a good reminder for us about how even a scheduled surgery can cause complications. Interesting stuff.


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