Continuous Urine monitoring

[Ashman]

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?

[CritterLover, BSN, RN]

there is a device that measures urine hourly, and records the amount. i think it is called "criticore." it isn't fool-proof, but generally works well. the foley "bag" isn't a bag at all, but a rigid palstic container that fits into the device that has a sensor that measures the amount of urine that passes into it. i believe it keeps the total for 24 hours. the first icu i ever worked in had these, and they were wonderful. the only problems you run into are if the container is full, or if the sensor is dirty (or if the batteries run dead). it also has an opening for the temperature probe, so you have a continuous bladder (core) temperature, though it doesn't record and store the temp like it does the urine output. i tried to post a picture but can't. here is the web site:

http://www.bardmedical.com/urology/criticoretour.html

[Ashman]

The staff needs to look at what's in the top of the bag--that is, where the urimeter is--every hour. That section has a separate valve, or stopcock. Read how much is in THERE after one hour, record it, and then empty that little bit of urine (however much you have just measured in the urimeter) into the Foley bag itself utilizing the urimeter stopcock. It only takes a few seconds. Repeat the process every hour.

Are you saying your staff is reluctant to do this--that they simply refuse to do hourly urine outputs, and won't measure the volume that collects in the urimeter reservoir---that they wait until the Foley bag itself is full, or an entire shift has passed? That's sure not good for an ICU setting.

Of course not, we have our SOP's at q1h and q2h in general, but what I am saying is that the whole issue of UO is overloaded with problems whether it be the manual measurement, the time factor associated with it, the potential susceptibility to infection and sometimes the fact that the staff doesn't get to it.

UO as a vital sign has been wholly ignored, and the problems that I mention are not just ours, but rampant. In my search for a solution (or at least a step in the right direction), I came across the following blurb:

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 L's 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 L's distended abdomen on his ward round early that evening, and he asked that a urologist be brought in, but did not himself examine Mr L's 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 L's 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 'it is necessary that the house staff and nursing staff should take early measures if acute retention of urine is suspected'.

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 patient's care and this needs to be addressed by both the medical and nursing staff on the ward.

International Casebook 16, February 2002

I do not exactly remember where I came across this, I think it was in a negligence/malpractice site that I ran into.

The point is that today you would never consider taking a pulse in the following fashion: 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.

UO is a great indicator for so many conditions as well as a great indicator of a general problem, unfortunately there do not seem to be the tools available. Ideally studies would need to be conducted to prove the use of UO as a vital sign, but someone needs to invent the tool first.

[Ashman]

there is a device that measures urine hourly, and records the amount. i think it is called "criticore." it isn't fool-proof, but generally works well. the foley "bag" isn't a bag at all, but a rigid palstic container that fits into the device that has a sensor that measures the amount of urine that passes into it. i believe it keeps the total for 24 hours. the first icu i ever worked in had these, and they were wonderful. the only problems you run into are if the container is full, or if the sensor is dirty (or if the batteries run dead). it also has an opening for the temperature probe, so you have a continuous bladder (core) temperature, though it doesn't record and store the temp like it does the urine output. i tried to post a picture but can't. here is the web site:

http://www.bardmedical.com/urology/criticoretour.html

thanks, i am looking into this.

[begalli]

I hear you. I wonder if urologists, nephrologists, or shock-trauma specialists have a more sophisticated and more efficient device for getting accurate urine outputs--automatically--every hour on the hour.

Such a thing does exist.

The urometers we use in the icu have a digital display of temp and output every hour. As the clock on the device turns over to each new hour it automatically resets the new hour's output to 0 and starts again. It keeps track of the entire stay's output and you can go back to view output for previous hours for up to 24 hours by pushing a down arrow and go back to present by pushing an up arrow.

The values slave automatically into our computer charting. It's backlit for night as well.

Pretty handy.

[begalli]

there is a device that measures urine hourly, and records the amount. i think it is called "criticore." it isn't fool-proof, but generally works well. the foley "bag" isn't a bag at all, but a rigid palstic container that fits into the device that has a sensor that measures the amount of urine that passes into it. i believe it keeps the total for 24 hours. the first icu i ever worked in had these, and they were wonderful. the only problems you run into are if the container is full, or if the sensor is dirty (or if the batteries run dead). it also has an opening for the temperature probe, so you have a continuous bladder (core) temperature, though it doesn't record and store the temp like it does the urine output. i tried to post a picture but can't. here is the web site:

http://www.bardmedical.com/urology/criticoretour.html

this is the one we use. we don't run ours on battery, rather it's rigged up into the wall for power and to communicate with our computers for charting.

it is a problem if it gets full because the air filter at the top of the rigid container gets wet and air can't escape - makes it near impossible to empty the container when this happens - but not a big deal, just change the tubing and container. we empty them q end of shift or sooner if needed. also, like i mentioned earlier, it keeps track of the length of stay output as long as someone doesn't intentionally reset it.

[stevierae]

Such a thing does exist.

The urometers we use in the icu have a digital display of temp and output every hour. As the clock on the device turns over to each new hour it automatically resets the new hour's output to 0 and starts again. It keeps track of the entire stay's output and you can go back to view output for previous hours for up to 24 hours by pushing a down arrow and go back to present by pushing an up arrow.

The values slave automatically into our computer charting. It's backlit for night as well.

Pretty handy.

That's really cool (the Criticore.) I have never seen one of these before, but I sure thought that someone, SOMEWHERE, had to have invented something by now, and, sure enough, they have, and it's available.

Man, engineers are smart!