Do you bladder train before removing a Foley cath?

TooterIA said:

I am curious if any facilities have policies on attempting to bladder train by clamping a Foley cather before removing it and if it seems to help. We do not and we frequently have to reinsert indwelling Foleys or do in and out caths because patients cant pee on their own and removal of a Foley.

Jessica

We do because if the foley has been inserted for any amount of time the sphincter looses its need to contract and relax, therefore when you bladder train clamp the foley for 2 hours then release for a short time. Repeat this several times before removing the foley to allow the sphincter to regain control. Our policy teaches that alhtough I am not sure how strictly it is inforced.

Yes we do at my facility (rehab). Most of our patients are 60 years old and up and had Foleys placed before or during surgery. We clamp the cath for 4 hours, then release the clamp for 15 minutes. We do it q4h for 24 hours before DCing the Foley. It helps so much with reducing incontinence. It reminds the bladder what it feels like to be full and then empty. There is usually an order written for an I&O cath if the patient cannot void on their own. But this is rarely the case, since the clamping and releasing is very effective in my experience.

'm not sure the evidence actually supports this. The sphincter is still open due to the foley being there. The bladder is going to react based on stretch receptors. I think this is one of those things that sounds logical but isn't supported. That being said, I think its time to do some research on this.

That was the rationale provided by a Nurse Practitioner. I am not sure if it is correct, but I definitely think bladder retraining has its benefits.

No. We just pull them out. Rarely do we have to straight cath or reinsert. Maybe it's the type of patients and how long they've been in that are causing problems where you work? My patients are trauma patients and the foleys aren't in for more than a few days. Usually they are put in the OR or ER and don't stay long.

I was so glad to see this question, as I have pondered the same issue many times. I work on a post-op/PCU and I have inserted many foley catheters when patients are unable to void. Unfortunately, many of these individuals already had incontinence issues to begin with and anesthesia and narcotics make matters worse. To add to the problems, we are required to bladder scan if the patient has not voided w/i 6 hrs post-op and then straight cath if the amount is over a certain specified (by the doc) amount. I have actually heard nurses say that a patient's bladder "could rupture" when residuals of more than 400mL are found. My issue is that in all the research I have done through med journals, books, and articles, I have learned that spontaneous rupture of the bladder due to retention is almost unheard of. In fact, in the few cases on record there were underlying causes such as bladder cancer, etc. According to the published documentaton that is out there, the bladder will spontaneously empty, not rupture when it can no longer hold more urine. Granted, it could lead to kidney infection after prolonged periods but the same can be said for the catheter. So not only do we not bladder train, but are we too quick to insert the foley in the first place?? Any thoughts on this?

If the patient is unable to void, I would think a Foley or I&O cath would be needed. As far as being too soon to put in a cath, it really depends on the patient. If they are incontinent, it could lead to skin breakdown or if the surgical wound is in close proximity, it could be exposed to the urine. I think early bladder training helps reduce incontinence following cath removal. But if the patient is regularly incontinent, I don't know. That is a good question.

I have found that some ambulatory patients with a Foley cath have trouble with constipation. They say "it just doesn't feel right to have a BM without peeing." I think in those cases, it's best to bladder retrain and remove the cath ASAP.

I found this question on the web and see it is three years old. I think it's a great question. A physician recently ordered to bladder train then DC, when I brought this up to the dsd he said that you have to DC then bladder train. Different from the order.

I am learning about this here. I have worked 0R and 3 med units. We did not do this, but it seems like a good idea for some patients.

I think one difference in theories is one is addressing the sphincster and the other is addressing the smooth muscle and reflex. I think both are adequate because they address both voluntary and involuntary muscles.

I'll get an order for bladder training if I have a patient that had a foley for a long time. When I say a long time, I'm generally speaking >2 weeks. I would certainly want this done for me if I were in this situation, and I provide this as a courtesy because it's no fun having to being straight cath'd due to inability to void. Clamping off the foley (bladder training) allows the detrusor muscle of the bladder regain muscle tone.

I guess this thread is a bit old, but I had my first exposure to this today. A doc ordered a foley clamping trial for a young POD #1 pt and I was pretty surprised, mostly b/c frankly I'd never even heard of clamping trials for a foley. Apparently he said it was because there had been some sort of incident the night before where the bladder got overdistended to 1000cc or some such, and consequently he wanted to retrain the bladder. It seems more or less reasonable, but then, this is the first time I've ever seen it and I have never had patients become newly incontinent of urine post-foley removal. I found this interesting article on the topic:

http://www.ncbi.nlm.nih.gov/pubmed/20500280

Their conclusion is that there isn't at least a routine indication for clamping trials. I was just surprised how little I found on the subject when looking it up, is it more common in certain areas? We rarely/never see it on my floor (surg onc).