Do you bladder train before removing a Foley cath?

[TooterIA]

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

[CharmedJ7]

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).

[LTCangel, ADN, BSN, LPN]

On my unit we generally pull foley's ASAP without bladder training. If the patient has trouble voiding after the catheter is removed, we will sometimes see orders to reinsert foley and bladder train for 24hours and then remove foley again. It really depends on the doc, some of them do not believe bladder training is beneficial. Personally, I have bladder trained pts who never felt fullness of their bladder when foley was clamped and on the other hand I have had pts who are very sensitive. So I think it is hard to say if it is beneficial for all pts but it doesn't hurt to try.

[thehipcrip]

The benefit of clamping is that it helps the smooth muscles of the bladder stretch and return to a normal capacity. (Using an indwelling catheter for even a few days can result in bladder shrinkage.) Bladder training does not affect sphincter function or control because, as a previous poster correctly pointed out, the continued presence of the catheter prevents the sphincter from closing and releasing and the individual from relearning to relax their sphincter.

Clamps should never be left in place for more than four hours. Since bacteria in the urine have a geometric progression of doubling, and with some bacteria the doubling time is a short as 15-20 minutes, 4 hours is preferred by most knowledgeable urologist as the maximum time you should have your bladder undrained.

[Elvish, BSN, DNP, RN, NP]

Most of our patients are s/p c-section and have their foleys in for

[dishes, BSN, RN]

According to the response in the attached link, the main thing to look at is the reason the person has the indwelling in the first place, if they have a neurogenic bladder or cognitive impairment then the indwelling should NOT be clamped

dishes

[Horseshoe, BSN, RN]

awareness said:

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.

i don't agree that this happens if a foley has been inserted "for any amount of time." on my unit, i've never been asked to do bladder training.

i'm working prn for a day surgery center. that foley comes out right after surgery, no bladder training, and they all do just fine.

perhaps by saying "any amount of time" you actually mean for an extended period?

[Chris14]

@thehipcrip- Can you direct me somewhere I can find research to back up your information? I was so grateful to see your post. I am a clinical educator and am looking into developing a bladder training protocol at my facility. I am looking for evidence based best practice. I appreciate any information you can pass along! Thank you.

[Andrea_TX]

I graduated from nursing school in the early 90's and bladder training was taught at that time. I have noticed that many younger nurses have not been taught this technique. I agree with thehipcrip about the rationale, but have not been able to find evidece-based best practice information on this topic. I reviewed some of literature about the use of bladder catheters in general, but so far, nothing I've found addressed this question. I will continue the practice since it seems to have some benefits and I can see no harm if performed properly. Hope this helps. If I find any other information, I will post it.