We recently began fast tracking total joints at our hospital. Patients receiving total joint surgery and spinal anesthesia will no longer have Foley catheters inserted in the OR. What evidence based practices or practices at all are you doing in your recovery room/PACU for these patients to treat and prevent POUR?
We moved your thread to the PACU forum for the best response.
For inpatients we make sure the spinal is resolving, sensation to the toes and able to move feet. Depending on the length of surgery/fluids given we may do a bladder scan and PRN straight cath depending on the results.
Outpatients need to void prior to discharge.
Our CRNA's have changed their spinal techniques to use only bupivicaine without the Fentanyl added to make the spinal wear off quicker. They also limit fluids during surgery, 500 mls or less. When BP is an issue they use phenylephrine. None of our joints get catheters, hips, knees, and immediately upon arrival to PACU we have to bladder scan. If there is over 400 mls then we offer bedpan or urinal, if they are not able to go than we straight cath. If there is less than 400 mls and still waiting for a MS room than we scan every hour to keep checking, and ones going home must void prior to discharge.
This was a huge learning curve for us and we have made progress with it. Even though patients void prior to going into the O.R. and fluids are minimal and spinal is minimal, we still get a lot of pt's who had 800 and higher, or they voided in their bed. It was very frustrating for a while but it has gotten better.
We have asked why the change to this method or if it was EBP and we have yet to be shown any evidence. We were also told that UTI's were a problem and they are trying to prevent them, yet when we asked for the data on the # of UTI's in the past compared to today to see if they are improved and still no data shown to us. BTW, we do a ton of straight caths in PACU now, so how is that helping with UTI's? Better to do it in the OR in a more sterile environment while the pt is still sleeping then for us to try and do it in a small gurney in pacu.
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