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Preventing Postoperative Urinary Retention

What is POUR?
Postoperative bladder volume
> 400 ml and unable to void.
Signs and Symptoms vary:
Restlessness
Confusion
Anxiety
Hypertension
Tachypnea
Tachycardia, Bradycardia, or other Arrhythmias
Or Asymptomatic

Why is it ImPOURtant?
Patient safety issue
Increased lengths of stay
Increased readmissions
and ED visits
Decreased patient
satisfaction

Risk Factors for POUR
Type of Anesthesia
Type of Surgery
Emergent surgery
Length of Procedure
> 65 years-old
Male
Meds: Opioids, Anticholinergics,
Sympathomimetics, Beta Blockers
Intraoperative Fluid Volume > 1000 ml

New Order Set for MDs
Patient must void prior to discharge
due to: (Hard Stop)
Spinal
Hernia Repair
Rectal Procedure
Urologic Procedure
Gynecologic/Laparoscopic Procedure
Past Medical History
Other (Specify): _______

If unable to void within ___ hours post procedure,
bladder scan and notify surgeon.

Algorithm
Is patient at
risk
for POUR?
Outpatient with
no risk factors
for POUR
Discharge
Outpatient with
risk factors
for POUR
Unable
to void
Assess
volume by
bladder scan
Bladder
volume
> 400 ml
Call MD for
catheterization
order
Bladder
volume
< 400 ml
Discharge
Advise
patient to
seek medical
assistance if
unable to
void within 8
hours
Void
< 150 ml > 150 ml
Take Away
You are your patients
advocate.

Recognize risk factors for
POUR and if patient needs
to void prior to discharge.

Use the Algorithm

Measure and bladder scan.
Help Prevent
POUR
References
Baldini, G., Bagry, H., Aprikian, A., & Carli, F. (2009). Postoperative urinary retention: anesthetic and perioperative
considerations. Anesthesiology, 110(5), 1139-1157.

Beatty, A.M., Martin, D.E., Couch, M., & Long, N. (1997). Relevance of oral intake an necessity to void as ambulatory
surgical discharge criteria. Journal of PeriAnesthesia Nursing, 12(6), 413-421.

Buchko, B.L. & Robinson, L.E. (2012). An evidence-based approach to decrease early post-operative urinary retention
following urogynecologic surgery. Urologic Nursing, 32(5), 260-273.

Buchko, B.L., Robinson, L.E., & Bell, T.D. (2013). Translating an evidence-based algorithm to decrease early post-operative
urinary retention after urogynecologic surgery. Urologic Nursing, 33(1), 24-32. doi: 10.7257/1053-816X2013.33.1.24

DiBlasi, S.M. (2013). Planned cesarean delivery and urinary retention associated with spinal morphine. Journal of
PeriAnesthesia Nursing, 28(3), 128-135. doi: 10.1016/j.jopan.2012.07.012

Dreijer, B., Moller, M.H., & Bartholdy, J. (2011). Post-operative urinary retention in a general surgical population. European
Journal of Anaesthesiology, 28(3), 190-194. doi: 10.1097/EJA.0b013e328341ac3b

Hansen, B.S., Soreide, E., Warland, A.M., & Nilsen, O.B. (2011). Risk factors of post-operative urinary retention in
hospitalised patients. Acta Anaesthesiologica Scandinavica, 55, 545-548. doi: 10.1111/j.1399-6576.2011.02416.x

Feliciano, T., Montero, J., McCarthy, M., & Priester, M. (2008). A retrospective, descriptive, exploratory study evaluating
incidence of postoperative urinary retention after spinal anesthesia and its effect on PACU discharge. Journal of
PeriAnesthesia Nursing, 23(6), 394-400. doi: 10.1016/j.jopan.2008.09.006

McLeod, L., Southerland, K., & Bond, J. (2013). A clinical audit of postoperative urinary retention in the postanesthesia care
unit. Journal of PeriAnesthesia Nursing, 28(4), 210-216. doi: 10.1016/j.jopan.2013.10.0006

Warner, A.J., Phillips, S., Riske, K., Haubert, M., & Lash, N. (2000). Postoperative bladder distension: Measurement with
bladder ultrasonography. Journal of PeriAnesthesia Nursing, 15(1), 20-25.