Evidence-Based Practice Poster Session (Posters #21-#28)
24 - Eliminating Urinary Catheter Use During Total Knee Arthroplasty
Description: Clinical Problem/SignificanceCatheter acquired urinary tract infections (CAUTIs) are a nationwide concern and facilities are finding ways to reduce or eliminate these infections. At Providence Mission Hospital the goal is to eliminate CAUTIs. One initiative is to eliminate unnecessary urinary catheterizations in surgical patients eliminating the risk of CAUTI.BackgroundThe objective was to implement a protocol to eliminate routine insertion of indwelling urinary catheters (IUC) in total knee arthroplasty (TKA) patients. Prior to August 1, 2018, all TKA patients received an IUC in the operating room. The use of IUC in these patients can cause both infectious and non-infectious harms, including increased prevalence of postoperative catheter-associated urinary tract infection (CAUTI), increased risk of joint infection, and delays in early ambulation.Clinical QuestionCan the practice of routine insertion of urinary catheters in total knee arthroplasty patients be safely eliminated? Description of Evidenced-Based ProtocolThe protocol for TKA patient selection criteria for avoiding bladder catheterization was developed by nursing in collaboration with surgeons and perioperative partners. All patients undergoing a primary unilateral TKA were included in the protocol. Exclusion criteria was developed and patients excluded from the protocol received an IUC only during the surgical procedure. A protocol for post-procedure bladder assessment and urinary retention was also developed. Staff in Perioperative services and surgical inpatient units received education on both protocols. Analysis includes monitoring post-operative bladder volume on all TKA patients in the PACU and surgical inpatient unit and recording instances of post-op urinary retention (POUR). Implementation of Evidenced-Based ProtocolThe evidence-based protocol was implemented beginning August 2018 following 2 months of education to the nurses and surgeons regarding both the exclusion criteria and the post-operative bladder assessment protocol.ResultsSpecific recommendations were provided for exclusion criteria from the protocol and for assessing urinary retention. From August to November 2018, of the patients who did not receive an IUC during surgery, 14% experienced POUR and required an intervention of either intermittent catheterization or placement of an IUC. For the patients with POUR that received an IUC, the urinary retention resolved by post-op day 1 and the catheter removed. Conclusions/DiscussionPatients undergoing TKA appear to be at a low risk for urinary retention. The successful implementation of a protocol to eliminate routine use of urinary catheters in TKA may also be expanded to additional procedures including total hip arthroplasty and some general surgeries. Earlier post-op ambulation and no risk of CAUTI were added benefits.Perioperative Nursing ImplicationsNursing time in the OR is shortened, as well as reduced cost and elimination of CAUTI risk.