Early Removal of Urinary Catheters in Patients After Rectal Surgery: a Prospective Study
| Status: | Completed |
|---|---|
| Conditions: | Colorectal Cancer, Cancer |
| Therapuetic Areas: | Oncology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 4/2/2016 |
| Start Date: | June 2010 |
| End Date: | August 2014 |
| Contact: | Moe Jalali, MD |
| Email: | moej@stanford.edu |
| Phone: | 650-724-4023 |
Recent national surgical quality guidelines (Surgical Care Improvement Project, National
Hospital Inpatient Quality Measures)state that removal of urinary catheters should occur by
post-operative day two for all surgical patients. These guidelines exclude neither patients
who have undergone rectal surgery nor those with epidural analgesic catheters. The common
practice among most colorectal surgeons is to leave urinary catheters in for three to five
days for patients who have undergone rectal operations, due to concern for urinary
retention. This study aims to explore the outcomes of following the national surgical
guidelines for early urinary catheter removal, especially with regards to urinary retention
and urinary tract infection.
Hospital Inpatient Quality Measures)state that removal of urinary catheters should occur by
post-operative day two for all surgical patients. These guidelines exclude neither patients
who have undergone rectal surgery nor those with epidural analgesic catheters. The common
practice among most colorectal surgeons is to leave urinary catheters in for three to five
days for patients who have undergone rectal operations, due to concern for urinary
retention. This study aims to explore the outcomes of following the national surgical
guidelines for early urinary catheter removal, especially with regards to urinary retention
and urinary tract infection.
All patients undergoing anterior resection (rectosigmoid), low anterior resection,
abdomino-perineal resection, total proctocolectomy with ileal pouch-anal anastomosis,
sigmoid colectomy, and coloanal anastomosis will be included in the study. All patients will
undergo standard pre-operative work-up prior to the operation. As part of the operative
note, the level of the anastomosis must be documented.
1. All patients will have foley catheters removed between 0600 and midnight of
post-operative day 3 (Day 0 being the day of operation).
2. All patients will undergo bladder ultrasound prior to catheter removal.
3. All patients will undergo bladder ultrasound by nursing staff six hours after catheter
removal, and after voiding the first time after catheter removal, or if the patient
experiences symptoms of urinary retention.
6. Patients who meet definition of urinary retention (>100cc post-void residual) will
undergo intermittent straight catheterization every six hours or with symptoms. For those
who refuse intermittent straight catheterization, a indwelling urinary catheter will be
inserted and left in for 24 hours before removal.
7. For patients who have low urine output indicating under-resuscitation, indwelling
catheters will be re-inserted and removed when ongoing resuscitation measures are completed.
8. For patients who are actively undergoing fluid resuscitation on post-operative day 3 will
not have their urinary catheters removed until resuscitation and monitoring is complete.
9. Patients who report symptoms of benign prostatic hypertrophy (BPH) and/or are already on
medications for BPH will be continued on those medications starting on post-operative day 1.
10. Patients who have persistent urinary retention when they are otherwise ready to be
discharged home will be sent home with a leg bag and follow up in urology clinic for voiding
trial in 1-2 weeks.
11. Urinalysis/urine culture will be performed for symptomatic patients.
abdomino-perineal resection, total proctocolectomy with ileal pouch-anal anastomosis,
sigmoid colectomy, and coloanal anastomosis will be included in the study. All patients will
undergo standard pre-operative work-up prior to the operation. As part of the operative
note, the level of the anastomosis must be documented.
1. All patients will have foley catheters removed between 0600 and midnight of
post-operative day 3 (Day 0 being the day of operation).
2. All patients will undergo bladder ultrasound prior to catheter removal.
3. All patients will undergo bladder ultrasound by nursing staff six hours after catheter
removal, and after voiding the first time after catheter removal, or if the patient
experiences symptoms of urinary retention.
6. Patients who meet definition of urinary retention (>100cc post-void residual) will
undergo intermittent straight catheterization every six hours or with symptoms. For those
who refuse intermittent straight catheterization, a indwelling urinary catheter will be
inserted and left in for 24 hours before removal.
7. For patients who have low urine output indicating under-resuscitation, indwelling
catheters will be re-inserted and removed when ongoing resuscitation measures are completed.
8. For patients who are actively undergoing fluid resuscitation on post-operative day 3 will
not have their urinary catheters removed until resuscitation and monitoring is complete.
9. Patients who report symptoms of benign prostatic hypertrophy (BPH) and/or are already on
medications for BPH will be continued on those medications starting on post-operative day 1.
10. Patients who have persistent urinary retention when they are otherwise ready to be
discharged home will be sent home with a leg bag and follow up in urology clinic for voiding
trial in 1-2 weeks.
11. Urinalysis/urine culture will be performed for symptomatic patients.
Inclusion criteria
All patients at Stanford Hospital undergoing:
- anterior resection
- sigmoid colectomy
- low anterior resection
- abdomino-perineal resection
- total proctocolectomy with ileal pouch-analanastomosis
- coloanalanastomosis.
Exclusion criteria Patients with history of neurogenic bladder who had indwelling
catheters or required intermittent straight catheterization prior to surgery
We found this trial at
1
site
Stanford University School of Medicine Vast in both its physical scale and its impact on...
Click here to add this to my saved trials
