You see a patient on the ward with an exacerbation of heart failure.
The team has inserted a urinary catheter for fluid monitoring. What would you do?
Open this thread and I'll share my approach.
#MedEd #Tweetorials
@MedTweetorials @SocietyHospMed
@tony_breu @AndreMansoor
The team has inserted a urinary catheter for fluid monitoring. What would you do?
Open this thread and I'll share my approach.
#MedEd #Tweetorials
@MedTweetorials @SocietyHospMed
@tony_breu @AndreMansoor
You might think the presence of a urinary catheter is useful in this instance to measure urinary outputs.
An accurate assessment of fluid status certainly will be important to guide diuresis for this patient.
An accurate assessment of fluid status certainly will be important to guide diuresis for this patient.
However, the presence of a urinary catheter confers an increased risk of catheter-associated UTIs.
These can lead to bacteraemia and have been associated with increased mortality.
These can lead to bacteraemia and have been associated with increased mortality.
The risk of infection outweighs any potential benefits of catheterisation in cases like these.
This has lead to the recommendation not to use catheters in non-critically ill patients for monitoring of urinary outputs.
They also shouldn't be used for incontinence or convenience.
This has lead to the recommendation not to use catheters in non-critically ill patients for monitoring of urinary outputs.
They also shouldn't be used for incontinence or convenience.
Acceptable indications for catheterisation include:
- critical illness
- urinary obstruction
- hospice care
- perioperatively for <2 days
- after urologic procedures.
However, this patient didn't have any of those indications.
- critical illness
- urinary obstruction
- hospice care
- perioperatively for <2 days
- after urologic procedures.
However, this patient didn't have any of those indications.
You decide to remove the urinary catheter and the patient passes a trial of void.
Instead you monitor fluid balance using clinical assessment and daily weighs.
The patient was discharged after four days without any complications.
Instead you monitor fluid balance using clinical assessment and daily weighs.
The patient was discharged after four days without any complications.
In summary:
- Urinary catheters are associated with increased risk of UTI and mortality
- Do not use urinary catheters for monitoring of output for non-critically ill patients
- Instead use clinical assessment and daily weights
- Urinary catheters are associated with increased risk of UTI and mortality
- Do not use urinary catheters for monitoring of output for non-critically ill patients
- Instead use clinical assessment and daily weights
If you found this thread helpful, please like and retweet it so others can find it.
I'm releasing new tweetorials weekly. Follow me today so you don't miss out on future threads!
I'm releasing new tweetorials weekly. Follow me today so you don't miss out on future threads!
Until then, Iād like to hear from you. Is my approach similar to yours? Is there anything you do differently? What did I miss?
Let me know by commenting below.
Let me know by commenting below.
Loading suggestions...