A Nurse-Led Voiding Algorithm for Managing Urinary Retention After General Thoracic Surgery

Abstract

Background Untreated postoperative urinary retention (POUR) leads to bladder overdistension. Treatment of POUR involves urinary catheterization, which predisposes patients to catheter-associated urinary tract infections. The hospital’s rate of POUR after lobectomy was 21%, exceeding the Society of Thoracic Surgeons’ benchmark of 6.4%. Nurses observed that more patients were being catheterized after implementation of a newly revised urinary catheter protocol. Objective To reduce the incidence of POUR by implementing a thoracic surgery–specific nurse-led voiding algorithm. Methods Experts validated the voiding algorithm that standardized postoperative assessment. It was initiated after general thoracic surgery among 179 patients in a thoracic surgery stepdown unit of a large Magnet hospital. After obtaining verbal consent from patients, nurses collected demographic and clinical data and followed the algorithm, documenting voided amounts and bladder scan results. Descriptive statistics characterized the sample and the incidence of POUR. Associations were determined between demographic and clinical factors and POUR status by using the t test and χ2 test. Results The POUR-positive group and the POUR-negative group were equivalent with regard to demographic and clinical factors, except more patients in the POUR–positive cohort had had a lobectomy (P = .05). The rate of POUR was 8%. Society of Thoracic Surgeons reports revealed a rapid and sustained reduction in the hospital’s rates of POUR after lobectomy: from 21% to 3%. Conclusion The use of this nurse-led voiding algorithm effectively reduced and sustained rates of POUR.