Dr. Meddings on catheterizing for urinary retention

In this video, Jennifer Ann Meddings, MD, MSc, describes the background and notable findings from the JAMA Network Open paper “Urinary Retention Evaluation and Catheterization Algorithm for Adult Inpatients.” Meddings is an associate professor at the University of Michigan in Ann Arbor.

Transcription:

Please describe the background for this research.

The background was, I've done a lot of work involving trying to improve the appropriateness of urinary catheter use. A lot of our work had been in, initially, indwelling Foley catheter use in medical patients. I'm an internist. And then we had also been asked, when we published the Medicine paper, what about common surgical patient populations for catheter use? And then when we started looking at, of course, the surgical patient population, one of the main issues for catheter use was post operative urinary retention. And so we reviewed the literature regarding this and realized there really were no clear guidelines for either how to diagnose or manage urinary retention in either the medical or the post operative patient population. That was the impetus for this project, where we first used the RAND UCLA Appropriateness method, which does a systematic literature review, which is where we actually found a paucity of literature for guidelines on this. We had also, at the same time, been doing for other projects a lot of hospital site visits involving urinary catheter use for a variety of different projects. And one thing we kept hearing over and over is, when should we be catheterizing for urinary retention? We heard this from experienced nurses, we heard this from particularly, our surgeons, who were saying, we got a lot of calls about this. And frankly, it seemed like the Wild West about when people were catheterizing or not, what definitions they were using. And I frankly remembered as a resident, I would get called, "so-and-so has 205 in their bladder and we put a catheter in, so can you sign the order?" So it was also this really interesting area where nurses were doing a lot of the assessment and decision for when to bladder scan, which also was a question - when should we be bladder scanning or not? And they were making that decision. And a lot of nurses we've heard in our research work, they work by protocols, and they're very comfortable with protocols. And so we thought it was an area ripe for improving clinical care.

What were some of the notable findings? Were any of them surprising to you and your coauthors?

One thing that we did in the initial part, which was, like lots of clinical scenarios, we initially did them with clinical scenarios where units had bladder scanners. And then we also asked them for units that did not have bladder scanners. Basically, we were surprised, initially, that not all units had bladder scanners when we started doing interviews, and so we had made criteria for both but then when we started trying to implement it in a study that we have that's currently ongoing, we realized that all hospitals tend to have bladder scanners. It's just a matter of if the units have them individually and if the nurses know where the bladder scanner is, and so what we learned is really these days...unless there's an anatomic reason why you can't use a bladder scanner reliably, then, really you should be using a bladder scanner and sometimes that's going to be the most important thing is making sure that your units have one, that it has actually been tested recently for accuracy and that your nurses are comfortable using them.

This transcription was edited for clarity.