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U r ina r y Incontinence

U r ina r y Incontinence. Fletcher T . P enn e y , MD Medical Uni v ersity of South Carolina Depa r tment of Medicine. Outline. Introduction. Outpatient. Inpatient. Lea r ning Objecti v es. Cha r acte r istics of p r ima r y types of incontinence

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U r ina r y Incontinence

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  1. UrinaryIncontinence Fletcher T. Penney, MD Medical University of South Carolina Department of Medicine

  2. Outline Introduction Outpatient Inpatient

  3. LearningObjectives • Characteristics of primarytypes of incontinence • Initial workup/management of incontinence • Importance of removing foley catheters • Valid indications for inpatient foley catheters

  4. Outline Introduction Outpatient Inpatient

  5. PatientScreening URINARYINCONTINENCE CircleYes orNo Yes No MedicalAsst. Ask: “Doyouever leakurine/water whenyoudon't want to? Yes No “Does it bother you enough to discuss various options?”

  6. PatientScreening

  7. TypesofUrinaryIncontinence • Urge • Stress • Overflow • Mixed

  8. UrgeIncontinence • Loss of urine with sensation of urgency • Low post-void residual • Detrusoroveractivity • Anticholinergic therapy

  9. StressIncontinence • Loss of urine with exertion, sneeze, cough • Low post-void residual • Kegelexercises, surgery

  10. OverflowIncontinence • Loss of urine in setting of bladder outlet obstruction • High post-void residual • BPH • Intermittent catheterization, treat cause 10/18

  11. MixedIncontinence • Someepisodes of incontinence are consistent with urge incontinence, andsome with stress incontinence • Common in older women • need to determineunderlying cause(s)

  12. Outline Introduction Outpatient Inpatient

  13. MUSC - Early CatheterDiscontinuationProtocol • Nurse-Driven Protocol • Encourageearly removal of foley catheters when appropriate • Shouldbeassessedevery24 hrs bynursing • If no justification for a catheter exists, it canberemovedby the nurse • Physician shouldbecontacted if there is anydoubt

  14. ValidIndicationsforFoleyCatheters • urinary tract obstruction • neurogenicbladder • urologic study or surgeryoncontiguous structures • sacral pressure ulcer (stage III or IV) with incontinence • end-of-lifecare • prolongedsurgery with general or spinal anesthesia • trauma • fluid challenge in acute renal insufficiency • intakeand output monitoring ANDcritically ill/unable to collect urine • lumbarepidural in place • continuousbladder irrigation • acute renal failure with anuria or oliguria

  15. WhatIsn’t aValidIndication? • Nonobstructive renal insufficiency • Transferred fromICU • Patient request • Confusion • Incontinence

  16. RisksofFoleyCatheters • 3–10% daily rate of bacteriuria • 10–25% of these patients will developsymptoms of UTI • 3% will developbacteremia • 42% of patients report it wasuncomfortable • 48% said it was painful • 61% said it restricted their ADLs • Saint, S., Lipsky, B. A., & Goold, S. D. (2002). Indwelling urinary catheters: a one-point restraint? Annals of internal medicine, 137(2), 125–127.

  17. OtherKeyPoints • Studiesshow that physicians are frequently unaware whether their patients haveafoley catheter in place • Highrisks for unnecessary catheters include admission from the EDand transfer from the ICU to the floor.

  18. FoleyTracking • We’re working onaworkflow to notify GenMedteam attendings when their patients havefoley catheters

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