THE TIMING OF URINARY CATHETER REMOVAL AFTER CAESAREAN SECTION WHY - - PowerPoint PPT Presentation

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the timing of urinary catheter removal after caesarean
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THE TIMING OF URINARY CATHETER REMOVAL AFTER CAESAREAN SECTION WHY - - PowerPoint PPT Presentation

Nov 15, 2023 40 likes •204 views

THE TIMING OF URINARY CATHETER REMOVAL AFTER CAESAREAN SECTION WHY INSERT A CATHETER FOR C-SECTION? Emptying the bladder helps protect it from injury during surgery Emptying the bladder improves visualisation of the surgical field

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SLIDE 1

THE TIMING OF URINARY CATHETER REMOVAL AFTER CAESAREAN SECTION

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SLIDE 2

WHY INSERT A CATHETER FOR C-SECTION?

  • Emptying the bladder helps protect it from injury during surgery
  • Emptying the bladder improves visualisation of the surgical field
  • Central neuraxial blocks (spinal, epidural) can cause urinary

retention and distension injuries

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SLIDE 3

CATHETER COMPLICATIONS

  • Increased incidence of UTI
  • Urethral pain
  • Voiding difficulties following removal
  • Delayed mobilisation
  • Increased length of hospital stay
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SLIDE 4

THE AUDIT

  • Aim: To help inform best practice regarding the timing of urinary

catheter removal after caesarean section

  • 2 sets of data to present (both for low risk, elective cases)
  • Pre enhanced recovery - March 2014
  • Post enhanced recovery - December 2014
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SLIDE 5

FIRST DATA SET

  • Data collection from 4th March to 4th April
  • Midwives to complete data collection form
  • 42 women
  • 31 (74%) women with complete data collection form
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SLIDE 6

Mean 17.8, SD 3.5 Median 19.0, IQR 4.6 (15-19.6)

Number of women

2 4 6 8 10 12 14

Length of time urinary catheter in-situ (hours)

0-2 2-4 4-6 6-8 8-10 10-12 12-14 14-16 16-18 18-20 20-22 22-24 24-26 26-28 28-30

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SLIDE 7

Number of women

2 4 6 8 10 12 14 16 18 20 22

Time of day of urinary catheter removal

00:00 - 02:00 02:00 - 04:00 04:00 - 06:00 06:00 - 08:00 08:00 - 10:00 10:00 - 12:00 12:00 - 14:00 14:00 - 16:00 16:00 - 18:00 18:00 - 20:00 20:00 - 22:00 22:00 - 00:00

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SLIDE 8

RECATHETRISATION

  • 2 women
  • Rate of 4.8% to 6.5% (optimistically)
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SLIDE 9

SECOND DATA SET

  • Data collection December 2014
  • Data collection from the post-natal care plan
  • 27 women
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SLIDE 10

Mean 9.8, SD 5.7 Median 7.0, IQR 5.0 (6.0-11.0)

Number of women

2 4 6 8 10 12 14 16 18

Length of time urinary catheter in-situ (hours)

0-2 2-4 4-6 6-8 8-10 10-12 12-14 14-16 16-18 18-20 20-22 22-24 24-26 26-28 28-30

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SLIDE 11

FIRST DATA SET VERSUS SECOND DATA SET

Introduction of the enhanced recovery program: → Reduction in length of time urinary catheters in-situ → Urinary catheters no longer simply removed at a convenient time

First data set Second data set Mean 17.8 9.8 SD 3.5 5.7 Median 19 7 IQR 4.6 5

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SLIDE 12

UNANSWERED QUESTIONS

  • Why aren’t all women having their catheters removed at 6 hours

as per the enhanced recovery program?

  • Has the earlier removal of catheters led to a change in the rate
  • f re-catheterisation?
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SLIDE 13

WHY AREN’T ALL WOMEN HAVING THEIR CATHETERS REMOVED AT 6 HOURS AS PER THE ENHANCED RECOVERY PROGRAM?

  • 8 women with catheter in-situ for more than 10 hours
  • 2 due to postpartum bleeding
  • 2 surmised due to postpartum bleeding
  • 2 due to women’s request
  • 2 no clear reason
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SLIDE 14

HAS THE EARLIER REMOVAL OF CATHETERS LED TO A CHANGE IN THE RATE OF RE-CATHETERISATION?

  • 2 women
  • Rate of 7.4% (compared to first data set of 4.8-6.5%)
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SLIDE 15

CONCLUSIONS

  • The introduction of the enhanced recovery program for low risk

women undergoing caesarean section has led to a reduction in the length of time that urinary catheters are in-situ without increasing the need for re-catheterisation

  • Note: Ongoing data collection is now underway to capture all

women undergoing caesarean section, not just low risk, elective cases

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SLIDE 16

ANY QUESTIONS?