.jpg "Marilyn Schallom, CCNS, PhD, FCCM photo")
Marilyn Schallom, CCNS, PhD, FCCM
Research Scientist
Barnes-Jewish Hospital
Saint Louis, MO
Disclosure information not submitted.
Laurie Robertson, MSN, MHA
BSN, MSN, MHA
Barnes Jewish Hospital, United States
Disclosure information not submitted.
Donna Prentice, PhD, RN, CNS, FCCM
Research Scientist
Barnes-Jewish Hospital
Saint Louis, Missouri, United States
Disclosure information not submitted.
Kristin Schmid, MD
Washington University in Saint Louis School of Medicine
Saint Louis
Disclosure information not submitted.
Maura Walsh, MD
Critical Care Fellow
Washington University in Saint Louis School of Medicine, United States
Disclosure information not submitted.
Carrie Sona, BSN, CCNS, CCRN, MSN
Clinical Nurse Specialist
Barnes Jewish Hospital
Saint Louis, MO
Disclosure information not submitted.
Brian Wessman, MD, FCCM
Division Chief Critical Care Medicine, Associate Professor of Emergency Medicine and Anesthesiology
Washington University in Saint Louis School of Medicine
Saint Louis, Missouri, United States
Disclosure information not submitted.
Enyo Ablordeppey, MD, MPH, FACEP
Washington University School of Medicine
Saint Louis, MO, United States
Disclosure information not submitted.
Title: Bedside US and Bladder Scanner Based Protocol Safely Reduces Urinary Catheter Use in Kidney Injury
INTRODUCTION/HYPOTHESIS:Catheter associated urinary tract infections (CAUTIs) remain a significant source of morbidity and mortality in ICU patients. Indwelling urinary catheters (IUCs) are often placed and maintained in oliguric patients to monitor renal recovery. A previous study by our group found that non-invasive bladder volume measurement via bedside bladder ultrasound (US) and bladder scanner are accurate and safe. The purpose of this initiative was to reduce IUC usage in oliguric acute kidney injury (AKI) and end stage renal disease (ESRD) patients via implementation of non-invasive bladder volume measurements.
Methods: Quality improvement study was conducted between March 1, 2021 and July 31, 2021. Bedside nurses and physicians working in the surgical ICU (SICU) received in-person and on-line education and training in the IUC removal protocol, bladder scanner (nurses), and bladder US (physicians) prior to project implementation. Adult SICU patients were screened for protocol criteria; IUCs were either not placed or removed per the protocol. Bladder volume measurements were made at predetermined intervals based on previous volume measurement
Results: UC was not placed or removed in 64 (87%) of patients who met criteria, 29 patients with ESRD and 45 with oliguric AKI; the 13% without removal were all AKI patients. Bladder scanners were used for 95% of patients; US for 5%. IUC removal or not placed led to 382 SICU catheter days avoided. IUC utilization rate showed a 9% reduction (73.5% in 2020 down to 66.8%) during first 5 months of program implementation. Seven patients had resumption of urine output (mean = 7 days): two began voiding and five required replacement of IUC. The largest catheter urine volume was 450 ml after measurement with BS of 490 ml in AKI patient with return of renal function. No complications occurred such as bladder rupture, moisture associated skin damage, or obstructive uropathy.
Conclusions: Removal of IUCs in patients with AKI and avoidance of placement in ESRD can be performed safely with non-invasive bladder volume monitoring thus eliminating the risk of CAUTIs.