Bladder Management for Stroke Unit Patients - WA Health

Bladder Management For Introduction
Stroke Unit Patients
¾ The most common cause of bladder dysfunction after
Sala Nanthakumar stroke is detrusor hyperreflexion which may be
CNS – Stroke/Neurology Ward compounded with stroke – related impairments (e.g.
weakness, cognitive or perceptual impairments), urinary
RPH tract infection and pre stroke bladder outflow obstruction
(e.g. prostatomegaly or gynaecological problem),
constipation and inability to communicate.

¾ 43 % of stroke patients are incontinent of urine in the first
72 hours.

¾ 26% of patients have catheterisation within one week of
admission.

Normal Bladder Function Management of Neurogenic Detrusor Hyperreflexia
Objectives and Goals
¾ The average bladder holds
between 300 and 500mls of ¾Maintain continence.
urine before it needs to ¾Ensure low bladder pressure
empty. ¾Minimise infection risk.
¾Avoid renal damage.
¾ It is normal to pass urine 4 ¾Improve patient quality of life.
to 6 times during the day ¾Support independent living and
and perhaps once at night.
rehabilitation
¾ Urine should flow easily,
without discomfort in a good
steady stream until the
bladder is empty.

Baseline Assessment Post Assessment
on Admission
¾The nurse will commence a fluid balance
¾Determine when the patient last voided, chart.
where possible.
¾ Facilitate void if bladder volume is > 300 –
¾ Pre admission voiding pattern. 500 mls.
¾ Ward U/A (consider MSU/CSU)
¾ Carry out a bladder scan to ascertain the ¾ Consider patient’s comfort, fluid
intake(2000mls in total per day unless
volume of urine in the bladder. medically contraindicated) and overall
¾Identify potential causes for problem medical management in the use of an IMC
regime.

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Total Urinary Retention Partial Urinary Retention

Residual IMC RE – Scan Residual Encourage IMC Re – Scan
Bladder Volume 5 (Hours) Bladder double Void Hours
5 4hrs volume
>600mls 55 4
6hrs >600mls 6
400 – 599 mls 1

400 – 599mls 5 5 2

200 – 399 mls - 1 hr

< 199 mls - 2hrs -

200 – 399mls 5

< 199mls 5

Bladder management Mandatory Considerations

¾ Residual bladder volume <100mls for 3 ¾ Sterile catheterisation technique should be used for
consecutive bladder scans, cease the
scans. IMCs.
¾ Consider cultural, ethical and communication
¾ Residual bladder volume <50 for 1
bladder scan, cease the scan. requirements for the patient . Utilise interpreter as
required.
¾ Document individual patient requirements ¾ DO NOT FORCE a catheter for insertion.
in the Nursing Care Plan and patient’s ¾ Consider indwelling catheter in neurologically unstable
integrated notes patients or if post void bladder volumes are greater then
3.5 litres in 24 hours.

Ongoing management of References
Incontinence
¾ Getliffe K, Dolman M, 2003. Promoting continence. A
¾Promote adequate fluid intake of 1500mls Clinical and Research Resource. London Bailliere:21-51,
– 2000mls per day unless medically 81-106.
contraindicated.
¾ Chua K, Chou A and Kong K. Urinary incontinence after
¾Maintain accurate intake and output. traumatic brain injury: Incidence, outcomes and
¾Ensure the patient has easy access to the correlates. Brain Injury 2003; 17(6): 469 – 478.

toilet. ¾ National Stroke Foundation 2009a: 99-101.
¾Ensure the patient has access to the call ¾ Jamison J, Macguire S, McCann J. Catheter policies for

bell. management of long term voiding problems in adults
¾Ensure bowel management does not with neurogenic bladder disorders. Cochrane Database
of systemic reviews 2004:2-6.
inhibit voiding. ¾ Rigby D. Underactive bladder syndrome. Nursing
Standard 2005: 19(35): 57-64.

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Bladder management

Any Questions?

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