If printed, this document is only valid for the day of printing.
Urinary Drainage - Trial Removal of Urethral Catheter in the
Inpatient Setting
Unique Identifier
CP01/BRD/117 – v02.00
Document Type
Clinical Guideline
Risk of non-compliance
may result in significant harm to the patient/DHB
Function
Clinical Practice, Patient Care
User Group(s)
Auckland DHB only
Organisation(s)
Auckland District Health Board
Directorate(s)
All Directorates
Department(s)
Any inpatient clinical area where an adult requires a trial removal
of urethral catheter
Used for which patients? High-risk adult patients requiring removal of urethral catheter
Used by which staff?
All nursing and midwifery staff employed at Auckland DHB
Excluded
Child Health
Keywords
Author
Clinical Nurse Specialist - Urology
Authorisation
Owner
Chief Nursing Officer
Delegate / Issuer
Chief Nursing Officer
Edited by
Document Control
First issued
29 March 2019
This version issued
16 August 2019 - updated
Review frequency
3 yearly
Contents
1. Purpose of guideline.......................................................................................................................... 3
2. High-risk patients ............................................................................................................................... 3
3. Risk factors which can interfere with a successful trial removal of catheter in high-risk patients
3
4. Abbreviations ..................................................................................................................................... 4
5. IDC removal and TROC flowcharts ................................................................................................... 4
IDC removal process .................................................................................................................. 4
TROC process.............................................................................................................................. 5
6. Removal of urethral catheter ........................................................................................................... 5
Equipment required ................................................................................................................... 5
Procedure ................................................................................................................................... 6
7. Following removal of urethral catheter ........................................................................................... 6
Education .................................................................................................................................... 6
Assessment ................................................................................................................................. 6
8. Failed trial removal of catheter ........................................................................................................ 8
9. Supporting evidence.......................................................................................................................... 8
10. Associated documents ...................................................................................................................... 8
11. Disclaimer ........................................................................................................................................... 9
Back to Contents
Trial-Removal-of-Urethral-Catheter-Inpatient-Setting_2019-08-16.docx
Page 1 of 9
If printed, this document is only valid for the day of printing.
12. Corrections and amendments .......................................................................................................... 9
Back to Contents
Trial-Removal-of-Urethral-Catheter-Inpatient-Setting_2019-08-16.docx
Page 2 of 9
If printed, this document is only valid for the day of printing.
1. Purpose of guideline
To ensure the safe removal of a urethral catheter in high-risk adult patients, in the inpatient
setting, by all nursing and midwifery staff employed at Auckland DHB.
2. High-risk patients
High-risk patients include but are not limited to, patients with:
Voiding difficulties prior to catheter insertion and/or known prostatic enlargement
History of chronic urinary retention
Recent AP resection or spinal surgery
Multiple sclerosis
History of previous difficult catheterisation
Diabetic neuropathy
Dementia
Parkinson’s
History of cerebrovascular accident
For these patients, a trial removal of catheter should be considered, as opposed to a simple
catheter removal and void.
3. Risk factors which can interfere with a successful trial removal of catheter in
high-risk patients
Epidural in situ
Antihistamine within last 10 hours
Anticholinergic within last 10 hours
Constipation
Ongoing haematuria and clots
Analgesia poly-pharmacy and unresolved pain
Do not remove urethral catheter until issues are resolved. Consider elevation to appropriate
services.
Back to Contents
Trial-Removal-of-Urethral-Catheter-Inpatient-Setting_2019-08-16.docx
Page 3 of 9
If printed, this document is only valid for the day of printing.
4. Abbreviations
Term
Definition
AP resection
Abdomino perineal resection
BPH
Benign prostatic hyperplasia
FBC
Fluid balance chart
IDC
Indwelling catheter
PVR
Post-void residual
RBP
Recommended best practice
TROC
Trial removal of catheter
5. IDC removal and TROC flowcharts
IDC removal process
Back to Contents
Trial-Removal-of-Urethral-Catheter-Inpatient-Setting_2019-08-16.docx
Page 4 of 9
If printed, this document is only valid for the day of printing.
TROC process
6. Removal of urethral catheter
The removal of a catheter is a medical order.For a trial removal of catheter
an acceptable
post-void residual (PVR) volume must be documented at the time of order. Acceptable
volumes vary for individuals.
A safe standard acceptable PVR is less than 200mL.
Catheters are often removed early in the morning (midnight to midday is preferable), so that
any retention problems can be dealt with during the day.
Pain is frequently encountered during the removal of a urethral catheter and is often a
consequence of ridge formation on the catheter balloon. This can be minimised by allowing
passive deflation of the balloon rather than applying active suction to the deflating channel
(Geng et al., 2012).
Equipment required
Non-sterile gloves (one pair)
30mL syringe for deflating balloon
Incontinence sheet (to protect bed)
Gauze swabs
Back to Contents
Trial-Removal-of-Urethral-Catheter-Inpatient-Setting_2019-08-16.docx
Page 5 of 9
If printed, this document is only valid for the day of printing.
Procedure
Step Action
1.
Explain procedure to patient and inform them of potential symptoms that may occur
following removal, i.e. incontinence, urgency, frequency, dysuria. Symptoms should
resolve over the following 24-48 hours. If not, further investigation may be needed, e.g.
mid-stream urine specimen taken for culture.
2.
Position patient in semi-recumbent position with legs parted. Place incontinence sheet
under patient.
3.
Perform hand hygiene and put on non-sterile gloves.
4.
Attach syringe to catheter valve to deflate the balloon.
Do not use suction on the
syringe but allow the fluid to come back spontaneously.
5.
Ask the patient to breathe in and then out, and to relax pelvic floor muscles. As the
patient exhales, gently remove the catheter, holding it near the urethral meatus. Male
patients should be warned of discomfort as the deflated balloon passes through the
prostatic urethra.
6.
Wrap removed catheter in incontinence sheet and discard.
7.
Clean meatus using gauze, clear away equipment, and make the patient comfortable.
8.
Perform hand hygiene.
9.
Document time of removal in patient’s clinical notes and on FBC.
7. Following removal of urethral catheter
Education
Ensure patient has a copy of the information sheet
Now that your catheter has been removed,
obtained from the Urology website on the Intranet or from Ward 73.
Discuss the need for adequate oral fluid intake of approximately 2-3 litres of fluid per day, for
adequate flushing of the bladder, unless contraindicated.
Advise the patient that frequency and dysuria is common, but will usually resolve once
micturition has occurred at least three times. Inform medical staff if the problem persists.
Advise the patient that urinary urgency may take 24-48 hours to resolve. If it doesn’t, consider
a urinary culture to exclude infection.
Ural sachets may help with stinging or burning on voiding.
If patient is anxious and unable to void, offer them a warm bath or shower to promote
relaxation.
Assessment
Maintain accurate FBC. Include all input and output. The FBC should be maintained until the
risk of high residual urine volumes and/or urinary retention has been fully assessed.
Ideally the patient should void three times to be deemed voiding satisfactorily before the FBC
is discontinued, unless the FBC is needed for other assessment purposes.
Back to Contents
Trial-Removal-of-Urethral-Catheter-Inpatient-Setting_2019-08-16.docx
Page 6 of 9
If printed, this document is only valid for the day of printing.
Following each void a bladder scan must be used to assess the PVR accurately. A PVR needs to
be measured immediately after the patient has voided, preferably after the second and third
void where possible.
Each void should be recorded separately with time, volume and colour of urine documented
on FBC, along with PVR volume.
If the patient is incontinent following removal of urethral catheter always consider urinary
retention with overflow incontinence, and assess with a bladder scan.
In general, a patient should void within six hours of IDC being removed. If the patient has not
voided within six hours of the urethral catheter being removed, the patient
must be assessed
with a bladder scan.
Back to Contents
Trial-Removal-of-Urethral-Catheter-Inpatient-Setting_2019-08-16.docx
Page 7 of 9
If printed, this document is only valid for the day of printing.
8. Failed trial removal of catheter
Contact medical staff if:
○ PVR is greater than documented PVR, after three voids
○ Patient has urinary retention with overflow incontinence, confirmed with bladder scan
○ Patient has not voided within six hours, patient’s comfort level has been assessed and
bladder volume has been assessed with bladder scan.
Medical staff to advise:
o A second reinsertion of catheter and repeat TROC whilst an inpatient or in the community.
o Elevation to Urology Service
- Urology Ward 73 ext.
- Urology Registrar on call
For a trial removal of catheter in the community
o TROC Referral Forms can be accessed from Urology website
○ TROC referral must be accompanied by a District Nursing referral
○ The medical team could consider the use of an alpha blocker (unless contraindicated) in
male patients with untreated benign prostatic hyperplasia (BPH). The TROC to be arranged
once the patient is on optimal dose.
○ GP to refer patient to the Urology Service if patient fails TROC in the community.
9. Supporting evidence
Geng, V., Cobussen-Boekhorst, H., Farrell, J., Gea-Sánchez, M., Pearce, I., Schwennesen, T.,
Vahr, S., & Vandewinkel, C. (2012).
Evidence-based guidelines for best practice in urological
health care. Catheterisation: Indwelling catheters in adults. Urethral and suprapubic. Arnhem,
Netherlands: European Association of Urology Nurses (EAUN).
10. Associated documents
Latex Safety
Infection Prevention and Control
Hand Hygiene - Infection Prevention
Standard Precautions - Infection Control
Now that your catheter has been removed
Trial Removal of Catheter (TROC) Referral Form
Urethral Catheter Management
Back to Contents
Trial-Removal-of-Urethral-Catheter-Inpatient-Setting_2019-08-16.docx
Page 8 of 9
If printed, this document is only valid for the day of printing.
11. Disclaimer
No guideline can cover all variations required for specific circumstances. It is the responsibility of
the health care practitioners using this Auckland DHB guideline to adapt it for safe use within their
own institution, recognise the need for specialist help, and call for it without delay, when an
individual patient falls outside of the boundaries of this guideline.
12. Corrections and amendments
The next scheduled review of this document is as per the document classification table (page 1).
However, if the reader notices any errors or believes that the document should be reviewed
before the scheduled date, they should contact the owner or Document Control without delay.
Back to Contents
Trial-Removal-of-Urethral-Catheter-Inpatient-Setting_2019-08-16.docx
Page 9 of 9