Document facilitator: CNS Gynaecology
Senior document owner: Clinical Leader Gynaecology
Document number: 1.101411
Issue Date 24 November 2021
Review Date 24 November 2026
Level:
Service Women’s Health
Type:
Protocol
Name:
Catheter management and Trial Removal Of
Catheter (TROC) for post-operative Gynaecology
patients
Purpose
To help staff working on the Gynaecology inpatient wards with the management of
catheters and Trial of Voids after Gynaecological surgery.
Scope
All Women’s Health Service staff working on the Gynaecology inpatient ward.
Trial Removal of Catheter (TROC)
When there are recognizable risks for urinary retention when removing a catheter, a
systematic approach to TROC that assists rapid assessment is to retrograde fill the bladder
through the Foley catheter.
Procedure:
Disconnect the urine bag
Using sterile technique retrograde fill the bladder via the catheter with 300mls (or as
tolerated) of warmed sterile saline
Remove the IDC and ask the woman to void
Measure the void and residual. The voided volume should be at least 200mL and the
residual less than 100mL.
If the patient is unable to void and not uncomfortable, wait a further 60mins and
then try again. Strategies to help initiate voiding may include running water or
voiding in the shower. If the void cannot be measured but the residual is <100mL
that can be considered successful
If TROC is successful, no further voids/residuals are required but the patient should
be encouraged to record voids for the remainder of the day/until discharge (if same
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Document facilitator: CNS Gynaecology
Senior document owner: Clinical Leader Gynaecology
Document number: 1.101411
Issue Date 24 November 2021
Review Date 24 November 2026
day). If voids are consecutively small (<150mL) or the patient is uncomfortable,
consider a bladder scan (see below).
If RTROV process is followed the patient needs to pass urine within an hour of IDC
removal. If unable to pass urine or passes <200ml with >100ml residual volume, IDC
to be reinserted.
An alternative to the retrograde trial is to remove the IDC at 0600 and then measure voids
and residuals as below:
- If patient has 2x successful voids > 200mls with residual <100mls, no further
measurements required
- If voids 100-200mls, continue measuring voids and residuals and liase with medical
staff
If voids < 100mls or residual > 300 mls resite IDC, advise Registrar or Consultant.
Post operative catheter management:
Urinary retention after gynaecological surgery must be prevented. Early warning signs
require catheter management and care to avoid secondary urinary tract infection.
Increasingly catheters are removed at the end of surgery, especially for laparoscopic
procedures.
Prolonged or repeated catheterisation will usually be managed with antibiotic cover: e.g.
Macrobid 100mg BD (1st line).
Gynaecology post-operative urinary retention should be suspected if there are any of the
following signs or symptoms:
Inability to pass urine spontaneously 4-6 hours after surgery
Development of acute lower abdominal pain associated with inability to pass urine
or;
Continuous leakage of urine with a palpable bladder
Slow hesitant intermittent stream, with straining to void, sense of incomplete
emptying
A palpable and percussable bladder
Spontaneously voided volumes less than 100mls with residual volumes >200mls.
Nursing Management of suspected urinary retention:
If you are able to use the bladder scanner:
Measure residual urine within 10 min of attempted void
If void < 150 mls and residual > 150 mls a catheter should be inserted (using aseptic
technique).
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Review Date 24 November 2026
If no catheter is in situ and/or unable to use the bladder scanner:
Insert a urethral Foley catheter (using aseptic technique) after failed/poor attempt at
voiding
If void < 150 mls and a residual > 150mls is drained the catheter balloon should be
inflated and the catheter left in.
If a catheter is placed, discuss with the medical team in terms of when to consider
TROC as above. In a postoperative patient who is unable to void on the day of
surgery, a catheter can be placed and then standard TROC procedure followed the
next morning
without discussion with the medical team.
If there is a Suprapubic catheter in situ:
Clamp the SPC and encourage voiding when desire felt or by 4h post clamping.
Following voiding, unclamp and measure ‘the residual’ urine volume.
If void > 100mls or residual < 200mls, continue observations and documentation.
If void < 100mls or residual > 200mls drains, leave SPC unclamped (‘on free
drainage’) overnight or until medical team review.
Supra-pubic catheter can be removed after:
Two voids > 200mls combined with residual volumes < 100mls.
Documentation
Use the
Trial of Void - Gynaecology form
(CapDocs ID 1.101413) and record:
1.
Every Voided urinary volume
2.
Every Residual volume until considered ‘passed’. The residual volume must be
measured within 10 minutes of voiding, either by a bladder scanner, draining the
Suprapubic catheter or inserting an ‘in-out’ urethral catheter with sterile technique.
Measurements can be stopped when:
A spontaneous void > 400mls,
or
2 successive spontaneous voids of > 200mls combined with residuals volumes <
100mls.
Catheter management and Trial of Void for post op Gynae patients Page 3 of 5
ID 1. 101411
Regard printed versions of this document as out of date – The CapitalDoc
document is the most current version
Document facilitator: CNS Gynaecology
Senior document owner: Clinical Leader Gynaecology
Document number: 1.101411
Issue Date 24 November 2021
Review Date 24 November 2026
Related form
Trial of Void - Gynaecology CapitalDocs ID 1.101413
Appendix
Appendix 1
: Diagnosis and management of urinary retention after gynaecology
surgery flow chart
Disclaimer: This document has been developed by Capital & Coast District Health Board
(CCDHB) specifically for its own use. Use of this document and any reliance on the
information contained therein by any third party is at their own risk and CCDHB assumes no
responsibility whatsoever.
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Document facilitator: CNS Gynaecology
Senior document owner: Clinical Leader Gynaecology
Document number: 1.101411
Issue Date 24 November 2021
Review Date 24 November 2026
Appendix 1
Diagnosis and Management of Ur
inary Retention after Gynae Surgery
Diagnosis
1.
Not passed urine within 6 hours of surgery
2.
Not passed urine within 6 hours after catheter removal
3.
Symptoms e.g. Passing frequent small amounts of urine, pain, hesitancy, poor
flow, needing to strain
Conservative Measures
Confirm or exclude urinary retention (examination, bladder scan)
Oral analgesia, mobilization, provide privacy, warm shower
Bladder scan or use in and out urethral catheter to measure residual urine if unable to
obtain accurate reading
Unable to pass urine after no more than 4 hours (monitor frequently) and bladder full
or voided volume <100mls with residual volume >150-200m;
Insert appropriate sized Foley catheter: Measure residual urine
Macrobid 100mg twice daily
Consider antibiotic cover for duration of IDC dwell period
If residual urine < 700mls, remove Foley catheter after 24 hours ( morning shift)
If residual urine > 700mls, remove Foley catheter after 48 hours (morning shift)
Treat constipation, ensure adequate analgesia.
Follow the gynaecology protocol for measuring voids and residuals and TROC after
urinary retention
Voiding satisfactory:
Unsatisfactory voiding 6 hours after removal of
Discharge home
catheter or after retrograde TROC test. Organise
repeat TROC 3-7 days post-discharge.
Discuss with Registrar or Consultant regarding IDC reinsertion either on free drainage or
with flip-flo valve or to consider requirement for intermittent self-catheterisation.
IDC reinsertion – consider Doxazosin 1mg (used off-license) on retrial of TROC for pelvic
floor repair patients.
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ID 1. 101411
Ensu
re adequate analgesia and bowels have opened.
Regard printed versions of this document as out of date – The CapitalDoc
Gynaecologist to oversee, consider Uro-gynaecology or Urology Consultation
document is the most current version
