Original Title: Installation d’une sonde urinaire chez un adulte avec un déclin de l’autonomie fonctionnelle et qui présente des symptômes suggestifs d’une rétention urinaire aigüe : Rapport en soutien au protocole médical national et de l’ordonnance collective

Authors' objectives: The Ministère de la Santé et des Services sociaux (MSSS) has tasked the Institut national d'excellence en santé et en services sociaux (INESSS) with developing, updating and hosting the current national medical protocols and prescription templates. Following a prioritization exercise, the MSSS’s Direction nationale des soins et services infirmiers asked INESSS to develop a national medical protocol on initiating therapeutic measures after identifying signs and symptoms suggestive of acute urinary retention in elderly patients in residential and long-term care centres (CHSLDs). However, the members of the advisory committee who assisted in the project proposed that the target population be expanded to include adults with functional autonomy decline possibly due to a major neurocognitive disorder, with no limitation to a particular living environment.

Authors' results and conclusions: The literature search yielded 1 581 items, including three clinical practice guidelines containing recommendations for the treatment of acute urinary retention by catheterization. Three additional documents, whose contents are relevant to the management of acute urinary retention in adults, were selected to supplement the information from the clinical practice guidelines. Five of the six selected publications were deemed to be of adequate methodological quality for use, based on the Appraisal of Guidelines for Research and Evaluation Global Rating Scale (AGREE GRS). Despite its methodological limitations, one publication was selected because it addresses the management of urinary retention in adults and was published by a recognized American association. The present national medical protocol concerns patients 18 years of age or older who present with functional autonomy decline and the following symptoms suggestive of urinary retention: the inability to empty the bladder and a sensation of bladder fullness or abdominal discomfort. If no contraindication to the application of the medical protocol is identified during the health status assessment, a urinary catheter should be installed to relieve the symptoms of urinary retention. A bladder volume measurement should be performed if a portable bladder scanner is available. If the measured bladder volume is greater than 300 ml, a urinary catheter should be installed to ensure complete bladder drainage. When installing a urinary catheter, a lubricating gel with or without an anesthetic can be used. Ideally, when the gel’s anesthetic effect is desired, a 10-minute window should be observed. However, this can be difficult when a urinary catheter is to be installed in a patient with a major neurocognitive disorder. In such case, it is reasonable to install the catheter more promptly, given that the gel has an immediate lubricating effect and that the experts consulted consider that anesthesia is not required for this procedure. A coude catheter can facilitate catheter placement in a male patient. A urine specimen for a microscopy and cell count, and a urine culture and sensitivity test should be obtained when the catheter is installed. Since a medical follow-up is planned, notably when catheter weaning is considered and for investigating the cause of the urinary retention, the test results are useful in checking whether a urinary tract infection may have contributed to the episode of urinary retention and in guiding the physician's decision as to whether or not to initiate antibiotic therapy when catheter weaning is being considered. These tests can also be useful if sepsis is suspected after catheter placement. The quantity and appearance of the urine drained during the first 30 minutes after catheter placement should be recorded in the patient’s chart. Urine flow (obstruction or leakage from the catheter) and the presence of any complications should be monitored during treatment. Conclusion The development of this national medical protocol and the collective prescription template is based on clinical data and clinical practice recommendations from the literature, which have been enhanced with the perspectives of different experts and clinicians, and with contextual information. The triangulation of data on the best available practices from the different sources consulted enabled the development of the protocol on urinary catheter placement in an adult with functional autonomy decline presenting with symptoms suggestive of acute urinary retention

Authors' methods: A systematic review of clinical practice guidelines, expert consensus statements, consensus conference reports, guidance documents and any other publications containing clinical recommendations was conducted in accordance with INESSS’s standards. The literature search was limited to items published between January 2000 and May 2020. The search parameters included, amongst others, the elements that define acute urinary retention, the contraindications to treatment and the therapeutic modalities of transurethral urinary catheterization. In addition, a manual literature search was conducted by consulting the websites of regulatory agencies, health technology assessment agencies, government bodies and professional associations in countries whose health-care system and clinical practices are similar to those in Québec. The national medical protocol and collective prescription template were developed in collaboration with an advisory committee. Its members provided information, expertise, opinions and perspectives that were essential for creating the protocol and template, this to ensure their scientific credibility, clinical relevance, and professional and social acceptability. The relevance of the contents and the overall scientific quality of the national medical protocol, the collective prescription template and the supporting report were assessed by three external reviewers: a specialized nurse practitioner, a family physician and a urologist. In addition, a panel of future users consisting of nurses and pharmacists was consulted to ascertain the clinical relevance of the protocol and the corresponding prescription template and to assess their clarity and ease of use.

Project Status: Completed

URL for project: https://www.inesss.qc.ca/thematiques/medicaments/protocoles-medicaux-nationaux-et-ordonnances-associees/protocoles-medicaux-nationaux-et-ordonnances-associees/retention-urinaire-aiguee.html

Year Published: 2021

URL for published report: https://www.inesss.qc.ca/fileadmin/doc/INESSS/Ordonnances_collectives/Retention_urinaire/INESSS_Retention_urinaire_GN.pdf

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Canada

Province: Quebec

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: L'Institut national d'excellence en sante et en services sociaux (INESSS)