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Acute Spinal Cord Injury Bladder Management - Adult - Inpatient [144]

Acute Spinal Cord Injury Bladder Management - Adult - Inpatient [144] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Inpatient Delegation Protocols


Delegation Protocol Number: 144

Delegation Protocol Title Acute Spinal Cord Injury Bladder Management - Adult - Inpatient

Delegation Protocol Applies To:
UW Health Inpatient Units

Target Patient Population:
UW Health Adult inpatients with acute spinal cord injury including:
• Complete
• Incomplete
• Central cord syndrome

This delegation protocol does NOT include acute spinal cord injury patients with:
• Indwelling urinary catheter placed by Urology
• Bladder outlet obstruction
• Gross hematuria

Delegation Protocol Champions:
Josh Medow, MD – Department of Neurosurgery
Suresh Agarwal, MD – Department of Surgery-Trauma
Courtney Hogendorn, MD – Department of Orthopedics and Rehabilitation

Delegation Protocol Reviewers:
Becky Brunker, BSN, RN, PCCN – Department of Surgery-Trauma
Alazda Kaun, MSN, RN, CNRN – Department of Surgery-Trauma
Anne Leclaire, MSN, RN, CRRN - Chief Clinical Officer – UW Health Rehab Hospital

Responsible Department:
Department of Neurosurgery
Department of Surgery-Trauma
Department of Orthopedics

Purpose Statement:
This protocol delegates authority from the ordering provider to the Registered Nurses (RNs) to
remove an indwelling urinary catheter (IUC) in an acute spinal cord injury (SCI) patient when using
the Acute Spinal Cord Injury Cathing Algorithm. This protocol is intended for use in patients during
their initial hospitalization following a SCI and per provider discretion. This delegated act will
facilitate timely removal and reduce the risk of catheter associated urinary tract infections.

This protocol also delegates authority from the ordering provider to the RNs to initiate a cathing
schedule in the acute SCI patient per the Acute Spinal Cord Injury Cathing Algorithm. The protocol
will assist in reducing the risk of complications including urinary tract infections, bladder over-
distention and permanent detrusor muscle damage. The protocol will also assist in re-training the
SCI patient’s bladder following injury.

Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org


Who May Carry Out This Delegation Protocol:
RNs trained in the use of this delegation protocol.

Guidelines for Implementation:
1. This protocol is initiated when a provider enters the “Initiate Acute Spinal Cord Injury Cathing
Algorithm” order. Prior to implementing this algorithm the nurse will verify that the patient
does not have any of the following: indwelling urinary catheter placed by Urology, bladder
outlet obstruction, or gross hematuria as this delegation protocol does not apply to this patient
population. If the patient has any of the conditions listed above, the nurse will consult with the
provider for further direction.
2. Patients with Foley catheters will have urine volume measured every 4 hours. Once the urine
volume is less than 500 mL every 4 hours for 24 hours the RN will remove the Foley catheter and
discontinue the Insert and Maintain Urinary Catheter order.
2.1. Foley removal for the SCI patient is NOT dependent upon a “YES” answer in the “Initiate
Urinary Catheter Removal Protocol?” question of the Insert and Maintain Urinary Catheter
Order. The Foley should be removed when indicated by the Acute Spinal Cord Injury
Cathing Algorithm
3. The RN will follow the Acute Spinal Cord Injury Cathing Algorithm to determine how frequently
to straight cath the patient. The frequency of cathing will be adjusted to maintain urine volumes
< 500 mL as directed by the algorithm.
4. If cathing volumes every 2 hours are greater than 275 mL for over 24 hours the RN will re-insert
the Foley catheter.
4.1. If an IUC is placed per algorithm, the RN will place an “Insert and Maintain Urinary Catheter”
order and sign it with an ordering mode of Protocol/Policy, Without Cosign. The RN will
answer “No” to the question “Initiate Urinary Catheter Removal Protocol?” within the
“Insert and Maintain Urinary Catheter” order.
4.2. The RN will then restart at the top of the Acute Spinal Cord Injury Cathing Algorithm and
again remove the IUC when directed to per the algorithm.

Order Mode: Protocol/Policy, Without Cosign

Collateral Documents/Tools:
IP - Spinal Cord Injury - ICU IMC - Admission [5306] order set

References:
1. Consortium for Spinal Cord Medicine. Outcomes Following Traumatic Spinal Cord Injury: Clinical
Practice Guidelines for Health-Care Professionals. Washington, DC: Paralyzed Veterans of
America; 1999.
2. Consortium for Spinal Cord Medicine. Bladder Management for adults with spinal cord injury: A
clinical practice guideline for health-care providers. Journal of Spinal Cord Medicine. 2006;
29(5): 527-573.
3. Consortium for Spinal Cord Medicine. Early acute management in adults with spinal cord injury:
A clinical practice guideline. Journal of Spinal Cord Medicine. 2008; 31(4): 360-484.
4. Consortium for Spinal Cord Medicine. Bladder Management Following Spinal Cord Injury: What
You Should Know. A Guide for People with Spinal Cord Injury. Washington, DC: Paralyzed
Veterans of America; 2010.
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

5. Dufour L, Williams J, Coleman K. Traumatic Injuries: TBI and SCI. In: PA Edwards, ed. The
Specialty Practice of Rehabilitation Nursing: A Core Curriculum. 4th ed. Glenview, IL: Association
of Rehabilitation Nurses; 2000:196-198.
6. Kirshblum S, Campagnolo D. Spinal Cord Medicine. 2
nd
ed. Philadelphia, PA: Lippincott Williams
& Wilkins; 2011.
7. Lehman, C. Traumatic injuries: traumatic brain injury and spinal cord injury. In C D Jacelon, ed.
The Specialty Practice of Rehabilitation Nursing: A Core Curriculum. 7
th
ed. Chicago, IL:
Association of Rehabilitation Nurses; 2015: 511-551.
8. Lindsey, L. Bladder Management Options Following Spinal Cord Injury. Spinal Cord Injury
Network. Retrieved from http://www.msktc.org/lib/docs/Factsheets/SCI_Bladder_Health.pdf.
9. Spinal cord injury rehabilitation evidence: Bladder management following spinal cord injury.
Spinal Cord Injury Rehabilitation Evidence Web site.
http://www.scireproject.com/sites/default/files/bladder_management.pdf.
10. Wan D, Krassioukov AV. Life-threatening outcomes associated with autonomic dysreflexia: A
clinical review. The Journal of Spinal Cord Medicine. 2014; 37(1): 2-10.

Approved By:
UWHC Nursing Practice Council: July 2016
UW Health Clinical Knowledge Management Council: July 2016
UWHC Medical Board: August 2016

Effective Date: August 2016

Scheduled for Review: August 2018
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

ACUTE SPINAL CORD INJURY CATHING ALGORITHM
Provider order placed to initiate Algorithm
Empty foley catheter
every 4 hours
Volume < 500 mL
every 4 hours for 24
hours?
Keep foley catheter in
Discontinue foley
catheter order
Straight cath every 4
hours
Is the 4 hour
volume >500 mL?***
NO
YES
NO
Are 2 hour volumes
> 275 mL for 24
hours?
Re-insert foley catheter by placing order in HealthLink for
foley catheter per protocol without cosign. Notify provider
and restart the Acute Spinal Cord Injury Cathing Algorithm
*** Considerations to discuss with
MD if the 4 hour straight cath
volumes are > 500 mL.
- Recommend spreading out PO intake
of 2L/day over 24 hours
- Decreasing IV fluids
- Limiting free water with tube feeding
YES
Straight cath every 3
hours
YES
Is the 3 hour
volume > 500 mL?
Straight cath every 2
hours
YES
NO
Is the 3 hour
volume > 375 mL?
NO
YES
NO

Host document: Delegation Protocol “Acute Spinal Cord Injury Bladder Management – Adult – Inpatient”
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org