/policies/,/policies/clinical/,/policies/clinical/uwhc-clinical/,/policies/clinical/uwhc-clinical/department-specific/,/policies/clinical/uwhc-clinical/department-specific/ambulatory/,/policies/clinical/uwhc-clinical/department-specific/ambulatory/clinic-specific/,

/policies/clinical/uwhc-clinical/department-specific/ambulatory/clinic-specific/1218.policy

201410286

page

100

UWHC,

Policies,Clinical,UWHC Clinical,Department Specific,Ambulatory,Clinic Specific

Prostate Balloon Dilation - Urology Procedure Center (UPC) (12.18)

Prostate Balloon Dilation - Urology Procedure Center (UPC) (12.18) - Policies, Clinical, UWHC Clinical, Department Specific, Ambulatory, Clinic Specific

12.18



12.18 Prostate Balloon Dilation - Urology Procedure Center
(UPC)
Category: UWHC Departmental Policy
Policy Number: 12.18
Effective Date: March 26, 2014
Version: Revision
Manual: Ambulatory
Section: Clinic Specific (Ambulatory)
I. PURPOSE

Describe the process for Urology Clinic staff or Diagnostic Radiology Technicians
(DRTs) to assist physicians with prostatic balloon dilation. During a cystoscopy, the
prostatic urethra is dilated by a physician to relieve urinary obstruction.

II. PROCEDURE
A. Urology Clinic physicians will initiate an order to schedule a Prostate Balloon
Dilation.
B. Consent for the procedure is obtained by the physician and documented on
UWHC Consent Form #1289139 prior to the procedure.
C. Obtain a mid-stream urine sample for urinalysis per Delegation Protocol 73 –
Ordering Urinalysis for Office Visit – Adult/Pediatrics – Outpatient – Urology.
Complete prior to the procedure and review results.
1. If the results show no bacteria present, proceed with the preparation for
the procedure.
2. If the results are positive for presence of bacteria, contact the
physician. The physician may decide to proceed or cancel the procedure
on patients with a history of chronic infections.
D. Provide assessment, per Ambulatory Policy 8.02 – Assessment and Reassessment
of Patients and Documentation in Clinics.
E. Assemble equipment and open onto the sterile field:
1. Cysto tray
2. 21 French sheath and obturator
3. Inflation syringe with pressure gauge (Uromax Ultra Balloon Kit)
4. 18 French catheter
5. Medium leg bag
6. Catheter connector tubing for leg bag
7. Leg strap for leg bag
F. Perform and document Universal Protocol verifying right patient, right
procedure, appropriate equipment, and correctly identified radiology/diagnostic
test results per Administrative Policy 8.48 - Operative, Invasive and Other
Procedures.

Page 1 of 312.18 Prostate Balloon Dilation - Urology Procedure Center (UPC) | UWHC Departmenta...
5/6/2014http://content.uwhealth.wisc.edu/servlet/Satellite?pagename=OpenMarket/Xcelerate/Previe...


G. Prep the patient and prepare for the procedure. Ask the patient if they feel the
need to void. If they do, have them empty their bladder.
H. If conscious sedation is used for the procedure, the Registered Nurse (RN) must
be present to monitor the patient. The RN will follow Administrative Policy
8.38 - Adult Sedation.
I. Perform a Time Out prior to beginning the procedure, per Administrative Policy
8.48. Assist the physician as needed during the procedure.
J. During the procedure, the Licensed Practical Nurse (LPN), Medical Assistant
(MA) or DRT may be asked to assist the physician with inflating the dilation
balloon to a specific pressure. The dilating process may give the patient a strong
urge to void and some patients become very uncomfortable at this point. The
patient may require additional support during this part of the procedure.
K. The physician may insert a catheter. If the catheter is indwelling the LPN, MA,
or DRT will connect the catheter to a leg bag and instruct the patient on the use
of the bag and home care. Provide the patient with Health Facts For You #4591
– Urine Drainage Bags–Home Use and #6903 - Foley Catheter FAQ, and ask the
patient if they understand the instructions. If additional teaching is required, the
RN should be contacted for further education. Document the outcomes, all
teaching and patient’s comprehension in patient’s electronic medical record
(EMR).
L. Perform reassessment per Ambulatory Policy 8.02 - Assessment and
Reassessment of Patient and Documentation in Clinics.
M. If the patient does not have an indwelling catheter in place he/she will be asked
to remain in the clinic area until he/she can void. If the patient is able to void
without difficulty he/she will be discharged to home. Notify the physician for
further orders if the patient is unable to void.
N. Document the outcomes in patient's EMR.
III. REFERENCES

Administrative Policy 8.38 – UWHC Adult Sedation Policy
Ambulatory Policy 8.02 - Assessment and Reassessment of Patients and Documentation
in Clinics
Delegation Protocol 73 – Obtaining Urinalysis for Office Visit – Adult/Pediatric –
Outpatient - Urology
Administrative Policy 8.48 – Operative, Invasive and Other Procedures
Health Facts For You #4591 – Urine Drainage Bags–Home Use
Health Facts For You #6903 - Foley Catheter FAQ

IV. REVIEWED BY

Urology Clinic Manager
Ambulatory Policy and Procedure Committee
Urology Clinic Registered Nurses
Clinics Administration

SIGNED BY

Deborah D. Tinker, MSN RN CENP, Director, Ambulatory Nursing
Copyright 2014 - UW Health
e-Health Innovation and Policy
Page last updated 5/6/2014
Page 2 of 312.18 Prostate Balloon Dilation - Urology Procedure Center (UPC) | UWHC Departmenta...
5/6/2014http://content.uwhealth.wisc.edu/servlet/Satellite?pagename=OpenMarket/Xcelerate/Previe...

PREVIEW WARNING: Render error -10004 while rendering 12.18 Prostate Balloon Dilation - Urology Procedure Center (UPC) (Flex Member
#1126661257465) with Extranet/UWH/Policy/Template/FlexMember/Show_Policy
Page 3 of 312.18 Prostate Balloon Dilation - Urology Procedure Center (UPC) | UWHC Departmenta...
5/6/2014http://content.uwhealth.wisc.edu/servlet/Satellite?pagename=OpenMarket/Xcelerate/Previe...