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Cutting Remarks: 'I Can't Pee'
A stream of good advice if you require patients to void before discharge.
John Kelly, IV
Publish Date: January 7, 2015   |  Tags:   Opinion
urinary throughput GOOD TO THE LAST DROP Patients sometimes need help increasing their urinary throughput.

One of the challenges of working in an outpatient surgicenter is ensuring that patients are well enough to go home. Included in the checklist for discharge is the ability to urinate. While some facilities insist the patient pass urine before discharge, others are more liberal in the plumbing department. Nonetheless, I have learned much in my career about the many nursing tricks of the trade to ensure voluminous urine flow.

  • Reassurance. Simply giving the patient some reassurance and letting him calm down often enhances urinary output. Most of us can't urinate under duress. To illustrate this, I would ask male readers to recall their experiences at the football stadium men's room urinal when throngs of desperate distended fans are breathing down your neck. I bet you'd be happy if your flow was a trickle!
    Merely trying to keep the patient's mind off of the act of urination may do wonders to increase urinary throughput. Trouble is, if the patient has a prostate the size of a melon, their bladder is ready to plotz, and they are already taking industrial-strength Xanax, it is difficult to get them to relax.
  • Running water. The old tried and true "run the tap water" seems to be most nurses' top choice to relax the bladder sphincter. One simply has the patient sit quietly and run the tap water in a nearby sink for several minutes. The patient must hear the running water and it should sound like a babbling brook. Some nurses also whisper sweet nothings in the patient's ear to obtain the full effect of this exercise. I don't know if any science exists for this, but it surely doesn't help the facility's water bill. When several patients undergo this treatment simultaneously, our PACU sounds like a car wash.
  • Max out on the Flomax. Certain meds may help, especially the alpha inhibitors like Flomax. Trouble is, most drugs may take a while to kick in and many facilities don't want to spend the time observing a patient who is otherwise doing well unless they are a big tipper. Also, these types of drugs may make the patient light-headed. Great, the patient finally pees, but passes out while doing so!
  • Call urology. When in doubt, call urology. Truth is, the urologist may take 2 hours to see the patient, only to order expensive tests, make the patient even more anxious and end up recommending — you guessed it — Flomax.
  • Dreaded straight cath. Nothing instills fear into the soul of a patient more than the mention of the words straight cath. For men especially, the pain inflicted rivals an extended stay by in-laws. Thank God this is the last resort, unless your patient is into self-mutilation.

When in doubt, 'YOYO' (you're on your own)
In the end, most patients are left to fend for themselves. They may receive the admonition, "If you don't pee in 8 hours, simply go to the nearest ER." Sounds OK, but what if the nearest ER is 20 miles away, only has catheters the size of chest tubes and has a staff urologist named Rambo who thinks coating catheters with lidocaine is for sissies?

My patients rarely endure plumbing problems. I'm blessed with truly seasoned nurses who can spot a potential problem days before it occurs. However, as I age and feel my prostate growing daily, I think I will forgo my next procedure (facelift — just kidding) in order to avert even the remotest chance of a dreaded straight cath. The mere mention of these words still makes me shudder.

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