BLADDER TRAINING (FOR RESIDENT WITH A CATHETER)

PURPOSE The purpose of this procedure is to retrain the bladder to empty at timed intervals and in adequate amounts and to improve a residents morale, dignity and self-respect. GENERAL GUIDELINES 1. Review the residents care plan to assess for any special needs. 2. Assemble equipment and supplies as needed. 3. A physicians order must be obtained to initiate this procedure. 4. This procedure is not to be delegated to non-licensed personnel. A licensed nurse should perform this procedure. 5. It is essential that the time schedule is maintained and that close attention is given to the resident during this procedure. 6. This procedure takes a minimum of 4 days to complete. 7. Empty the urine collection bag each time the catheter is clamped. 8. Each time the catheter is unclamped, measure the urine noting the color, clarity and amount of urine. Record this information in the residents medical record. 9. The resident should be able to tolerate a minimum of 250cc of urine in the bladder before removing the catheter. EQUIPMENT Catheter clamp Graduated container Personal protective equipment PROCEDURE 1. Screen the resident for privacy. 2. Wash and dry your hands thoroughly and put on gloves. 3. Explain the procedure to the resident. 4. On the first day clamp the catheter closed for 1-2 hours. (Preferably 2 hours if resident can tolerate the full time). 5. Empty urine collection bag. 6. Check the resident frequently. If the resident complains of pain or cannot tolerate the full 2 hours, shorten the time and then increase it gradually. 7. Unclamp the catheter after two hours and allow the bladder to empty. 8. Note the amount, color and clarity of the urine. 9. Encourage the resident to press down with abdominal muscles to assist in emptying the bladder. 10. Leave the catheter unclamped for 15 minutes, then re-clamp for 1-2 hours. 11. Continue this process for the first 24 hour period. 12. On day 2 increase clamping time to 2-3 hours, unclamp for 15 minutes and then re-clamp.

13. Continue this process for the second 24 hour period. 14. On day 3 increase clamping time to 3-4 hours, unclamp for 15 minutes and then re-clamp. 15. Continue this process for the third 24 hour period. 16. On the fourth day, remove the catheter paying close attention and responding to the residents requests for help when toileting. 17. Assist the cognitively impaired resident to the toilet every two hours to prevent incontinent episodes. 18. After removal of the catheter, begin a formal bladder training program, if needed, for urinary incontinence. DOCUMENTATION The following information should be documented in the residents medical record: Name and title of person performing this procedure. Each time catheter is clamped and when it is unclamped. Amount, clarity, and color of urine each time the catheter is unclamped. How the resident tolerated the procedure. If resident refused the procedure, reason why and interventions taken. When catheter is removed, document the residents ability to toilet with or without incontinent episodes. Any complaints of pain or discomfort related to the procedure. Signature and title of person recording the data. REPORTING 1. Notify the supervisor if resident refuses the procedure. 2. Report any other information in accordance with facility policy or professional standards of practice.