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Title: CATCH-22: a manual bladder washout protocol to improve care for clot retention.
Austin Authors: Clarebrough, Emma;McGrath, Shannon ;Christidis, Daniel;Lawrentschuk, Nathan
Affiliation: Department of Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
Young Urology Researchers Organisation (YURO), Melbourne, Australia
Department of Surgery, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia
Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
Issue Date: Dec-2018
Date: 2018-05-28
Publication information: World Journal of Urology 2018; 36(12): 2043-2050
Abstract: To review current practices in manual bladder washouts (MBW) for haematuria with clot retention, comparing those conducted by a urology unit to other inpatient services. Secondly, to describe a standardised protocol for MBWs. Prospective data were collected for patients treated for clot retention, from initial management by referral units through to implementation of a standardised MBW by the urology service. Outcomes measured included re-catheterisation, MBW volumes, clot evacuated and time to discharge or subsequent intervention. Initial catheters inserted by referral teams were sized 16 Fr-20 Fr, all except one requiring upsizing. Mean washout volumes of 145 ml (SD 125) and 5392 ml (SD 847) were used by referring units and the urology service, respectively. Mean volume of clot evacuated by the standardised MBW was 617 ml (SD 313). Continuous bladder irrigation (CBI) was commenced in 16 patients (66%) prior to referral to urology. Median time to discharge was 48 h. Initial catheter insertion is of inadequate size, as is the volume of washout performed. Referring services fail to clear adequate amounts of clot with washouts posing potential risks to patients. The standard management of clot retention should involve the use of at least a 22 F catheter, implement best practice infection control and adopt the last Clot + 1L rule with catheter manipulation. The key points of our recommended MBW are summarised with the acronym CATCH-22. This protocol can guide initial management of clot retention and be used as an educational tool.
DOI: 10.1007/s00345-018-2346-z
ORCID: 0000-0002-1630-4629
Journal: World Journal of Urology
PubMed URL: 29808300
Type: Journal Article
Subjects: Clot retention
Continuous bladder irrigation
Manual bladder washout
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