Voiding Trial

Turn on sink

Bladder instilled and peed out. If patient pees out 2/3 of volume instilled patient does not need foley.

Odds can’t pee < 5% 

Criteria 

No clots through irrigation 

Good peeing capacity 

Sensation 

Good flow 

200ml ccs before has sensation of peeing 

300ml is retention 

Odds can’t pee < 5%.  

https://www.youtube.com/watch?v=lgzvS9MQ9rI&ab_channel=DanielGruber

https://www.youtube.com/watch?v=cu8--IMoTaI&ab_channel=egrncobmba

 fill and pull also known as an active voiding trial is routinely done after pelvic surgery this is a quick and easy way to know if a patient can void adequately the whole process takes less than 10 minutes it's ideal to have the patient stand and walk at least once after surgery before performing this to ensure that they are stable when they walk to the bathroom later this is the equipment needed a urine hat to collect the patient's voided volume place this into the toilet before performing the bladder installation a collection container a 60 milliliter two me or catheter tip syringe fluid such as sterile water or saline a 10 milliliter syringe for catheter removal start by taking apart the foley catheter from the bag or foley plug drain the bladder with the foley catheter having the patient stand to empty is also an option this allows the bladder to be fully empty then remove the cap from the syringe tip and take the plunger out of the tumi syringe next connect the tumi syringe to the open channel of the foley not the balloon port fill the tumi with sterile water or saline to the 50 milliliter line let the fluid go into the empty bladder by gravity on rare occasion it may be necessary to use the plunger to instill fluid repeat this step until there is 300 milliliters in the bladder you can go up to 400 milliliters if the patient doesn't feel a strong urge to void the goal is to fill the patient until they get a strong sense of urgency if the patient has a very strong urge or significant bladder discomfort prior to reaching 300 milliliters stop filling and record how much fluid was instilled when all the fluid is in connect the 10 milliliter syringe to the balloon port and deflate the balloon keep holding the catheter above the bladder so fluid doesn't drain out also fold the catheter to prevent fluid from leaking back into the tumi then pull the foley out of the bladder if the patient has a sense of urgency tell them to kegel and hold the best they can assist the patient to the bathroom immediately when setting up consider placing the hat into the toilet so it's ready have the patient void into the hat and give the patient a maximum of 10 minutes to void it is important to not allow the patient more than 10 minutes as their bladder will keep filling naturally and the test will be invalid many nurses set a timer on their phone to make sure they come back within the if possible give the patient privacy and tell them to relax and not push another helpful tip is to turn on the sink so the patient can hear running water record the voided volume into the progress note when the patient is done if they avoid two-thirds or more of the volume you instilled then they've passed and a new foley catheter does not need to go in for example if you place 300 milliliters in the bladder and avoid 200 milliliters into the hat then they've passed if they void less than two-thirds then a new foley should be placed immediately in most cases a bag or leg bag is not needed if the patient had a cystotomy then drainage with a bag is required a foley plug can be used which is much easier for the patient and greatly increases patient satisfaction the only thing needed is the foley tube and yellow plug when the patient feels the natural urge to void then they'll remove the plug drain the bladder and then replace the plug the fill-in pull is a simple and quick method to test bladder function postoperatively the overall idea is that their bladder is empty you fill it to a known volume they then void and now you will know the volume voided 

Performing a voiding trial (trial without a catheter)

Voiding trial procedure — In our practice, a voiding trial starts with catheter removal early in the morning either at home, in the office, or in the inpatient setting if hospitalized. Patients are encouraged to hydrate aggressively and have a PVR measured four to six hours later in the office or while inpatient. The outcome of the voiding trial is determined by PVR measurement, as below.

Interpretation of voiding trial

●PVR <200 mL is considered a successful voiding trial and the catheter is discontinued.

●PVR >200 mL is considered equivocal. In such patients, we provide instruction on clean intermittent catheterization (CIC), if manageable by the patient or care team, as it can be used as an adjunct to voiding or for AUR recurrences that may require rescue bladder drainage. In patients with AUR, CIC is preferred, as it is associated with an increased rate of spontaneous voiding and reduction in urinary tract infections compared with indwelling catheters [52]. (See "Placement and management of urinary bladder catheters in adults".)

If patients are unable or unwilling to perform CIC, an indwelling urethral catheter is replaced.

Reported success rates for initial voiding trials in males with prostate disease with AUR have ranged from 20 to 40 percent [53]. Factors that favor a successful voiding trial include age less than 65 years, detrusor pressure greater than 35 cm H2O, a drained volume of less than one liter at catheterization, and the identification of a precipitating event [48,53].