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Case Study: Urinary Retention in Bed-Bound Patient at Home

Patient is a 67 year-old male with a history of diabetes, vascular dementia, stroke with left side weakness, intracranial hemorrhage, GERD, and hypertension. He is fed via PEG tube, bed-bound, non-verbal, and incontinent of both urine and stool at baseline. Family lives 45 minutes away from the nearest clinic, and the patient is very difficult to transport.

The family called the physician to indicate that his urine output (number of diapers changed) had decreased from 7-8 per day to 1-3 per day for the last two days. His abdomen looks more distended than normal, and there is swelling in his feet.

Case Summary:

Typical course is ambulance to ER, 3-4 day stay to stabilize output, and ambulance ride home.  Cost is $9,000 – $12,000 plus transportation.  StatPoint conducts three (3) visits: foley placement, voiding trial, and follow up for $1,300.  Savings $7,700+, ROI = 5.9x or more.

Bladder scan showed 439mL; the provider was called, who instructed the nurse to place a Foley catheter, perform rapid UTI test, urine dip, and measure abdominal girths:

  • 16f Foley placed with ~500mL clear yellow urine return
  • Rapid UTI negative
  • Urine dip unremarkable
  • Abdominal girth measured at 47.25″.

Instructed family and caregiver on how to care for the Foley catheter, empty and measure the urine output, and perform and record daily abdominal girth measurements. 

At the final visit, Day 7 after initial visit: 

Patient had urinated 30 minutes prior to arrival –  

  • Bladder scan showed volume of 130ml
  • Patient had urinated 3 times in the night and twice during the day 
  • Patient appears to have returned to baseline  
  • Physician was informed, and the episode was closed.

A StatPoint nurse arrived within 12 hours to find:

  • Patient is well cared for by the family and caregiver
  • Vital signs are stable
  • Tube feeds were infusing without difficulty, with minimal residuals
  • Abdomen is distended and caregiver states it’s more than usual
  • Left flank is firmer than the right
  • Distention does not appear to be ascites, no wave motion and tympany present, except
    over left-lower quadrant
  • Bowel sounds present; patient has a scar on his lower midline abdomen
  • Edema is minimal and not noticeable

Bladder scan completed which showed 439mL; the provider was called, who instructed the nurse to place a Foley catheter, perform rapid UTI test, urine dip, and measure abdominal girths:

  • 16f Foley placed w/o difficulty with ~500mL clear yellow urine return
  • Rapid UTI negative
  • Urine dip unremarkable
  • Abdominal girth measured at 47.25″.

Instructed family and caregiver on how to care for the Foley catheter, empty and measure the urine output, and perform and record daily abdominal girth measurements.

6 days later, a follow-up visit was performed:
  • Urine output has been good and urine remains clear
  • Foley d/c’d without difficulty. Abdominal girths measure 43-45″
  • Physician was called, who ordered a bladder scan for the next day.
At the final visit:
  • Patient had urinated 30 minutes prior to arrival
  • Bladder scan showed volume of 130ml
  • Patient had urinated 3 times in the night and twice during the day
  • Patient appears to have returned to baseline
  • Physician was informed, and the episode was closed

DISCUSSION:

This case demonstrates that complex patient situations can be safely handled in the home.  The provider and family were closely involved, and StatPoint’s team coordinated the care and delivered procedures and services to the home that were previously unavailable.

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