Physiological Integrity Q 28
The rationale for inserting a French catheter every hour for the client with epidural anesthesia is:
A. The bladder fills more rapidly because of the medication used for the epidural.
B. Her level of consciousness is such that she is in a trancelike state.
C. The sensation of the bladder filling is diminished or lost.
D. She is embarrassed to ask for the bedpan that frequently.
Correct Answer: C. The sensation of the bladder filling is diminished or lost.
Epidural anesthesia decreases the urge to void and sensation of a full bladder. A full bladder will decrease the progression of labor. Under the influence of epidural analgesia, patients may not feel the urge to urinate, which can result in urinary retention and bladder overdistension. Overfilling of the bladder can stretch and damage the detrusor muscle. For example, the use of lumbar epidural analgesia for labor and delivery has frequently been implicated as a causative factor for postpartum urinary retention. This is supported by the fact that these patients demonstrate a difficulty voiding.
Option A: The medication used for the epidural does not have a diuretic effect. Spinal and epidural opioid administration influence the function of the lower urinary tract by direct spinal action on the sacral nociceptive neurons and autonomic fibres. Long-acting local anesthetics administered intrathecally rapidly block the micturition reflex. Detrusor contraction is restored approximately 7-8 hours after spinal injection of bupivacaine. For this reason, bladder catheterization is a common practice in patients with spinal or epidural anesthesia.
Option B: An epidural does not create a trancelike state for the client. Acute urinary retention is one of the most common complications after surgery and anesthesia. It can occur in patients of both sexes and all age groups and after all types of surgical procedures. It is linked to several factors including increased intravenous fluids, postoperative pain, and type of anesthesia. Micturition depends on coordinated actions between the detrusor muscle and the external urethral sphincter.
Option D: Embarrassed or not, the client would still need to have a French catheter inserted to manage her voiding. The risk of infection with a single catheterization is 1-2% and can rise by 3 to 7 % for every additional day with an indwelling catheter. Traumatic or prolonged catheterization may lead to urethritis and to urethral strictures. There has yet been no consensus for appropriate catheterization strategy during regional anesthesia.