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Theatre nursing

Decision-making around removal of indwelling urinary catheters after pituitary surgery

10 October 2024
Professional
02 October 2024
Volume 33 · Issue 18

Abstract

Background:

Diabetes insipidus (DI) is a common complication following pituitary surgery, causing significant health issues if left untreated. As part of the diagnostic process, accurate urinary output monitoring via indwelling urinary catheters (IDUCs) is essential, despite risks such as urinary tract infections and hindered recovery. Research on IDUC removal after pituitary surgery remains scarce.

Aim:

To explore health professionals' perspectives on IDUC management following pituitary surgery.

Methods:

Employing a qualitative design, semistructured interviews were conducted with 15 professionals in the neurosurgical ward of a Dutch academic hospital.

Findings:

Four themes emerged: Concerns about missing identifying DI, patient–nurse dynamics, workload management, and lack of shared decision making.

Conclusion:

The findings underscore the need to balance clinical needs with patient care efficiency. There is a need for evidence-based guidelines and a multidisciplinary approach to optimise IDUC management, given the importance of patient-centred care and shared decision-making.

Diabetes insipidus (DI) is a complication following pituitary gland surgery. Various definitions are used across studies, which means that reported rates vary, but a large systematic review (Fountas et al, 2024) found the rate following transsphenoidal pituitary surgery to be 17%. DI is caused by a shortage of the antidiuretic hormone and results in polyuria and compensatory polydipsia in the first 12–24 hours after surgery (Prete et al, 2017). If left untreated, DI can lead to hypovolaemia, dehydration and electrolyte imbalances, which subsequently can lead to multi-system organ failure (Ajlan et al, 2018). The diagnosis of DI is based on clinical and biochemical findings, with the first step in the diagnostic process being the presence of polyuria and polydipsia, which can be detected by monitoring fluid balances (Garrahy et al, 2019).

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Diabetes insipidus
Pituitary surgery
Urinary catheterisation
Urinary tract infections
Collaboration
Decision-making