What is the best intervention for a patient with incontinence and an intravenous (IV) catheter, who is receiving heparin for pulmonary embolism and having difficulty reaching the bathroom?

Best Intervention for a Patient with Urinary Incontinence and IV Catheter

The best intervention for this patient is to write an order for a bedside commode to address her incontinence while maintaining mobility and reducing infection risk. 1

Assessment of the Situation

• The 74-year-old female patient is experiencing urinary incontinence due to mobility limitations caused by her IV catheter while receiving heparin for pulmonary embolism 1
• The patient is embarrassed by her incontinence, which can negatively impact her psychological well-being and rehabilitation 1
• The patient is currently mobile enough to attempt to reach the bathroom, indicating some preserved functional capacity 1

Rationale for Bedside Commode

• A bedside commode provides the optimal balance between accessibility and maintaining mobility for this patient 1
• Early mobilization is critical for patients receiving treatment for pulmonary embolism to reduce risk of complications including atelectasis, pneumonia, and further deep vein thrombosis 1
• Immobility accounts for up to 51% of deaths in the first 30 days after ischemic stroke and can lead to similar complications in pulmonary embolism patients 1

Why Other Options Are Less Appropriate

• Indwelling Foley catheter (Option B):

  • Indwelling catheters significantly increase the risk of urinary tract infections (UTIs), which occur in 15-60% of patients and independently predict poor outcomes 1
  • Guidelines specifically recommend avoiding indwelling catheters when possible and removing them as soon as the patient is medically stable 1, 2
  • UTIs can complicate pulmonary embolism treatment and recovery 1

• Bedpan use (Option A):

  • Restricting the patient to bed rest would increase risk of complications from immobility, including further DVT and pulmonary embolism 1
  • Early mobilization is recommended when patients are hemodynamically stable to reduce these risks 1

• Incontinence pads (Option C):

  • While incontinence pads are an option for managing incontinence, they don't address the underlying mobility issue 1
  • This approach may increase skin breakdown risk and doesn't promote independence 1

Implementation of Bedside Commode

• Place the commode near the patient's bed to minimize the distance she needs to travel 1
• Ensure the IV pole is easily maneuverable to accompany her to the commode 1
• Implement a prompted voiding schedule every 2 hours during waking hours and every 4 hours at night 1, 2
• Encourage high fluid intake during the day and decreased fluid intake in the evening 1

Additional Considerations

• Assess for other factors that might be contributing to incontinence, such as medications or constipation 2
• Monitor skin integrity to prevent breakdown from any episodes of incontinence 1
• Consider implementing a bladder training program to decrease incontinent episodes 1, 2
• Evaluate the patient's need for assistance with transfers to ensure safety while using the commode 1

The bedside commode represents the best balance between maintaining mobility (important for pulmonary embolism recovery) while addressing the immediate problem of incontinence in a dignified manner that preserves the patient's independence 1.