Development and implementation of a procedure for the use of an external urinary pouch in adult males in acute care settings

Purpose/Objectives:  Urinary catherization is often initiated due to patient’s inability to void or for the management of urinary incontinence. Timely discontinuation of indwelling catheters is one the most important interventions to prevent catheter-associated urinary tract infection (CAUTI). However, some indications, such as the need for accurate intake and output, or presence of perianal wounds  requires either prolonged use of an indwelling urinary catheter, or utilization of external collection devices (ECDs) for urine containment and/or collection. Most common ECD in males is a condom catheter, but requires an inch of penile protrusion to achieve a secure seal. 

An alternative approach was proposed by the Wound Ostomy Continence (WOCN) advanced practice nurse (APN) which included the use of ostomy urinary pouch. A new procedure titled “External Urinary Pouch for Adult Males” was developed in collaboration by the WOCN APN and the APNs working in other areas of the hospital. While many clinical guidelines recommended ECDs, a literature search demonstrated limited evidence regarding the safety and efficacy of ECDs. Implementation was carried out in two phases. During the first phase, application of the ostomy pouch for urinary incontinence was performed by a designated team including WOCN APN and specially trained APNs; training was provided by WOCN APN. Once safety and efficacy were determined for at least ten patients consecutively, the second phase was implemented, which included training the charge nurses in the medical intensive care unit to assess and apply the ECDs on identified patients.

Outcomes:  Implementation of an alternative ECD innovative to our facility resulted in providing an additional option for urine collection in male patients incontinent of urine. We found this procedure to be a safe and efficient method, as to date we have not had complications related to device use.