A bulb drainage device or Hemovac may be used to ensure drainage during the immediate postoperative phase and for postoperative day (POD) #1 (or as needed into the postoperative period until the drainage is minimal). The bulb and Hemovac devices provide continuous, less aggressive suction to the surgical site. Surgical incisions drain to the absorptive sterile dressings. Residual bleeding resulting from adjacent, underlying tissue may accumulate under, or nearby, the surgical incision, therefore, a bulb drainage or Hemovac provides a mechanical outlet via the drain inserted so that fluid is evacuated.
Urinary retention is commonly a problem, and many surgeons prefer to insert a Foley catheter while the patient is in the operating room. Accurate measurements of output should be ascertained. If a urinary catheter is not in place, the patient should be checked frequently for bladder distention, which may indicate an overfull bladder and urinary retention. In Phase I PACU, the patient may or may not void, especially as he or she emerges from the effects of an anesthetic and the stressful experience of the surgery itself.
The PACU RN records the patient leaving the PACU. Additional documentation may indicate when the patient is due to void. If the patient is unable to void, usually a bladder scanner is used to evaluate the specific amount of urinary retention. An indwelling urinary catheterization order may be needed along with a corresponding physician’s order (Schick & Windle, 2016). Patient may require the use of an indwelling urinary catheter and its use may be justified. Surgeons have usually been proponents of discontinuing all tubes as soon as possible to restore the patient to the preoperative level. In recent years, catheter-associated urinary tract infection (CAUTI) has been a major focus for all acute care centers. The National Database of Nursing Quality Indicators (NDNQI) includes CAUTI as a nurse-sensitive indicator (Montalvo, 2010). The recent change for some clinicians is the change in clinical culture to discontinue the Foley catheter as soon as possible postoperatively. The existence of an indwelling urinary catheter may be justified clinically; that clinical need is now usually documented daily in many acute care hospitals.