Abstract
This article proposes a counter-argument to standard Advanced Trauma Life Support
(ATLS) training – which advocates bladder catheterisation to be performed as an adjunct
to the primary survey and resuscitation for early decompression of the bladder and
urine output monitoring. We argue the case for delaying bladder catheterisation until
after definitive truncal Computed Tomography (CT) imaging.
To reduce pelvic volume and associated bleeding, our trauma team delay catheter insertion
until after the initial CT scan. The benefits of a full bladder also include improved
views on initial Focussed Assessment with Sonography in Trauma (FAST) scan and improved
interpretation of injuries on CT. Our urinary catheter related infection rates anecdotally
decreased when insertion was delayed and consequently performed in a more controlled,
non-resuscitation setting following CT.
Adult blunt multitrauma patients with pelvic ring fractures are at risk of significant
haemorrhage. Venous, arterial and medullary injuries with associated bleeding may
be potentiated by an increased pelvic volume with ring disruption, as well as a reduced
pressure effect from retroperitoneal and intra-pelvic organs on bleeding sites. Various
techniques are used to reduce intra-pelvic bleeding.
For shocked patients who have sustained major pelvic injuries with no other signs
of urinary tract trauma and minimal urine in the bladder on initial FAST scan, we
advocate careful, aseptic Foley catheter insertion followed by bladder insufflation
with 500–600 mL of Normal Saline (NS) and subsequent catheter clamping to tamponade pelvic bleeding.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to InjuryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Advanced trauma life support ATLS student manual.9th ed. American College of Surgeons, Chicago2012
- Emergent management of pelvic ring fractures: an update.Can J Surg. 2005; 48: 49-56
- Pelvic fracture: the last 50 years.J Trauma. 2010; 69: 483-488
- Three-dimensional analysis of pelvic volume in an unstable pelvic fracture.J Trauma. 2006; 61: 905-908
- Eastern association for the surgery of trauma practice management guidelines for hemorrhage in pelvic fracture—update and systematic review.J Trauma. 2011; 71: 1850-1868
- Hemorrhage in pelvic fracture: who needs angiography?.Curr Opin Crit Care. 2003; 9: 515-523
- The development of a urinary tract infection is associated with increased mortality in trauma patients.J Trauma Inj Infect Crit Care. 2011; 71: 1569-1574
- Does catheter-associated urinary tract infection increase mortality in critically ill patients?.Infect Control Hosp Epidemiol. 2007; 28: 1367-1373
- Pelvic fracture and associated urologic injuries.World J Surg. 2001; 25: 1578-1587
- Retrograde urethrocystography impairs computed tomography diagnosis of pelvic arterial hemorrhage in the presence of a lower urologic tract injury.J Am Coll Surg. 2008; 206: 322-327
- Pelvic fracture urethral injuries: the unresolved controversy.J Urol. 1999; 161: 1433-1441
- Delays and difficulties in the diagnosis of lower urologic injuries in the context of pelvic fractures.J Trauma. 2005; 58: 533-537
- The diagnosis of acute urethral trauma.J Inj. 2011; 42: 913-916
- Bladder injuries: evaluation and management.Br J Urol. 2000; 26: 408-414
- Blunt traumatic bladder rupture: a 10-year perspective.Am Surg. 2013; 79: 589-593
Article info
Publication history
Published online: March 17, 2015
Accepted:
March 5,
2015
Identification
Copyright
© 2015 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
