Pre‐procedure

ActionRationale

1. 1.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [126], C).
2. 2.Show
   Determine the relevant sources of fluid output (see Table 8.3) and note them on the fluid balance chart.
   To ensure all possibilities have been considered and to ensure accurate (as far as possible) output determination (Scales and Pilsworth [158], E).
3. 3.Show
   Wash hands thoroughly and/or use an alcohol‐based handrub and apply personal protective equipment necessary for handling body fluids.
   To appropriately decontaminate hands and avoid cross‐contamination ([115], C).

Procedure

1. 4.Show
   Explain to the patient that it is necessary to monitor their urine output and that you will be doing so every hour.
   To ensure that the patient is not alarmed by frequent observation and that they are kept informed about their current care (Bryant [26], E).
2. 5.Show
   Attach a urometer to the catheter using an aseptic technique (see Procedure guideline 4.11: Aseptic technique example: changing a wound dressing).
   To allow accurate assessment of hourly urine output. E

   To prevent cross‐infection (Loveday et al. [91], R).
3. 6.Show
   Each hour, on the hour, note the volume of urine in the urometer, recording this on the fluid balance chart.
   To determine urine output and to keep accurate records of this, enabling the assessment of fluid balance (Scales and Pilsworth [158], E).
4. 7.Show
   Empty the urometer into the collection bag (until the bag is three‐quarters full; this will then need emptying).
   To ensure the urometer is empty for the next hour's determination and that there is no backflow of urine. E
5. 8.Show
   Add recorded urine output to the other values for output, giving an hourly total.
   To allow for fluid balance determination. E

Post‐procedure

1. 9.Show
   Once all output has been determined and noted on the chart, calculate the total hourly output and then subtract the total output from the total input.
   To calculate hourly fluid balance. E
2. 10.Show
   Document all values on the chart and record any other actions relating to your findings in the patient's notes.
   To ensure accurate documentation (NMC [126], C).