When lower motor neuron damage impairs the voiding reflex, the bladder may become flaccid or areflexic. Because the bladder fails to contract properly, urine collects inside it, causing distention. Crede’s maneuver—application of manual pressure over the lower abdomen—promotes complete emptying of the bladder. After appropriate instruction, the patient can perform the maneuver himself, unless he can’t reach his lower abdomen or lacks sufficient strength and dexterity. Even when performed properly, however, Crede’s maneuver isn’t always successful and doesn’t always eliminate the need for catheterization.
Crede’s maneuver can’t be used after abdominal surgery if the incision isn’t completely healed. When using Crede’s maneuver, close monitoring of urine output is necessary to help detect possible infection from accumulation of residual urine.
Gloves ▪ bedpan, urinal, or bedside commode.
Verify the doctor’s order, if needed.
Confirm the patient’s identity using at least two patient identifiers according to your facility’s policy.4
Explain the procedure to the patient and answer any questions to decrease anxiety.
Place the patient in Fowler’s position and position the bedpan or urinal, or if the patient’s condition permits, assist into the bathroom or onto the bedside commode. A male patient may benefit from standing, if possible.
Place your hands flat on the patient’s abdomen just below the umbilicus. Ask the female patient to bend forward from the hips. Then firmly stroke downward toward the bladder about six times to stimulate the voiding reflex.
Place one hand on top of the other above the pubic arch. Press firmly inward and downward to compress the bladder and expel residual urine. (See Crede’s maneuver, page 218.)
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