[gwenith]

Okay - this came up at work yesterday and interestingly 50% of the staff said put in a LARGER catheter and 50% said put in a SMALLER catheter.

:studyowl:So, now it is up to me I have to find some recent research on this, very possibly because I opened my mouth and said that the research was done back in the dark ages when I was training at my hospital.

I was one of the advocates for smaller catheter on the basis that urine bypassing the catheter is usually caused by bladder spasm from a too large catheter. There ensued some cognitive dissonance in relation to this

In the meantime, given the split in the beliefs held by the staff on duty I thought I would post a poll and see what other nurses out there thought.

[fluffwad]

I'd check to see if the catheter that was there was patent first. There are some folks out there that just put out lots of mucus , crystals, etc......do they have a UTI? esp. if that cath has been there a while.

Are they having bladder spasms because that cath is unsecured and getting tugged on?

[RealNurseWitch]

I personally would leave it alone for the time being until a decision can be made as to whether the patient can just have the catheter taken out alltogether. I wouldn't just automatically take that catheter out and put another one in.

OTOH, it depends on the situation. A small leak, the above would apply. A very large leak, I'd go ahead and call and see if the doc wants another one put in.

Also, there are patients that have permanent indwelling catheters. In that case, I would try putting in a larger one.

[gwenith]

Lots and lots of Googling later I found the answer.

http://www.o-wm.com/article/2272

This is an awesome article and supports what other articles say - you put in a smaller catheter not a larger one.

However you are right about checking for other causes - I did not know that constipation can cause bladder spasms.

As for removing the catheter - my poor patient was in ICU so that was NOT an option.

[NRSKarenRN]

Advice seen in this thread: overinflate catheter balloon