[elizabells]

Hey all, I think I did something stupid last night; just wanted some input. So I have this baby with all kinds of issues, the main one being a massive teratoma in his chest. Secondary issue being that he's in HORRID renal failure. Pitting edema all over, UOP < 0.5ml/kg/hr. He's got a Foley, but there's so little urine draining that it just collects around the rim of the collection canister and won't drain out the hole in the bottom. MDs are getting frustrated with me because the I&O sheet isn't accurate because of this. So I disconnected the Foley from the collection canister (w/ sterile gloves on) and popped the end of the Foley into a sterile urostomy bag and sealed the hole (at the top of the bag, through which the Foley is inserted) with Tegaderm. The day shift nurse pointed out (rightly) that that was pretty much a big break in the sterile system that a Foley should be, and she was going to replace the Foley. Now, the baby is on Vanc and Zosyn at this time. My thoughts were that accurate urine measurement was the priority, but I definitely see her point.

What do you all think?

Oh, and don't even get me started on how the kid coded at 0650. Thanks, mister!

[dawngloves]

Hmmm...not being familiar with your system, how much urine are we talking here? 1-2 mls in 8 hours? If that's the case I would have written "gtts" on the I&O sheet because really the amount of urine he is putting out is hardly worth measuring.Clearly the kid is in failure and the docs should have recognized he was barely making urine rather than how much urine he is barely making.
Second, I think you had a good idea, but I would have replaced the foley with your new set up.That would have kept your system sterile and CYA if any docs questioned your position of the foley as possibly being the cause of the poor output.
And yeah, the only thing I love more than my patient go down the tubes 10 minutes before end of shift, is walking in at begining of shift and they are coding one of my pts.

[elizabells]

So here's a funny thing: when I got to work last night, the Foley was back to its usual setup, but he's still not peeing. About ten minutes into my shift the attending comes up to me and asks me to disconnect the system and put the end of the Foley in an ostomy bag! This MD was NOT there the night before when I did it the first time.

And dawn, the gtt idea is a good one, except we chart on the computer. "Gtts" is not an option, unfortunately. First time I've ever wished for paper charts...