Clamping a Newly Inserted Foley

  1. 0
    Has anyone out there ever been told/taught that after inserting a foley, if the patient output exceeds 350 ml in a short period of time (say 10 minutes) then the catheter should be clamped for 10 minutes and reopened as not to cause the bladder to prolapse or injury to the bladder to occur because of the negative pressure created by emptying a full bladder too quickly?

    I was talking to an experienced RN yesterday who explained this to me . . .but I had never been taught or told this before. Iím still a novice nurse (10 months ICU experience) and have inserted my share of foleys that have drained a full bladder quickly. Iíve also assisted other (more experienced) nurses in foley insertion and have never seen anyone clamp the catheter when a full bladder in emptying quickly.

    Has anyone ever experienced a pt. bladder injury or prolapse because of too quick emptying as a result of a newly placed foley?

    Maybe I missed something in nursing school about this one!! :stone
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  3. 12 Comments so far...

  4. 0
    I was always taught that, as well; however, there is evidence to suggest that the Foley should be allowed to drain, regardless of volume.

    Here are a few examples you might want to review:

    Pro-clamping:
    http://www.emedicine.com/EMERG/topic624.htm
    http://www.brooksidepress.org/Produc...tion/Urine.htm

    Anti-clamping:
    http://www.ncemi.org/cse/cse0709.htm
    http://www.utmb.edu/aging/clinical/i...0%20bladder%22
  5. 0
    here in the UK many years ago I was taught this but then we changed to place the urine bag in the bed level with the patient if we was worried that too much urine was draining.
  6. 0
    We were taught that the "old school" of thought was to clamp at 1000ml of output, but no one could justify why so it was not considered to be knowledge based practice so we did not abide by it. I don't see the issue with it. If a person were to sit and void, their bladder would empty itself of whatever volume is present without any harm.
  7. 0
    I feel that the bladder should be drained. Stagnant urine breeds bacteria so I think it's best to empty it while you can. Other than possibly causing a bladder spasm, I haven't seen a pt have a problem with draining >1000. I myself had 1700 out after I had a hysterectomy and subsequent lazy bladder, lol!
  8. 1
    I was taught the same thing about clamping at 800-1000ml. I thought it was hogwash. I have however seen two patients in my career (not a lot I know) that had the issues we were warned about. What I was warned about was that it could cause hypotension. The theory being the sudden release of pressure from the pelvic wall will allow blood to rush to fill that area and cause hypotension/dizziness.

    I did see this with two patients as I mentioned. Both were patients that required intermittent caths every 6-8 hrs for neurogenic bladders. If you allowed more than about 700-800 to drain at once they would be cause faint and hypotensive. Why doesn't it happen when people void on their own? Well, in my experience MOST (not all) of the time people don't void that much at once. Also, with as many people as I've cath'd that had large volumes initially, I've only seen these two patients that had issues so it's obviously not that common.
    xjessx likes this.
  9. 1
    I was taught to clamp, but not because of bladder injury. If the pt is older or a spinal pt and is hypertensive, the BP can drop too much if the bladder empties too fast.
    xjessx likes this.
  10. 0
    I haven't seen bladder collapse but I have seen my share of painful bladder spasms with 1000 cc emptying before I knew better....
  11. 0
    I have also seen bladder spasms one time.
  12. 1
    I was taught to clamp off after 1000ml drained when first placing a foley. The rationale was that by draining too quickly the bladder decompresses to fast and can cause spasms and hypotension. I have seen both in different pts, so I always clamp now at 1000, give it some time then unclamp, and reclamp if necessary.
    xjessx likes this.


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