What would you have done? *urinary retention*

[Crux1024]

Pt with foley d/c'd (another shift) and due to void 6-8 hrs later. After 9 hours, was only able to piddle a scant amount (with ENORMOUS encouragement...). Bladder scan > 300. Called doc, Straight cath order obtained, pt refusing attempt. Pt states they are comfortable, (not distended or hardened as far as I could feel) I let them rest for a few hrs. BP rechecked and it is now 170 and wasnt before (basline about 130). Straight cath finally consented to, and ..swing and a miss.... (wasnt able to get straight cath on the first shot). Pt NOW adamantly refusing to be recathed and wants to sleep. Rechecked BP manually about 10 mins later and was 140's. Pt states no desire/urge to urinate. Is incontinent, but not enough on the brief to justify the > 300 mls on the scan.

I felt bad sending the pt on to the next shift with urinary issues, but I had no choice, Is there something else I could of done. Im not sure if the 170 BP was due to the retention issues, but I felt like it sure didnt help. I had asked the other nurses their thoughts but no one had any further than what I had already done. I charted as appropriate RE: refusals and attempts and etc.

*And for the record....I am the straight cath Queen...Last night though, I was dethroned...

[SwansonRN]

I don't get hypertensive when I have 300mL in my bladder. I don't know the patient's history, so I'm not saying they weren't related, but it's not a huge amount. If she refuses, just educate, do some great documentation, and continue to monitor.

[LadyFree28, BSN, LPN, RN]

You did everything right; many posters gave excellent techniques; don't beat yourself up too much.

I wouldn't be concerned about the PVR; if I was coming on, I wouldn't be upset either; I would get parameters with the provider, check with the bladder scan and monitor the pt; you would be free to go home.

[ChipNurse]

Did you rescan the bladder after the 2 hours? If the patient refuses, then you can't force the issue. Just tell the Dr. and document the refusal and the education that you provided to the patient.

[wanderlust99]

You did everything right. I palpate the bladder and often times pt will c/o of full bladder, strong urge to void but unable..this is when we must straight cath. Check pt's fluid status as well, how much did he get in. We have trouble with post op patients waiting to void in order to go home. OP said greater than 300mL, not just 300mL, so it was hard to tell the exact amount. Sometimes the bladder scanner will say the exact amount, like 750mL other times it'll be a greater than 300mL reading. We hate to see a patient go home without voiding and then end up in the ER next morning still unable to void, it does happen. I would rest easier knowing the patient said he felt comfortable. Document and let the MD know pt refused, try again after 11 hours, give more fluid if needed, stick his hand in water, etc..