Why instill saline into foley Cath for bladder ultrasound?

  1. 0 Hello, all my wonderful colleagues. I wanted to ask some of you a question. Why would I need to disconnect a one-way Foley to instill normal saline into the bladder for an ultrasound as opposed to just clamping off catheter tube and waiting for the bladder to fill on its own?

    I was wondering why do this just for convenience of the ultrasound technician? Is there something I don't know that I should? If I am wrong, please tell me. I'm not very experienced (2 years experience) and haven't seen a lot. So, if I'm wrong, please tell me. I won't be offended. Here's the scenario.

    One of my co-workers had a pt. that was supposed to have an ultrasound of the bladder done. I guess she forgot to clamp the catheter before the ultrasound tech came up or didn't know the patient was supposed to have one. Well, when the ultrasound tech got there he stopped me and asked me about the patient. I went in and saw that she had the foley and proceeded to clamp it. He was like, "I am getting ready to go home, I won't have time to wait for her bladder to fill up. They usually just put about 300 ccs of saline in the bladder." Since that was something I had never heard of or was never taught to do, I went and asked my co-worker about it. She told me to just put sterile saline in through the foley. I told her that the patient didn't have a 3-way foley, so how would I do it. She told me to just disconnect the drainage tube from the cathether and instill it.

    Now, I was reluctant to do such a thing for two reasons. One reason was because the patient was unresponsive. The other reason, the MAIN reason was because I felt that was a big way to introduce pathogens to the urinary tract very easily. For liability reasons, I refused to do that and clamped the tube and told the US tech he would have to just wait. Do you all think I did the right thing? I mean, I would be liable if she got a urinary tract infection as a result right? And I didn't have a doctor's order to do so.

    I just really felt that it would put the patient at risk for infection just for the convenience of the US tech. There was another tech coming in to relieve him. I didn't see why do that when the oncoming tech could come and do it when the bladder was full. If it had off been a 3-way, i would have had no problem doing it. But since this was a one way, I was scared. Should I have been? Please, your input is needed. Thanx to all who reply.
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  3. Visit  Kanani_Ikike profile page

    About Kanani_Ikike

    Joined Jan '07; Posts: 167; Likes: 178.

    12 Comments so far...

  4. Visit  Marie_LPN, RN profile page
    1
    I would have said that for me to instill saline into the bladder like that would be like a bladder irrigation, and that i don't have the Dr.'s order to do so.
    Kanani_Ikike likes this.
  5. Visit  cardiacRN2006 profile page
    1
    I agree, I'd want to see either a protocol or Drs order on that.

    It seems a lot of decisions are made (or attempted to be made) at the sake of someone else's convienence-other than the pts.

    I remember we would struggle to get open heart pts into a chair for the 1st time, and US would always seem to come right then and say, "He's got to be in bed for this test! Otherwise I go home on call and you will be responsible for calling me in"

    Ugh.
    Kanani_Ikike likes this.
  6. Visit  Jolie profile page
    1
    Thank you for putting patient safety and comfort above convenience and not allowing another staff member to pressure you into doing something you had no order for.

    A number of years ago, I had to have a stat U/S to diagnose a suspected tubal pregnancy. Due to the urgent need for the U/S, my bladder was filled with saline via a Foley rather than waiting for natural filling. It was the most excruciating pain of my life. Worse than the pain of the ruptured tube itself.

    This is a practice that has largely gone by the wayside, thankfully.
    Kanani_Ikike likes this.
  7. Visit  FUNNYGIRLRN profile page
    1
    I remember that I went to the ER once (on my PCP's orders) with terrible pain in my lower abdomen and the ER doctor wanted to do a vaginal ultrasound to look at my ovaries. Well they said that in order to see and hvae better land marks I had to have a full bladder. Well here I am 20 years old at the time and scared to death. The nurse says we have to put in a catheter and I started to cry. The nurse sits down in the room and goes, "I'll wait for you to calm down, I can't do this with you crying, vaginal muscles are strong and you could crush my hand." A few minutes later she stearnly says, "Ok either we are going to do this or we aren't those are your only options." I asked if i could drink a buntch of water really quick and she snapped at me saying they didn't have time for that. So in goes the catheter and they fill it with saline and I kept saying it felt like I was peeing and they said, "no your not your fine." Afterwards when it was over my whole back side was soaking wet and the table was wet from where saline leaked everywhere. Then the x-ray tech comes in and says that she noticed my bladder wasn't emptying well but did not see anything else. When I went to my PCP the next week they had faxed him the report and I said, "I already know my bladder isn't emptying well." The doctor said , "Uhh this report doesn't say anything about that it says you have mulitple cysts on your ovaries. I had to go back and have the whole procedure started again. Ughhhh. That was the worst experience of my life.
    Kanani_Ikike likes this.
  8. Visit  Kanani_Ikike profile page
    0
    Quote from Marie_LPN
    I would have said that for me to instill saline into the bladder like that would be like a bladder irrigation, and that i don't have the Dr.'s order to do so.
    Thank you for replying. That's what I was thinking. I just had never heard of instilling saline except for bladder irrigation. And I just never do ANYTHING like invasive without a Dr.'s order. Thank you for this.
  9. Visit  Kanani_Ikike profile page
    0
    Quote from cardiacRN2006
    I agree, I'd want to see either a protocol or Drs order on that.

    It seems a lot of decisions are made (or attempted to be made) at the sake of someone else's convienence-other than the pts.

    I remember we would struggle to get open heart pts into a chair for the 1st time, and US would always seem to come right then and say, "He's got to be in bed for this test! Otherwise I go home on call and you will be responsible for calling me in"

    Ugh.
    Thank you for your reply. I think it was a question of convenience, too. I just didn't see why take that risk for something that wasn't STAT. And this lady was very, very, elderly. She was in her late 90s. I probably would have killed her or something. I'm so glad that you feel the same way. It makes me feel so much better. Thank you.
  10. Visit  cardiacRN2006 profile page
    0
    Oh gosh, in her 90's!!!

    How sad. I'm even more glad that you didn't do it!
  11. Visit  Kanani_Ikike profile page
    0
    Quote from Jolie
    Thank you for putting patient safety and comfort above convenience and not allowing another staff member to pressure you into doing something you had no order for.

    A number of years ago, I had to have a stat U/S to diagnose a suspected tubal pregnancy. Due to the urgent need for the U/S, my bladder was filled with saline via a Foley rather than waiting for natural filling. It was the most excruciating pain of my life. Worse than the pain of the ruptured tube itself.

    This is a practice that has largely gone by the wayside, thankfully.
    Thank you for replying. And thank you for your support. I'm sorry you had to go through such excruciating procedures. Now in your urgent case, i could understand the need for filling your bladder. Time was of the essence. But with this lady, this US tech was ready to go home. I understand how it is when you're ready to go home, but that's why we are a 24/7 facility. Care doesn't end at 5pm. I'm am, too, glad that this practice is not taught and not practiced a lot. I'm also glad that I did teach this brand new graduate nurse to do the right thing. It's good to have brand new nurses pick up good habits. Thank you.
  12. Visit  Kanani_Ikike profile page
    0
    Quote from FUNNYGIRLRN
    I remember that I went to the ER once (on my PCP's orders) with terrible pain in my lower abdomen and the ER doctor wanted to do a vaginal ultrasound to look at my ovaries. Well they said that in order to see and hvae better land marks I had to have a full bladder. Well here I am 20 years old at the time and scared to death. The nurse says we have to put in a catheter and I started to cry. The nurse sits down in the room and goes, "I'll wait for you to calm down, I can't do this with you crying, vaginal muscles are strong and you could crush my hand." A few minutes later she stearnly says, "Ok either we are going to do this or we aren't those are your only options." I asked if i could drink a buntch of water really quick and she snapped at me saying they didn't have time for that. So in goes the catheter and they fill it with saline and I kept saying it felt like I was peeing and they said, "no your not your fine." Afterwards when it was over my whole back side was soaking wet and the table was wet from where saline leaked everywhere. Then the x-ray tech comes in and says that she noticed my bladder wasn't emptying well but did not see anything else. When I went to my PCP the next week they had faxed him the report and I said, "I already know my bladder isn't emptying well." The doctor said , "Uhh this report doesn't say anything about that it says you have mulitple cysts on your ovaries. I had to go back and have the whole procedure started again. Ughhhh. That was the worst experience of my life.
    Thank you for your reply. I am sorry to hear that you went through that. And that nurse wasn't very comforting, was she? It sometimes makes things worse when you have a not-so-nice caregiver. And I bet that was painful. And that's what I was thinking about when they wanted to do this with this poor lady. A bladder infection would probably have taken her out quicker at her age. And that was something I didn't want to risk doing. Thank you.
  13. Visit  KimTheRN profile page
    0
    I agree. While it's quite possible that it's a normal procedure, it's still a procedure that you haven't even witnessed, let alone been taught. It's your license on the line. If the U/S tech wants it so badly, let HIM do it, and sign his name and take the fall if something goes wrong. There's a reason your an RN and he is a tech. You're there to protect your patients from harm, and you were right to trust your instinct.

    That's why you make the big bucks.
  14. Visit  rnmi2004 profile page
    0
    Quote from FUNNYGIRLRN
    The nurse sits down in the room and goes, "I'll wait for you to calm down, I can't do this with you crying, vaginal muscles are strong and you could crush my hand."

    Funnygirlrn, forgive me because it sounds like a stressful situation where you were denied the compassion you needed. But the nurse who said this to you has me because her catheter insertion technique is wayyyyy off if she felt that she was in danger of having her hand crushed by the powerful vaginal muscles.

    I do my kegels, but I still doubt I could crush a hand.

  15. Visit  KimTheRN profile page
    0
    Quote from FUNNYGIRLRN
    I can't do this with you crying, vaginal muscles are strong and you could crush my hand." A few minutes later she stearnly says, "Ok either we are going to do this or we aren't those are your only options." I asked if i could drink a buntch of water really quick and she snapped at me saying they didn't have time for that. So in goes the catheter and they fill it with saline and I kept saying it felt like I was peeing and they said, "no your not your fine." Afterwards when it was over my whole back side was soaking wet and the table was wet from where saline leaked everywhere. Then the x-ray tech comes in and says that she noticed my bladder wasn't emptying well

    Well, I'm not sure what happened here, but your nurse was an idiot. First of all, vaginal muscles would never be strong enough to crush a hand. Secondly, proper catheter insertion does NOT involve inserting the hand into the vagina! On 90% of women, the ureter opening (where your pee comes out) is outside the vaginal opening, and slightly above it. Now, she was right about one thing: in an emergency situation, there is not enough time to drink a lot of water for the ultrasound. Worst case scenario, if the baby was found to be in danger, you may be rushed for an emergency c-section. There was a reason you were in the ER, and it's better to be safe than sorry. Now, the feeling that you need to pee is caused by having the tube in your ureter. And it is normal to have that feeling when the catheter is in. I have often have elderly or confused patients wake up, not realizing that they have a catheter in and telling me that they need to pee....and I tell them that they already are peeing- the catheter continually drains the bladder.

    The one thing I am confused about is that you mentioned the saline leaking out on the bed, and the tech mentioning that your bladder wasn't emptying well. I'm not sure exactly what could have caused this, and the only thing I can think of is either the nurse screwed up and inserted it into your vagina instead of your bladder....or that the little balloon that keeps it in place wasn't inflated enough and saline leaked around the sides. Any of you nurses have any other ideas? I haven't run into that problem before...


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