How long can a patient go without urinating after receiving a Duramorph spinal? - page 2

by willyRN86 36,276 Views | 19 Comments

I had a patient come back from a TKA at 1500. I'm a new grad, and this was my first fresh ortho surgical that I've had. He received a Duramorph spinal as well as general anesthesia. The patient did not have a foley. I asked if... Read More


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    i have a question on how to assess a patient after an abdominal surgery for example when shuould you expect to hear bowel sounds, passing gas or bm. For example in nursing school I was taught if a patient has no bowel sounds they should not eat but I saw a patient that was 1 day post op with no bowel sounds but was on a clear liquid diet. I dont understand when bowel sounds should be heard and when the diet should be advanced.
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    I would have done a bladder scan by then.....
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    Quote from beauty912
    I work on an ortho floor and if a patient doesn't void in 6 hours, we bladder scan and do a straight cath. Lots of times I'll even scan @ 5 hours just to see how much is in there. I always tell the patient around hour 4 or 5 ( if I haven't already) what interventions will take place at hour 6. Sometimes hearing about a catheter really motivates people to void on their own. Especially men. LOL
    Did the EXACT SAME THING.
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    i am more liberal with time for peeing and our ortho usually writes for a straight cath if the bladder scanner shows more than 600. 2400 is not a lot of fluid after a joint surgery.
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    I work in Pediatric Surgery, lots of Ortho. We let 8-10 hours go by and most kids use most of the time. The longest I'll let them go is 12. Perhaps the reason why this seems more than most posts is how traumtic something like cathing is for a kid. Most of the time if they need the cath, they'll be begging for it by the time it's inserted.
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    Quote from willyRN86
    I had a patient come back from a TKA at 1500. I'm a new grad, and this was my first fresh ortho surgical that I've had. He received a Duramorph spinal as well as general anesthesia. The patient did not have a foley. I asked if the patient peed in recovery, the surgical nurse stated no. He had 2400 mL of fluids in during the surgery and he was a very large gentleman and had peed before they took him in at 1200, which the surgical nurse told me it was fine if he didn't pee for awhile. I had the patient try to pee at about 1830, even though he couldn't feel like he had to pee. The patient had full sensation back from his spinal (another story all together). The doctor came in at 1845 and was furious he hadn't peed yet. How long is it OK to wait for a patient to pee after getting a spinal?? Any thoughts? I felt terrible!
    According
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    Quote from tigerrn

    According
    According to standards of practice, eight hours is your window. Studies show after this time , bacteria will begin to grow. The same reason nurses have frequent UTIs. Certainly your order takes priority. And as for bladder scanners, they are about as accurate as a warped boomerang! Happy cathing!
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    We have standing orders that say after the foley is removed, if the pt has not urinated in 4-6 hours straight cath x 1 and then if the pt is still unable to urinate in the next 4-6 hours, call the MD.
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    Our Duramorph patients always keep their foley till 6am POD#1 (which is part of the reason we don't use it anymore). As far as voiding, our docs tends to be pretty laid back about it. I'd bladder scan at 6-8 hours unless the patient was complaining of discomfort. We don't cath unless the volume is over 500 or a ridiculous amount of time has passed. The answer is usually give them more time and get them up and walking. And if they're peeing at all, even as little as 25-50mL, they won't cath them unless the volume get up around 700 or 800 or they're uncomfortable. Everything is about the minimum intervention possible.
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    Our window is 6-8 hours for our patient to urinate, when they haven't in the slotted time we get our bladder scanner and check to see if the patient is even making urine or is just dehydrated. Many times if the patients bladder is holding less than 200mL we won't straight cath the patient but inform the doctor that the patient has inadequate mL's of urine.

    Unfortunately many older male patients suffer from BPH or other prostate problems and they can be difficult to straight cath or require multiple straight catharsis (many doctors on my unit will order straight cath PRN q6hrs x3).


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