Am I right or wrong?

Burnt Out, ASN, RN · Nov 10, 2004

I ALWAYS go by the urine in the tubing, not the bag. I usually will drain what is in the tube into the bag and look at what starts entering the tube from the bladder.

peeps79 · Nov 10, 2004

I'm fairly new to nursing but I've worked with TURPS before and If I'm correct isn't there supposed to be Blood in the Urine? That's what the CBI is there for and if it's present then, CBI needs to be turned up? I was also taught to check in the tubing. to determine the nature of blood present. Maybe I miss understood the circumstances, but in the Urology floor where I used to work this is what they did. If I'm wrong about any of this I'd love more education.

thanks

URO-RN · Nov 10, 2004

When assessing the color of urine when a pt has a foley do you not look at the urine in the "clear tubing" not the urine thats been sitting in the bag. I have been a nurse for many years and got screamed at the other night (totally humiliated me) by a CNA that my pts urine was bloody "and that I needed to call the doc" I had just left the room 2 mins before and it was clear yellow in the tubing (he was a post op TURP and had CBI). I had been checking his urine every 15 mins.

If he was fresh post-op TURP and CBI, of course his urine will be bloody. I look for clots and notify MD accordingly.

Seems that you were doing things right .:)

When I had a case just like yours, the MD (not me) adjusted the rate. He actually came in and adjusted the flow.

UM Review RN, ASN, RN · Nov 10, 2004

That's what the CBI is there for and if it's present then, CBI needs to be turned up?

The purpose of CBI is to wash out clots from the bladder, and because of the continuous wash of NS, actually keep clots from forming that would prevent the flow of the urine.

So the answer is no, hematuria is not normal, but after a TURP it is. In fact, there are specific colors to describe the Foley output, such as cherry red, light pink, etc. Cherry red might be a concern, as it could indicate an arterial bleed. Dark red could be a venous bleed.

This is why we check the Pt's H&H pretty frequently, also. Something that the normal CNA wouldn't have the authority nor the expertise to determine, but I'll address that whole issue in a moment.

You consider what's in the Foley, and describe the color of the urine to the tubing, and the amount and size of the clots occurring, and the number of times you have to irrigate, and the rate of the CBI flow, but what's actually in the bottom of the Foley is old news. It could've even been from hours or days ago, if you think about it, because there's always a little bit left in a Foley, especially if there are clots.

If I have a question about whether or not the urine color is improving, I drain the bag and mentally decide whether the color is lighter or darker and whether or not the clots are smaller, more numerous, and such.

To sum it up, I would've done the assessment the same way. If I was concerned about too much blood loss, I would've drained the bag and reassessed. I would've considered the H&H before I called the doc.

The CNA that "screamed" at you was waaaaaaaaaaaaaaaaaaaay out of line. She should be reported for insubordination.

Nurseboy1 · Nov 10, 2004

I always look at the foley tubing. BTW the CNA is out of line. I would have politely reminded that person that assessment of the patient and communication with the doc is within my discretion.

peeps79 · Nov 10, 2004

So the answer is no, hematuria is not normal, but after a TURP it is.

Thanks. That was what I meant. I knew hematuria wasn't normal. but the RN was, at that point, talking about TURPs. That's great that I have been consistent in my assessments with the descriptions! Should I encounter them again, I'll continue to do what I did!

once again thank you!

Jo Dirt · Nov 10, 2004

I'm glad to know these things. You should report that CNA and fast. He/she needs to be put in their place. Seriously. No where else would you get away with back talking a supervisor.

UM Review RN, ASN, RN · Nov 10, 2004

If I'm wrong about any of this I'd love more education.

OK, just one more really important thing about TURPs, then. :)

Make sure you check the urine flow frequently, as the OP was doing, because just think what'd happen to the poor Patient's bladder with a CBI at a fast rate and a big ol' clot stopping the flow.

Sometimes your Patient will tell you he's having bladder pain and that's your first clue he's having spasms from a clot, so just make sure you check that output very frequently.

Another danger point is when the urologist comes in. I frankly have never failed to see a urologist come into a patient's room, do something, and then finishing the visit off by turning down the CBI. :uhoh3: Which can cause more clots, which can obstruct the urine flow, which can cause the patient's bladder to burst if left unattended.

So whenever the urologist leaves the room, check the orders and if CBI is still running, go check the rate. Just a helpful lil tip.

URO-RN · Nov 10, 2004

OK, just one more really important thing about TURPs, then. :)
Make sure you check the urine flow frequently, as the OP was doing, because just think what'd happen to the poor Patient's bladder with a CBI at a fast rate and a big ol' clot stopping the flow.
Sometimes your Patient will tell you he's having bladder pain and that's your first clue he's having spasms from a clot, so just make sure you check that output very frequently.
Another danger point is when the urologist comes in. I frankly have never failed to see a urologist come into a patient's room, do something, and then finishing the visit off by turning down the CBI. Which can cause more clots, which can obstruct the urine flow, which can cause the patient's bladder to burst if left unattended.
So whenever the urologist leaves the room, check the orders and if CBI is still running, go check the rate. Just a helpful lil tip.

Excellent!:) Post.!

peeps79 · Nov 10, 2004

thanks so much for the info.

lovingtheunloved, ASN, RN · Nov 10, 2004

I'm a CNA, and I would never DREAM of disrespecting my supervisor like that. He/she does need to be put in her place. Um, calling the doc is a NURSING judgement, and guess what? I'm not a nurse!