catheter and BP??? what?

Pediatric Critical Care Columnist · Oct 27, 2004

Not just quadriplegics, paraplegics can crash on you if you empty a very full bladder too fast.

People with spinal cord injuries may develop autonomic dysreflexia, due to stimulation of sensory nerves in the absense of perception of sensation. Things like full bladders or bowels, wrinkles in their socks, too-tight shoes, overheating and other relatively minor discomforts may cause an episode. Their skin becomes blotchy above the injury, they become hypertensive and develop reflex bradycardia. This can be a life-threatening event. Correcting the problem as soon as possible is the best treatment, but they may require nifedipine (Adalat) to bring down their BP and up their heart rate. Controlling the environment and ensuring that the linen or clothing have no wrinkles is important in preventing episodes. When I've cared for kids with autonomic dysreflexia, the first thing we would do is empty their bladders. Quickly. In this case, the hypotension comes first, from the full bladder. If that didn't work, then we'd go to disimpaction and then on down the list of possible causes, cycling the blood pressure monitor every minute until the episode resolved. It's very frightening to have a toddler with a heart rate of 30 and a BP of 140/95, and believe me, the fear never leaves you!

Pediatric Critical Care Columnist · Oct 27, 2004

Not just quadriplegics, paraplegics can crash on you if you empty a very full bladder too fast.

People with spinal cord injuries may develop autonomic dysreflexia, due to stimulation of sensory nerves in the absense of perception of sensation. Things like full bladders or bowels, wrinkles in their socks, too-tight shoes, overheating and other relatively minor discomforts may cause an episode. Their skin becomes blotchy above the injury, they become hypertensive and develop reflex bradycardia. This can be a life-threatening event. Correcting the problem as soon as possible is the best treatment, but they may require nifedipine (Adalat) to bring down their BP and up their heart rate. Controlling the environment and ensuring that the linen or clothing have no wrinkles is important in preventing episodes. When I've cared for kids with autonomic dysreflexia, the first thing we would do is empty their bladders. Quickly. In this case, the hypotension comes first, from the full bladder. If that didn't work, then we'd go to disimpaction and then on down the list of possible causes, cycling the blood pressure monitor every minute until the episode resolved. It's very frightening to have a toddler with a heart rate of 30 and a BP of 140/95, and believe me, the fear never leaves you!

rnmi2004 · Oct 27, 2004

I did a quick google & found this info:

With acute overdistention of the bladder, no more than 1000 cc of urine should be removed from the bladder at one time. The theory behind this is that removal of more than 1000 cc suddenly releases pressure on the pelvic blood vessels. This can affect overall circulatory function and acute blood pressure changes can follow.

rnmi2004 · Oct 27, 2004

I did a quick google & found this info:

With acute overdistention of the bladder, no more than 1000 cc of urine should be removed from the bladder at one time. The theory behind this is that removal of more than 1000 cc suddenly releases pressure on the pelvic blood vessels. This can affect overall circulatory function and acute blood pressure changes can follow.

Pediatric Critical Care Columnist · Oct 27, 2004

Okay, that makes sense. I was thinking it probably was something along that track.

Pediatric Critical Care Columnist · Oct 27, 2004

Okay, that makes sense. I was thinking it probably was something along that track.

TiffyRN, BSN, PhD · Oct 27, 2004

Back when I worked with big people we had a standard on our floor to never drain more than 1000cc for fear of BP drop due (as someone already posted) to release of pressure on the pelvic blood vessels. I was a non-believer though I followed the policy. I did have one instance when we were straight cathing a man with guillian barre syndrome and he got all sweaty and pasty towards the end of his cath. We checked his BP and found the systolic had dropped 30-40points from his average. We rarely clamped during straight caths but rarely had more than 1000 cc out but this guy was different. He was cath'd every 6 hours and routinely had 1000-1400, he had to be clamped at around 600-700 and then wait 10-15 minutes to finish draining. It was probably more a neuro thing but it made all of us cautious about letting large volumes drain with any of our patients after the experiences with him.

TiffyRN, BSN, PhD · Oct 27, 2004

Back when I worked with big people we had a standard on our floor to never drain more than 1000cc for fear of BP drop due (as someone already posted) to release of pressure on the pelvic blood vessels. I was a non-believer though I followed the policy. I did have one instance when we were straight cathing a man with guillian barre syndrome and he got all sweaty and pasty towards the end of his cath. We checked his BP and found the systolic had dropped 30-40points from his average. We rarely clamped during straight caths but rarely had more than 1000 cc out but this guy was different. He was cath'd every 6 hours and routinely had 1000-1400, he had to be clamped at around 600-700 and then wait 10-15 minutes to finish draining. It was probably more a neuro thing but it made all of us cautious about letting large volumes drain with any of our patients after the experiences with him.

talaxandra · Oct 28, 2004

I'm not disagreeing at all, but last week I had a patient who only voided once or twice a day, well over a litre each time (and once almost two litres - that was a pan I didn't want to drop!), with no hypotensive effect. She's in her forties, average size, and a former nurse, which could explain her bladder capacity!

talaxandra · Oct 28, 2004

I'm not disagreeing at all, but last week I had a patient who only voided once or twice a day, well over a litre each time (and once almost two litres - that was a pan I didn't want to drop!), with no hypotensive effect. She's in her forties, average size, and a former nurse, which could explain her bladder capacity!

FZ1Tom · Oct 28, 2004

I don't know if it had anything to do with BP or not, but I did have an episode of transient urinary retention during my prostate troubles a couple months back. Short version, I ended up voiding about 3 liters or so in around 20 minutes' time after not going in about 14 hours (yeah, it hurt....a lot). What I remember most was the sheer exhaustion afterwards. Slept in the gurney for nearly an hour, I think. So yeah, its possible....just my .02

Tom

FZ1Tom · Oct 28, 2004

I don't know if it had anything to do with BP or not, but I did have an episode of transient urinary retention during my prostate troubles a couple months back. Short version, I ended up voiding about 3 liters or so in around 20 minutes' time after not going in about 14 hours (yeah, it hurt....a lot). What I remember most was the sheer exhaustion afterwards. Slept in the gurney for nearly an hour, I think. So yeah, its possible....just my .02

Tom