catheter and BP??? what?

[djsrn]

This pt hadn't been voiding, bladder scanned 800ccs, doc ordered foley. simple enough. but then the nurse told her orientee to go and clamp the foley cuz if it drains too fast the pt could go into shock. Now, mind you i don't have anyone here to discuss it with, and i am not going to argue with her. she's been a nurse forever and i don't want her to think i'm being difficult. but isn't the only thing that could really happen is the pt would get bladder spasms? Urine already in the bladder has nothing to do with BP, right? (I feel like I am having a debate with myself!!)

[Agnus]

I hadnt heard anything about shock, but we were taught that a quick drarin of over 800-1000ml would damage the receptors on the posterior lining of the bladder and cause the patient to not be able to determine when the bladder was full causing overflow incontinence.

But isnt a bladder scan a pretty expensive way to determine if the bladder is full? Was the bladder palpated to see if it was distended? Why wouldnt you just do a straight cath for residual? Had an attempt been made to insert a foley and was not successful? Seems a lot of expense and time, not to mention potential discomfort for the patient with a full bladder to have to be moved and wait so someone can put pressure over the bladder during the scan to find out if its full. I dont know the whole situation but doing a scan for a non urinating patient before other options were unsuccessful could almost be called medicare/insurance fraud couldnt it?

You have the cart before the horse. We do a bladdar scan instead of just cathing a patient because. A catheter is invasive, can cause trauma, can introduce bacteria into the bladdar. A bladdar scan is a safe non invasive way of determining how much is in the bladdar.

I do bladdar scans before I cath for residual because often there is so little residual there is no need to remove it. The scan tells me if this is the case. ALWAYS do the conservitive non invasive approach in any situation first in the interest of patient safty. If you think a bladdar scan is uncomfortable then you have not inquired about the comfort of having a catheter placed. Safty is the first consideration always.