cathethers, and swollen hands

dollphyn · Nov 16, 2008

Hi,
I just had a couple questions if anyone could shoot some answers my way.. i would appreciate it!
1) when a patient is retaining urine and you have to do an in + out catheter, what is the best way/position to drain the pt's bladder? last night did a bladder scan for 900ccs and was only able to drain ~400cc! I waited for quite awhile, holding that catheter in place, applying pressure to her abdomen, having her take deep breaths, putting the bed up or down.. Does anyone have efficient tips on how to get a good empty??
2) When a patient has an IV in their hand, and their hand begins to swell, however the IV is dripping well, it flushes without resistance, there's no pain etc... is it safe to assume that the iv is still in the vein? Is it possible for the hand in which the IV is inserted in, to swell over time, but the IV still be patent?
thank you so much for your answers! i'm sure there are tons more that run through my head throughout the shift.. but i can't think of them now.. :)

I really do not like bladder scans. The patients I have had the scan says that they have 400mls in the bladder, but I pull off 900-1300 depending on the patient. I have never come across the instance where it says 900 and only pull off 400, so I will be looking for other responses.

Regarding IVs, your IV is probably in the tissue and that is why it is swelling. It doesn't necessarily hurt at first, but as the arm continues to swell, the patient will let you know. The fluids will continue to run and go into the tissue and you could flush it and the arm still swell. I would stop and start a new IV just to be on the safe side. I actually had this happen to me as a patient. I told my mom that my arm looked gigantic, and the nurse said oh it is ok your IV is flushing well and the fluids are still running. An hour later my arm was 3 times the size of my other arm and it was painful. The fluids had gone into the tissues and made my arm swell.

Hope this helps.

clemmm78, RN · Nov 16, 2008

re the IV - it may be running well but it sounds like it's in the tissue. Do you get any blood return? That's the only way to know if it's still in the vein.

schyte804 · Nov 16, 2008

For IV's..it is case to case basis..somtimes it swell maybe because of the medications administered, especially antibiotics, which are painful.

i have experienced it few months ago. what i did was I observed the swelling hand of the patient for 15 minutes. I marked the swollen hand and measured it using a tape measure. when it passed through the mark, I removed it quickly then notified the attending physician.

schyte804 · Nov 16, 2008

re the IV - it may be running well but it sounds like it's in the tissue. Do you get any blood return? That's the only way to know if it's still in the vein.

yah..I agree!!

suzanne4, RN · Nov 16, 2008

Bladder scans are only an observation and are not always definitive. Also depends on technique. If there is urine in the bladder it is going to drain out thru the foley. It is very hard to hide 500 ml of urine in there and not have it come out.

As far as the IV, if you do not get a blood return, then you have no guarantee that it is in a vein. It can continue to infuse directly into the tissue as everyone else here has stated. You can easily flush right into the soft tissue and not know it until it gets quite painful and then it is too late to do anything. If you do not get a blood return and the hand is starting to swell, just take it out and start a new intravenous catheter in another locale.

CoffeeRTC, BSN, RN · Nov 16, 2008

Did you rescan after cathing? Just wondering if it showed anything.

Sunflowerinsc, ADN, RN · Nov 17, 2008

If the IV site is swollen, cool to touch, red, no blood return ,take it out right then. I wouldn't measure and wait or call the Dr. Out and restart then. Even if there is a "sorta" blood return, if there is swelling, the fluid is not going into the right place. What if the fluid had KCl in it, that's 15 more minuets trauma to the tissues.

Bladder scans are a guide for how much urine is in the bladder. The amounts can change as you scan each section of the bladder. Or maybe the I and O cath was clogged with mucous or clot ,ect and didn't drain as much as you scanned .

It is often a good idea to check the pt ,not the machine. Did bladder still seem distended, pt feel like still had to "go" ?

Access and keep on looking out for the pt.

iluvivt, BSN, RN · Nov 17, 2008

I hate to be the bearer of bad news but a blood return is not a guarantee that you are in a vein and that it is OK to continue to use the site. This is a common misconception. You may be able to get a blood return while a site is infiltrating b/c the cannula is partially in the vein (thus the blood return) and partially out (and thus some s/sx of infiltration). I like to see a blood return along with all the other assessment parameters that let me know all is OK. So instead of looking at just one thing look at the whole picture...is there any redness swelling or pain....is the site cool...how does it look in comparison to the other arm or opposite side...and how old is the site and where is it located. At areas of flexion there is always an increased risk,as of half of all IV complications occur at an area of flexion.

you need to look at the whole picture,the odds are if the opposite hand is not swollen your site is probably no good!!!. Where is the site located (was it in the forearm above the hand?) You will oftien see edema r/t to an infiltration distal to a site as well as proximal especially if the infiltration has been going on for awhile. You can also try the TOURNIQUET TEST if the situation allows. In this test you apply a tourniquet proximal to the IV site and run in some IV fluids (NOT ON A PUMP) IF they continue to flow you are no longer in the vein. If they STOP you are still in the vein. Also remeber any adult site 3-4 days is not going to last much longer if is being used.