Cathing a Patient: Bladder Spasms?

[Pediatric4077]

We have a number of kids lately who get cathed q 6 hrs for either no void or reguardless of void. One nurse brought it to my attention that you should only remove a certain amount of urine, not to cath them until flow stops. She said this prevents bladder spasms. Is this true? Sometimes one patient has almost 1,000mls out, am I taking "too much" out?

Any info on this subject would be appreciated.

Thank you!!

[Bumashes, MSN, APRN, NP]

Not sure about spasms. I just graduated, but I remember a lecture involving something like this. I remember the instructor saying something to the effect of "Don't let more than 500-750cc drain out at a time." Don't remember the reasoning, sorry. I think, think mind you, that you were supposed to let out the 500-750, then if there's more, wait 20-30 minutes to do 500-750 more, etc. Sorry I'm not more help, but someone with more experience will write in to cover whatever I've screwed up.

[adrienurse, LPN]

deleted

[nightmare, RN]

I wasn't aware of the guidelines in the O.P. until a few weeks ago when I cathed a badly rententice little old man and drained more than 1500 cc's.

The person can have a vaso-vagal reaction from the shift in fluids.

That would make sense.just the same as them having a vaso-vagal after a large or constipated BM.

[chadash]

Sounds good, but with neurogenic bladders, would you be concerned with leaving a residual and increasing the incidence of UTIs?

[Pediatric4077]

I didn't even think about the fluid shift... So what are the recommendations? Only take out 1,000? And like the other poster said, if I leave another 200 or whatever in there, wouldn't that increase the risk of UTI's? The reason I'm cathing this patient is for neurogenic bladder and chronic UTI's.

[nightmare, RN]

In an adult I would take out 750ml,clip and leave for 20 minutes release again.After bladder is initially drained would put on continuous drainage plus antispasmodic till spasms settle.

[Pediatric4077]

Patient only has straight cath order. So.. maybe take out 750ml then re-check? Or the patient does get cathed q6 hours so is that sufficient?

[chenoaspirit, ASN, RN]

Draining too much can cause bladder spasms. I only drain about 800 ml's, then drain again in about 20 minutes. Once I drained about 1500 and caused the bladder spasms.

I dont understand the fluid shift. If the person had peed on his own... Ive peed more than that. Isnt the fluid in the bladder separate from actual body fluids? Its supposed to drain. It isnt like doing a paracentesis. Just wondering, it doesnt make sense to me.

[NewWayofLife]

I had a lab instructor in nursing school who told me the "clamp the foley" thing was a myth. Kept thinking of her the night in LTC that I placed a foley at 3AM and the pt just starting POURING out urine like nothing I'd ever seen. Decided to clamp the foley after every 700-800mls, just to be on the safe side. At 5am, when I last checked on her, the pt was comfortable for the first time in hours. Vitals were stable. Output >2000ml over those 2 hours. MD was aware. At 6:45, when the next shift came in, pt was found to be expired. She was DNR/DNI, had multiple disease processes, and at least died comfortably and peacefully. I never did find out the true cause of death, but from that point on, everyone talked about the night I "killed that lady with the foley".

Could have been a coincidence... but I think I'll be on the cautious side, just the same!

[bhlocke]

The rule of thumb is that you do not want to overdistend the bladder and cause nerve damage. There is a formula for peds the age and weight of the pt. in kg calculated into cc's. If the bladder feels distended or if the pt. complains of feeling the need to void but can not..then cath and totally empty the bladder. We use a bladder scan ultasound machine that helps us keep up with the amount. If the bladder scan shows greater than 500 on a child 10yrs and up it's time to cath.If we have a baseline measurement that the pt. can hold more then we will let them go a little longer but not much over 550. Rule of thumb for us is if you have to cath 3 times the 3rd cath replace the foley. I do not understand not emptying the baldder fully. There is only vagal response if you bear down. Bladder spasms come from irritating the bladder trigone area. Leving urine in the bladder sounds like a set up for another cath and a UTI. Hope this helps.