Clogged 3 way foley with CBI?

Nurses General Nursing

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I work on a general med-surg floor and consistently have post-op TURP patients with 3 way foleys and CBI. Yesterday I encountered a situation I've never experienced before of probably 50 CBI pt's I've had. This gentleman had a 3way foley with CBI set up, and the urologist came in at 0830 with orders to stop CBI, but restart for clotty or bloody urine. So I clamped off the CBI but kept all tubing connected just in case I needed to restart. Sure enough by 1400 the pt. put out 1000cc of bright red urine. So I open up the CBI clamp to restart...and nothing. Will not flow in. I irrigate the foley--nothing. Pull back with a 60cc syringe to check for clots--nothing. Flushed the CBI tubing into the garbage to see if the tubing was patent--it was. Pt. not c/o any pain, bladder soft and nondistended. Had charge nurse come in, who trouble shooted basically just as I did with no success. We ended up asking every nurse on the floor who all said they had no idea and had never had this problem. First instinct is to think there is a clot..but urine was still flowing out (1L in 5 hrs.) so I would think if it was a clot, there would be an obstruction in flow of urine, but there wasn't. Ended up calling MD who just said "keep the CBI clamped, put a new 3way foley at bedside, and I'll be in later." (Assuming he's going to switch out the foleys...but why?) Ended up leaving my shift and he still hadn't come in, so I don't know how it turned out! Anyone ever had this or can come up with any ideas why this happened?

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Specializes in ICU.
I work on a general med-surg floor and consistently have post-op TURP patients with 3 way foleys and CBI. Yesterday I encountered a situation I've never experienced before of probably 50 CBI pt's I've had. This gentleman had a 3way foley with CBI set up, and the urologist came in at 0830 with orders to stop CBI, but restart for clotty or bloody urine. So I clamped off the CBI but kept all tubing connected just in case I needed to restart. Sure enough by 1400 the pt. put out 1000cc of bright red urine. So I open up the CBI clamp to restart...and nothing. Will not flow in. I irrigate the foley--nothing. Pull back with a 60cc syringe to check for clots--nothing. Flushed the CBI tubing into the garbage to see if the tubing was patent--it was. Pt. not c/o any pain, bladder soft and nondistended. Had charge nurse come in, who trouble shooted basically just as I did with no success. We ended up asking every nurse on the floor who all said they had no idea and had never had this problem. First instinct is to think there is a clot..but urine was still flowing out (1L in 5 hrs.) so I would think if it was a clot, there would be an obstruction in flow of urine, but there wasn't. Ended up calling MD who just said "keep the CBI clamped, put a new 3way foley at bedside, and I'll be in later." (Assuming he's going to switch out the foleys...but why?) Ended up leaving my shift and he still hadn't come in, so I don't know how it turned out! Anyone ever had this or can come up with any ideas why this happened?

which port did you try pulling back fluid out of? the irrigation port or the drainage port?

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which port did you try pulling back fluid out of? the irrigation port or the drainage port?

The irrigation port. The drainage port was patent as urine was flowing out of it.

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Specializes in ICU.

there must have been a clot. i have once aspirated a "long" clot. it ran through the whole length oh the catheter. got a clot out that looked like a big worm, or more like a baby snake.lol

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Specializes in Surgical, quality,management.

there could of been a partial occlusion by a clot that allowed the higher force of a flush to go into the catherter but the lower pressure CBI could not push past it. I would of tried to flush the urine port as it a more "direct" line to the catheter eyelets and the change of angle may be all that was required.

I loved my TURP pts and CBI as it is very satisfying to see the urine change from bloody to clear with CBI!!!

A little pathetic lol!

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Specializes in Orthopedics.

I agree that it was a partial obstruction by a clot. If all else fails I also deflate the balloon very carefully and readjust to ensure that a clot isn't caught around the cuff and not obstructing the catheter. Then, I would go back to the urine port and flush direct with hopes of flowback or drawing in of any clot. Also, prior to any irrigation, I make the patient move around ALOT sometimes their own body movements can dislodge a clot in the right way to allow everything to flow.

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