Excessive Foley drainage

BinkieRN, BSN, RN · Nov 16, 2008

Hi everyone,
I have a question, I know nursing texts say to clamp the Foley after 1 liter. Is this still what you find to be true? At what point do you clamp if at all or do you let it flow. (I am referring to urine retetion, hard distended belly, not a pt being given Lasix).

I do clamp a foley for 15 minutes, after a liter, if the bladder is very distended. I learned in school that emptying the bladder too quickly can cause bladder spasms. I don't have a problem doing it if it saves the patient from having any discomfort.

On the other hand, when some patients, such as those who have had a pelvic ultrasound, come back from US and sit on the potty and empty their bladders they don't stop at one liter and they only feel relief afterwards.

Personally I don't think it matters.

Tweety, BSN, RN · Nov 16, 2008

I agree with the above poster. I think it's old school to clamp. I know many times traveling, or working a long shift I void more than a liter at a time and don't have electrolyte imbalances and bladder spasms.

truern · Nov 16, 2008

Have had a urologist tell me he never wants his patients clamped...said what was the point of the foley if not to empty the bladder?

Personally, I've had more discomfort from an full bladder than from emptying it (said by one with bladder issues).

Aneroo, LPN · Nov 19, 2008

I had a coworker clamp a foley on a burn patient (since we were of course loading her liter after liter of fluid). She said we were going to bottom out her pressure because of the excessive urinary output. It wasn't worth arguing with this nurse (trust me, I'd done that plenty of time and might as well turned to the wall to talk) about it. LOL My logic- they've already excreted that fluid from the kidneys, and from the bladder to another bag to hold it in, that isn't going to drop their pressure (she didn't see my view though).

allnurses Guide · Nov 19, 2008

When a guy is having bad retention, I don't stop at a liter. I've seen around 1500 or more, and never a spasm in sight.

APNgonnabe · Nov 19, 2008

Besides spasms an over expanded bladder can bleed if decompressed to quickly..I've seen this happen but was not quick enough to put it together until I was talking with a urologist.

bill4745, RN · Nov 19, 2008

I think it's old school to clamp. I know many times traveling, or working a long shift I void more than a liter at a time and don't have electrolyte imbalances and bladder spasms.

But your'e not experiencing a medical problem.

Pediatric Critical Care Columnist · Nov 20, 2008

i had a coworker clamp a foley on a burn patient (since we were of course loading her liter after liter of fluid). she said we were going to bottom out her pressure because of the excessive urinary output. it wasn't worth arguing with this nurse (trust me, i'd done that plenty of time and might as well turned to the wall to talk) about it. lol my logic- they've already excreted that fluid from the kidneys, and from the bladder to another bag to hold it in, that isn't going to drop their pressure (she didn't see my view though).

overly rapid decompression of a very full bladder has been shown to cause a significant fall in blood pressure secondary to the shift in intra-abdominal pressure and the associated relaxation of the vena cava in certain patients. let me see if i can find a reference...

http://www.mayoclinicproceedings.com/inside.asp?aid=3396&uid=

anyone who has ever worked with spinal-cord injured patients will be familiar with autonomic dysreflexia. autonomic dysreflexia,"ad" or "autonomic hyperreflexia" is a massive sympathetic discharge that can occur in association with sci or disease (e.g. multiple sclerosis. ad is believed to be triggered by afferent stimuli (nerve signals that send messages back to the spinal cord and brain) which originate below the level of the spinal cord lesion. it is believed that these afferent stimuli trigger and maintain an increase in blood pressure via a sympathetically mediated vasoconstriction in muscle, skin and splanchnic (gut) vascular beds (karlsson, 1999). things like an environment that is too warm, wrinkles in the linen under a patient, ingrown toenails, full bladder or bowel can trigger an ad episode which is characterized by flushing abd diaphoresis above the level of the injury, severe headache, hypertension and bradycardia. these episodes are life-threatening if not recognized and treated. the rapid fall in bp following catheterization is dramatic; in these cases it might save a life, but in someone with normal or low-normal bp, it could be a problem.

Aneroo, LPN · Nov 20, 2008

overly rapid decompression of a very full bladder has been shown to cause a significant fall in blood pressure secondary to the shift in intra-abdominal pressure and the associated relaxation of the vena cava in certain patients. let me see if i can find a reference...
http://www.mayoclinicproceedings.com/inside.asp?aid=3396&uid=
anyone who has ever worked with spinal-cord injured patients will be familiar with autonomic dysreflexia. autonomic dysreflexia,"ad" or "autonomic hyperreflexia" is a massive sympathetic discharge that can occur in association with sci or disease (e.g. multiple sclerosis. ad is believed to be triggered by afferent stimuli (nerve signals that send messages back to the spinal cord and brain) which originate below the level of the spinal cord lesion. it is believed that these afferent stimuli trigger and maintain an increase in blood pressure via a sympathetically mediated vasoconstriction in muscle, skin and splanchnic (gut) vascular beds (karlsson, 1999). things like an environment that is too warm, wrinkles in the linen under a patient, ingrown toenails, full bladder or bowel can trigger an ad episode which is characterized by flushing abd diaphoresis above the level of the injury, severe headache, hypertension and bradycardia. these episodes are life-threatening if not recognized and treated. the rapid fall in bp following catheterization is dramatic; in these cases it might save a life, but in someone with normal or low-normal bp, it could be a problem.

thank you! what about the burn patient though? her bladder wasn't very full yet (our trauma team had a cna on it, and on of their first tasks is to get the foley inserted, so it was inserted when she had been there maybe 5 minutes). would that still cause the bp changes, or just if you go from really full to empty quickly?