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Fully drain distended bladder?

Posted

Specializes in Ortho/Neuro (2yrs); Mom/Baby (6yrs); LDRP (<1yr). Has 10 years experience.

I'm wondering if I did the right thing...

I was helping a newer nurse with a patient that had a distended bladder, on whom she had obtained an order for a straight cath. She was approximately 22 hours postpartum, vag delivery. Bladder scan showed 999+ mL of retained urine. Pt's uterus remained firm and lochia was WNL.

Straight cath netted 3075 mL of urine. Upon hearing this, one of the older, more experienced nurses said that we should not have drained the urine all at once. I don't remember being taught that or hearing it.

Did I mess up?

I do not have any experience with this but I came across an nclex question days ago that stated that fully draing a distended bladder could result in damage to the bladder and I am pretty sure it said you should not drain more than 500mL at once.

I do not have any experience with this but I came across an nclex question days ago that stated that fully draing a distended bladder could result in damage to the bladder and I am pretty sure it said you should not drain more than 500mL at once.

How, exactly would the bladder get damaged? (I am asking this as a general question to anyone...)

I have heard the same admonition, but where are the examples of people this actually happened to? Studies? Research? Anything concrete we can go on other than "it can damage the bladder"?

iPink, BSN, RN

Specializes in Critical Care, Postpartum. Has 8 years experience.

I have drained more than 1000mLs of urine on a patient. The only thing that happened was the patient felt relief and his vitals were normal.

How, exactly would the bladder get damaged? (I am asking this as a general question to anyone...)

I have heard the same admonition, but where are the examples of people this actually happened to? Studies? Research? Anything concrete we can go on other than "it can damage the bladder"?

I really don't know what damage can be caused. I suppose that is why I got that question wrong :D

There are several threads here on AN about it, with different reasons as to why the bladder should not be fully emptied, none that I read made a great amount of sense to me.

Zara, RN

Specializes in Rehab, Skilled Nursing. Has 3 years experience.

From my experience and understanding draining more than 1000cc of urine will cause the bladder to spasm and cause hypotension.

For my own reasons I always clamp at 1000.

RunBabyRN

Specializes in L&D, infusion, urology. Has 2 years experience.

I believe the risk is hypotension, but I've heard it more related to ascites and other fluid balance issues. If the uterus is midline and lochia light, I don't see a need to drain 3000+ ml at one time, but I think as long as the pt responded well (which is what it sounds like), I wouldn't stress too much.

LibraSunCNM, MSN

Specializes in OB. Has 10 years experience.

Not to seem judgmental, but may I ask why a patient was left 22 hours post-delivery without voiding before someone straight-cathed her? She could have ruptured her bladder with that much urine retained.

sandytoes

Has 1 years experience.

Following with interest. I've never straight cathed for more than about 1000 and I had huge wide eyes when I did. That poor woman w/3000+!!!

idialyze, BSN, RN

Specializes in Dialysis.

I was taught years ago, that draining that much urine at once would cause hypotension due to the rapid refill of the capillary bed in the abdomen.

loriangel14, RN

Specializes in Acute Care, Rehab, Palliative.

Where I work we clamp the catheter after 500mls and then open it up again after 30 minutes or so and drain a bit more.Draining than a few hundred at a time can cause painful bladder spasms and hypotension.

Why on earth would they leave a patient that long with no void?

haunani, BSN, RN

Specializes in Ortho/Neuro (2yrs); Mom/Baby (6yrs); LDRP (<1yr). Has 10 years experience.

Let me reiterate that this wasn't my patient. The patient was non-English speaking and it appears the day shift nurse wasn't very thorough in her questioning of the patient during her assessments. When I went in with the new(er) nurse at her request, I immediately noticed her fundus was grossly displaced (though still firm), and asked her if when she went to the bathroom if she "peed a lot or a little". She responded very little, so I told the nurse to bladder scan her.

Our straight caths drain fairly slowly, and it took well over 30 minutes to fully drain her bladder. She expressed a relief from most of the pain after the first 1000mL and we were both shocked that it kept draining...

and kept draining. By the time it was done, her abdoment was visually noticeably less distended.

She ended up being straight cathed again later in last night's shift, then started voiding very small amounts today, and a foley was finally inserted this evening to give her bladder a chance to rest and recover.

I was taught in school that draining more than 1000ml at once might cause fluid shifts. Some hospitals (hopefully) have it stated in their facility policy.

Now, if she was actively hemorrhaging and had a boggy uterus, that might be a different story....... Because if you only drained 1000ml at a time, you would have 2075ml left and she might continue to bleed because the uterus still won't clamp down.....

pearlsrwisdom

Specializes in Labor/delivery(13yr)-Med/Surg(1yr)-sup6y. Has 14 years experience.

Yes..i too was taught in school to not drain more than 1000cc at a time due to bladder spasms.

I work in ICU as a Nurse Practitioner. I spoke to one of the intensivists about it one time and he told me the bladder shouldn't be drained all at once to prevent hemorrhagic cystitis. The reason why I spoke to him specifically about it is because back when I was a nurse I was taught not to drain a bladder to prevent hypotension. Obviously it is not true, the urine is not in the vascular compartment.

Edited by JoannaK

brownbook

Has 36 years experience.

On 7/2/2014 at 12:12 PM, LibraSunCNM said:

Not to seem judgmental, but may I ask why a patient was left 22 hours post-delivery without voiding before someone straight-cathed her? She could have ruptured her bladder with that much urine retained.

This whole discussion is clear as mud......as usual with technical questions. I suppose it depends on the patients underlying health, why the bladder is full, etc.

Once I had a full bladder on a slow bus ride to my hotel after an all night flight. A more memorable part of a not so great vacation. The last few miles of the bus ride I kept thinking....now I will find out if a bladder can really burst!

The bus stopped in front of the luxury hotel. I ran off the bus dragging my suitcase into the lobby, asked where the bathroom was, of course it was down a flight of stairs. I ran down the stairs banging, my suitcase behind me. It was an open marble staircase, made a heck of a lot of noise. I made it to the bathroom with several (many) people staring at me! A lady from reception even came by and asked if I was okay. My bladder didn't burst and I didn't have hypotension or hemorrhagic cystitis. Unfortunately I didn't have any way to measure the amount of urine 🤣 to do a scientific study.

Skips, MSN, RN

Specializes in L&D.

I was taught to stop draining at 800ml d/t hypotension and bladder spasm. I think you should consult your hospital's specific policy on this, as the exact numbers vary facility to facility. Let us know what you find! 🙂