I went against another nurse... did I make the right call?

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Ok... I started a new job and I'm still orienting to this particular hospital. I have a patient I've been caring for this week who has BPH. He retains pretty badly and there's an order in place to straight cath for any PVR over 450cc. The order states to check pvr q 12 hours. Well, I checked him at 2:30 and he voided 100cc and retained about 400. I didn't cath him for multiple reasons, including that the order calls for 450. The urologist wants him to feel the urge to go which is why they won't put a foley in (which I have asked for). He has no distention, and no discomfort. I told the nurse coming on the situation and if he stated any discomfort, check him again. Well, the nurse training me (who I wasn't very impressed with) yelled at me as I was leaving and demanded that I go and cath him before I leave. I told her why I didn't feel comfortable doing that and she got all ****** off and said, "well then I'll go do it". I said, "that's your call... I am going to follow the orders as written."

Was I wrong???

Specializes in ob/gyn med /surg.

well i would of cathed him at 400cc.. 50cc would not of made much a difference. if he hasn't voided at 400cc and only voided 100cc , then he is not emptying his his bladder ..in reality you need to do what you think is best.. you are the one in charge of your license.. if you feel good about it , then i feel good about it.. i wouldn't worry about it.. you did just fine...

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You acted correctly. You followed orders. Personally, the only way I would have cathed him is if he was distended, uncomfortable, etc. Your preceptor was dead wrong for not following orders and for putting the patient through an unnecessary, uncomfortable procedure. One thing to think about is the potential for infection every time you cath someone.

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Specializes in medical-surgical.

If he had 450 in before urination, and 350 after urination, you could document the situation and be covered, since technically you don't need to straight cath. Or you could recheck in an hour or so, ask him to void and then scan again. If it was the same or less, I would have the next nurse check it in 12 hours. If it was more than before or more than the volume in the doctor's order, I would carry out the order, and document doing such. Your preceptor is wrong, technically, if she cathed the patient, she would be carrying out the order incorrectly.

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Order said cath at 450. It was not 450. You don't cath. Will he need cathed during the next shift... you betcha. But we don't cath to save the next shift work, we cath at 450....

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Specializes in rehab.

Dear OP,

At the risk of sounding mean or being the bag guy, I will take the "side" of the precepting nurse, here is my reasoning

I work in acute rehab, all we do is bowel and bladder training (not all we do but sure feels like it sometimes ) ;)

You probably already know this but the reason why i an o caths above 450cc is done is that is the amount a "normal" or "avarage" bladder should hold before the urge to void is intense. Anything more the that 500 cc> causes the bladder to be stretched out and decrease the chances of returning to a normal bladder able to contract on its own, that is the stretching ruins the bladders ability to contract. with that said, and taking into concideration the guy had prostrate issues as well, which may further complicate things, I would have cathed the pt at 400cc, if the order was 450, why, because urine is continously produced by the kidneys. By the time you gave report , it may already be 425cc, whats 50 cc?! very little. If it would have been line 380cc then that would be a diffrent story. The nurse however should have communicated to you better that to yell at you and say "then I will do it". this is like parameters for blodd pressure. You get one of thoes that says "hold for sbp

Hope this helps. either way, you sound, (to me at least) like a good nures :)

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I'm curious and this is not related to the topic, well sort of, but why is it that everyone is using "cc". I thought that had

been changed to "ml"?

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Specializes in PMHNP.

To the nurse that disagreed with me. I hear you. The thing with this patient is that his bladder is already totally stretched out. I have cathed him before and gotten over 650 out and he never felt the urge to void before I cathed him. The doctor is really trying to get him to feel a full bladder and actually have the sensation to void. If the doctor felt that this person couldn't be retrained, then he would just have a foley put in and be done with it. I had been taking care of this patient all week and the precepting nurse just met him that day (I had other preceptors during my training). I was well aware of his situation and I was acting accordingly. I even asked the charge nurse before my preceptor yelled at me and she agreed not to cath. The fact that he has frank red blood and a UTI due to his catheterizations led me to want to give him a chance to void on his own! I think some of the nurse's are just too lazy to try and consistantly encourage him to void. They would rather let him lay around all day and just cath him. Not me!

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Specializes in Staff nurse.

Is he ambulatory? Have him walk or change position and see if that helps next shift you have with him.

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I am on the side of the OP here. The patient wasn't uncomfortable and you practiced doctor's orders. If they doctor wanted him cathed at 400cc, he would have written it that way. Just my opinion and what I would have done in your shoes.

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Specializes in NICU.

It is so hard to be on orientation when you have experience already. At some point during orientation your opinions and views will clash. Do what you feel is right for the patient. Document what you did and why. Let her document what she did and why. You followed orders. Yea it may be a pain in butt for the next shift but look at it another way. If there were orders to give a fluid bolus for SBP

I'm on orientation at a new facility as well... Last week my preceptor told me the BP of my post op (65/38) was "not that low." She said not to call the MD.... I just looked at her like she was crazy and called the MD anyways.....

Just because they are your preceptor doesn't mean you can't make your own decisions.

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