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Discussion

Intermittent cath issue

Today I had patient that we were doing Q6 bladder scans and intermittent cath if it met criteria of the order. So at 2000, I bladder scan and it was a lot so I notified the provider and I did the intermittent cath. The only issue was, when I went in with the catheter, I thought I was possibly not in the correct spot because I wasn’t getting urine. I was going to remove the catheter until I saw this THICK slow red blood come out on the tube. It didn’t even make it into the bag, it was so thick. I had the resource RN page the provider to stop by and see. They said they wanted to put in a foley and I did and they were there to witness again, very thick blood slowly coming into the tubing. No urine whatsoever. I asked the provider If I could irrigate the foley and it didn’t do anything. Anyways, has anyone ever seen that? The provider said it could be because of trauma. I’ve only seen trauma with blood clots in urine, not extremely thick blood that clogged up an intermittent cath tubing. They consulted urology and they suggest 20 FR coude, which had to be done by the next shift because it was shift change by that point. 

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    Yes, I have seen some urological blood baths from catheters, it a lot of times is from trauma especially if the person has BPH, a UTI, or any condition were the urethra may be constricted or inflamed. If the person is on anticoags that'll contribute as well. Usually what I've seen done is either CBI or frequent irrigation, like q1hr or more. 

    Despite how bad it looks, I've never really had anyone's H+H effected from all the blood passed, I had a urologist tell me one time that even with thick clots it still mixes with the urine so that it looks worse than it is. 

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    • Author
    50 minutes ago, TheMoonisMyLantern said:

    Yes, I have seen some urological blood baths from catheters, it a lot of times is from trauma especially if the person has BPH, a UTI, or any condition were the urethra may be constricted or inflamed. If the person is on anticoags that'll contribute as well. Usually what I've seen done is either CBI or frequent irrigation, like q1hr or more. 

    Despite how bad it looks, I've never really had anyone's H+H effected from all the blood passed, I had a urologist tell me one time that even with thick clots it still mixes with the urine so that it looks worse than it is. 

    Thanks for sharing! I’m a newer nurse and I honestly have never seen it that bad, I was shocked!

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    Gross hematuria in a catheter can be quite 'take-you-breath-away' for the nurse.  I have seen it caused by catheterizing trauma. For those pts, I found I freq had to 'milk' the clots to keep the cath patent. But for you to be doing the bladder scanning/intermittent caths, tells me there must be a serious underlying problem.

    Just make sure Urology Service is closely following and you've been using good technique.

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    • Expert

    Members offered good advice. Seen this a few times in my career due to severe BPH, Urinary retention with sepsis, + bladder cancer.  Continuous bladder irrigation using 3 way foley often resolves issues- some irrigation solutions contain an antibiotic

    These articles provide some insight:

    Life‐threatening urethral hemorrhage after placement of a Foley catheter in a patient with uroseptic disseminated intravascular coagulation due to chronic urinary retention induced by untreated benign prostatic hyperplasia

    Hematuria

    Complications - Intermittent Catheters

    Impaired Urinary Elimination Nursing Care Plan

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