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Low Urine Output s/p TURP and Bilateral Nephrostomy Tube Placement

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Pt s/p TURP and Bilateral nephrostomy tube placement.

Day 2: Continuous bladder irrigation discontinued. Pt has a three way foley and two clamped nephrostomy tubes connected to urinary bags. Pt has 50 ml of urine output in foley over six hours despite multiple manual irrigation and removal of one nickel sized clot.

Urologist informed and nephrostomy tubes unclamped. MD ordered not to call him regarding low urine output.

Day 3: Nephrostomy with 1100 ml output and foley has 50 ml output. Urologist clamped nephrostomy tubes. Now over next 8 hours, foley has 60 ml of output. What should be the next step? Should foley be continued to be manually irrigated? Bladder scan patient?

AceOfHearts<3

Specializes in Critical care.

Is this homework?

Edited by AceOfHearts<3

This is not a hw question.

AceOfHearts<3

Specializes in Critical care.

This is not a hw question.

Ok, thanks. Would have changed how I answered the question if it was.

Here are my initial thoughts:

The nephrostomy tubes are doing their job, aren't they? If you have output from them then why do you need output from the foley? The neph tubes were obviously placed for a reason. The urine is draining directly from the neph tubes (when they aren't clamped) and not making it to the bladder. You know the kidneys are functioning properly because of the output from the neph tubes, so the issue isn't with the kidneys. When the tubes are clamped something is preventing the urine from making it to the foley- this to me sounds like an obstruction issue somewhere between where the neph tubes are placed and the urethra.

Maybe I'm just not understanding though and I hope somebody chimes in if I'm not understanding this right- I've only had one patient with neph tubes before. They were placed because the patient was in severe postrenal AKI from a massive bladder tumor. Once the b/l neph tubes were placed the kidneys started to recover. The patient had great UO from the neph tubes and almost no UO from his foley (which was later removed) and the pt went home with the neph tubes. The bladder tumor was going to be addressed when the AKI had resolved and the patient could have more testing.

The foley on the pt was changed. Low to no UO from new foley.

Nephrostomy tube was unclamped and pt went home with nephrostomy tubes.

This is not a hw question.

You sure? Your other recent post is written entirely in third person without any personal details as well.

traumaRUs, MSN, APRN, CNS

Specializes in Nephrology, Cardiology, ER, ICU. Has 27 years experience.

Moved to urology forum

I am trying to comply with HIPPA.

You sure? Your other recent post is written entirely in third person without any personal details as well.

I am trying to comply with HIPPA.

Hoosier_RN, MSN

Specializes in dialysis. Has 28 years experience.

Ok, thanks. Would have changed how I answered the question if it was.

Here are my initial thoughts:

The nephrostomy tubes are doing their job, aren't they? If you have output from them then why do you need output from the foley? The neph tubes were obviously placed for a reason. The urine is draining directly from the neph tubes (when they aren't clamped) and not making it to the bladder. You know the kidneys are functioning properly because of the output from the neph tubes, so the issue isn't with the kidneys. When the tubes are clamped something is preventing the urine from making it to the foley- this to me sounds like an obstruction issue somewhere between where the neph tubes are placed and the urethra.

Maybe I'm just not understanding though and I hope somebody chimes in if I'm not understanding this right- I've only had one patient with neph tubes before. They were placed because the patient was in severe postrenal AKI from a massive bladder tumor. Once the b/l neph tubes were placed the kidneys started to recover. The patient had great UO from the neph tubes and almost no UO from his foley (which was later removed) and the pt went home with the neph tubes. The bladder tumor was going to be addressed when the AKI had resolved and the patient could have more testing.

In agreement, have seen neph tubes 3 times in 20 years. I'm betting a blockage (tumor, etc) between kidney and urinary meatus