continous bladder irrigation I&O - slower but steady learner needs help

  1. Hi all,

    Okay, so twice I've been assigned a pt. on continuous bladder irrigation and twice the intake/output numbers don't come out right. Can someone help me understand why?

    Here's a rough scenario of what happens: I get the morning report on my pt with a "credit" of 1000mL. (What is a credit?) I diligently keep tabs on how much irrigant is coming out and how much is going in during my shift. Trouble is at the end of the day, I'm off by sometimes 1000mL! I've been told this is wrong and that the difference should be closer to 500mL. Does this sound right? What does the 500mL represent? The nurses, bless their hearts, apparently are too busy to fully & clearly explain how it's suppose to all work and balance out, give or take some mLs, and I'm discouraged. If I know what to look for, then I'll be able to figure out where the problem is and fix it. Oh, and my instructor, well, I much prefer asking people who aren't going to evaluate me.

    Thank you for helping this rookie student.

    Have a great week!
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    About vintagestudent

    Joined: Jun '08; Posts: 101; Likes: 34
    mom and lvn
    Specialty: Just started in HH

    8 Comments

  3. by   morte
    i have no idea what is meant by the term "credit", so you will have to get that defined for yourself......what you want is the amount of irrigant in, the amount of fluid out, subtract the first from the second and you should have urine output.........the 500ml mentioned, i would think is the expected urine output......1000ml would be a lot, but take into account what the patient is taking in, ie po and iv fluids.....meds such as lasix........good luck
  4. by   elkpark
    Quote from vintagestudent
    The nurses, bless their hearts, apparently are too busy to fully & clearly explain how it's suppose to all work and balance out, give or take some mLs, and I'm discouraged. If I know what to look for, then I'll be able to figure out where the problem is and fix it. Oh, and my instructor, well, I much prefer asking people who aren't going to evaluate me.

    Thank you for helping this rookie student.

    Have a great week!
    Your instructor is the person who is responsible for your clinical education. The staff nurses are there to do their own jobs. In my own experience as an instructor, I much prefer to have students ask me questions rather than the staff nurses, and I look much more kindly upon students who ask me questions because it is obvious they are trying to learn. The worrisome students are the ones who don't ask questions, and who give the impression that they think they don't need any assistance/guidance. Is your idea that, if you never ask your instructor any questions, s/he'll think that you already knew all this stuff before you came to nursing school? -- 'cause I can tell you right now, that's not going to be the conclusion s/he draws. You are a nursing student -- you're not expected to know all this stuff already, and your clinical evaluation will be based on how strong an effort you made to learn what you were supposed to during the rotation, not how few questions you asked during the term.

    Best wishes!
  5. by   vintagestudent
    Quote from elkpark
    ...The worrisome students are the ones who don't ask questions, and who give the impression that they think they don't need any assistance/guidance....
    Best wishes!
    I was frowned upon for asking too many questions--valid ones, I might add, and as my previous instructor admitted at our pinning ceremony back in December--by this same clinical instructor who, for the first month or so, would leave us students for hours at a time w/o a contact number to call her when we needed help. (It turns out, she had some personal istruggles going on that she admitted later on to some of us "seasoned" female students who took the time to inquire about her downcast look & irritability.) You have no idea the frustration and discouragement I experienced considering I came into the accelerated program with zero medical experience and in much need of professional guidance. I didn't get much training and have no idea why I was promoted to second semester. But I forgave her, learned from the experience, and continue to march forward in my nursing training. Still, I am aware that I now much prefer learning on my own with the help of competent nurses who aren't my evaluators, but I usually do go to my instructor. Really.

    You should also know that I really enjoy nursing. It has been a goal for over 20 years and I'm closer to accomplishing it, by the grace of God. I can smell it, taste it....woohoo!

    Thanks for your reply, elkpark!
  6. by   vintagestudent
    Quote from morte
    i have no idea what is meant by the term "credit", so you will have to get that defined for yourself......what you want is the amount of irrigant in, the amount of fluid out, subtract the first from the second and you should have urine output.........the 500ml mentioned, i would think is the expected urine output......1000ml would be a lot, but take into account what the patient is taking in, ie po and iv fluids.....meds such as lasix........good luck

    I will find out for myself what "credit" means.

    Thank you!
  7. by   Daytonite
    i was a surgical nurse for many years and worked on a unit where we had postop turps and cystos with continuous bladder irrigations running. i know exactly what you are talking about.

    "credit", by definition, is the amount of anything you have. so when you were told at morning report that the patient had "a credit of 1000ml" it meant that you had 1000 ml of irrigation solution that was hanging and ready to be used. many times these bottles hold 1500 or 2000 mls of the irrigating solution. the nurse was telling you that she was leaving 1000 mls of the solution for you to use to irrigate your patient's bladder. we used to call these things through-and-through irrigations, or t&ts, because the sterile water went through the catheter, into the bladder, right back out the catheter and into the foley bag. when that 1000 ml goes into the bladder as input, it must also be subtracted from the foley bag contents because it is not urine output.

    so, each time you empty the foley drainage bag, you need to determine how much is irrigating fluid and how much is actually urine. that is done by subtracting out the amount of irrigating fluid that was used. to do that you will also take a measurement of how much irrigating solution is remaining in the bottle at the time you empty the foley drainage bag. we used to mark the fluid level on the containers with a magic marker or a piece of tape. that becomes your new "credit" amount. to get the output measurement you take your old "credit" amount (ex: the 1000 ml you were left with) and subtract the new "credit" amount. that is the amount of irrigation solution that will be in the foley drainage bag. take that amount and subtract it from the amount you emptied from the foley drainage bag and that is the patient's true urine output. do this each time you empty the foley drainage bag.

    these can get hairy because some of these irrigations can be running very fast. if that is the case, keep on top of them, empty them frequently and do the calculations with each emptying. our surgeons instructed us to run the irrigant fast enough to keep the urine a light salmon color, so we sometimes ran 10,000 ml of irrigant a shift. if we didn't bad things happened. output should always be more than input. it is important to know that normal urine output should be around 30 ml/hour.

    http://www.smh.com/sections/services...ous_121608.pdf
  8. by   vintagestudent
    Excellent explanation, Daytonite! Makes more sense now. Thanks for taking the time to respond.
  9. by   Daytonite
    Just keep up with what is going in and out of these catheters and everything should calculate out alright. Be cautious of people who are being helpful and come along to empty the catheter drainage bag for you and that they write down what they emptied (or hung to flow on the irrigation line). As I mentioned, you do not want the catheter to become clogged with blood clots. The RN in charge of the patient will kill you because it requires painful hand irrigation which could put the patient into bladder spasms and the foley catheter usually ends up needing to be changed because it is so clogged with blood clots.
  10. by   vintagestudent
    Advice taken...certainly don't want my RN killin' me outside the pt's room. Seriously, thank you, thank you, thank you. Due to your explanation, I have a clear understanding of how CBI I&Os work.

    Blessings to you, Daytonite! :icon_hug:

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