Bladder Scanning Question

[westieluv]

I took care of a patient last week who had almost zero urinary output on my night shift. I bladder scanned her and it read 601 ml, so I called her MD who ordered a foley catheter. I inserted the foley and only got 250 ml return. We tried repositioning her, having her stand, etc. and there was no further output. I flushed the foley and the sterile water returned in the collection bag, but it was very dilute and didn't appear to have much urine in it, also only returned about the same amount that I flushed it with. There was no moisture underneath the patient after I flushed it, so I know that the foley was still in the bladder and the balloon inflated perfectly when I checked it before inserting the foley so I believe that it was still inflated in the patient's bladder. It came time for the day shift to take over and I offered to remove the foley and place a different one before I left but the day shift nurse said not to worry about it, she would check it out, and I never found out what happened with it because I have not worked on that floor again since that shift. (I am a float nurse with our company's internal agency). I should add that this patient denied an urge to void both before and after I placed the foley.

I have been an RN for 23 years and have never had anything like this happen before. My question is, have you ever seen a bladder scanner measure inaccurately, and if so, to this degree, which would have been about a 350 ml difference between what it read and what drained from the patient's bladder when I inserted the foley? I have inserted literally hundreds of foleys, so I know that my technique is okay, but I am baffled by this, especially since we repositioned the patient and had her stand and the foley flushed and returned freely. I don't have tons of experience using a bladder scanner because, at least where I practice, it seems to be a relatively new procedure that became common during the years that I was a hospice nurse in the field and never used one. However, it's very simple and pretty hard to mess up, right?

Any ideas?

[Do-over, ASN, RN]

Was it set correctly for a female versus male patient? I was taught to set the scanner to "male" if a female patient had had a hysterectomy.

I have no idea if this would cause that discrepancy or not. I have found that the bladder scanner is generally in the ballpark, but can't say that I've paid that much attention to the scanner number and the foley residual.

[westieluv]

Thanks for your reply. I did have the scanner set for a female patient, but it hadn't occurred to me that she may have had a hysterectomy, because she was one of those chronically ill patients with COPD, CHF, CAD, asthma, diabetes, and a whole laundry list of other stuff, so it's very possible that she had had a hyst and I just missed it on the long list of medical problems and history and I should have had it set for a male. Thanks for that information, I hadn't been told that before. : )

[Do-over, ASN, RN]

Well, like I said, it is how I was taught, and how I usually do it.

Something else I usually do, especially when I get a result I wasn't expecting, is scan several times with a different angle or slightly different position.

[westieluv]

Thanks, yeah, I did that. I had her lie flat and then sit in a semi-fowler's, and both times I got the same reading of 601 ml. I also gently palpated the bladder to make sure that I could locate it accurately before I scanned. It felt firm and she had no urge to void, but then she could have had bladder neuropathy secondary to her diabetes. She was a very brittle Type II diabetic who told me that her blood glucose readings at home often read over 400.

[kellycinalli]

The patient could of been retaining fluid (a cities). I've had a patient that had abdominal distension and parenthesis in the past, and it was her abdominal fluid vs bladder. Bladder was empty.

I've also had the machine measure more and when inserted foley was less.

[westieluv]

Thanks, kelly. Good to know, I hadn't thought that the scanner would measure abdominal fluid but that makes sense and this lady was definitely a candidate for abdominal fluid retention as her liver enzymes were all out of whack as well.

Thanks again!

[kellycinalli]

No problem?

[macawake, MSN]

I work in a pacu and we usually use a small handheld bladder scanner, but as far as I know the scanners in general are usually reasonably accurate when you've centered the probe. I can also confirm that the manual for the model I use says to use the male setting for a post-hysterectomi patient.

I'm curious. Did you repeat the scan after you'd emptied out what you could? If so, what was the new reading?

[anotherone, BSN, RN]

Even set correctly, I have seen this happen MANY TIMES. If the pt was retaining any type of fluid, ascites etc. it will be largely inaccurate.

[AJJKRN]

Ours can be inaccurate when the calibration is off whether the female Pt has been scanned as a male or female.

[CityRN123]

Yup, I've seen this happen with prior abdominal surgery, ascites, scars, and adhesions.