New RN with Question

Can't help you with question number 1, but on number 2 I strongly suggest you don't d/c the existing iv until you've got a good replacement in place.

Once again #1. don't really know. #2. Yes you have to d/c that iv and start a new one, they must be changed q72h, and the tubing must be changed q24h fyi.

A wonderful urologist whom I knew in the early days of my nursing career once told me a few drops of blood in urine can go a long way to discolor it. There are numerous reasons for hematuria; infections, renal calculi, bladder calculi, or tumors. What did the results of the U/A show? Does she have any hx of renal disease? Read her H & P to see if she has any medical hx of hematuria.

You asked if she was passing clots. Did she have clots in the tubing or foley drainage bag?

As for your second question: yes, peripheral IVs are supposed to be changed every 3 days. However, I have to agree with a previous post. Do not d/c the IV until a new one is inserted. Is there any documentation that states the patient was a difficult stick? If so, this is even more reason NOT to remove the existing IV until the new one has been inserted. You may have to get an order to leave the existing IV in place if new access cannot be obtained.

^^^Well I learned something new. Do not d/c the iv until you have the new one. Alright makes much sense sorry op for saying d/c it.

1) Is the pt pulling on the tubing? Confused? When there is bloody urine it's the first thing I think of. Does the pt have hx of bladder CA? Why was the foley inserted in the first place? What did the UA say?

2) Technically the IV site should be changed q 72 hrs. If the pt is a hard stick, the site is clear, and it flushes easily, we usually push that 72 hrs farther than we should. We don't DC a "good" site until another is established.

OOPS I just saw scoochy and I think alike. I guess I should pay more attention when reading previous posts.

Once again #1. don't really know. #2. Yes you have to d/c that iv and start a new one, they must be changed q72h, and the tubing must be changed q24h fyi.

Most places, tubing is good for 72 hours also, unless it's TPN tubing. Some places it's now 96 hours.

Most places, tubing is good for 72 hours also, unless it's TPN tubing. Some places it's now 96 hours.

Yea my hospital PIV's are good for 96 hr and so is the tubing. However as someone said TPN/Lipids and Mannitol are all changed Q24, propofol is Q12.

I was studying renal nursing and the blood could be caused by a number of things. I STRONGLY SUGGEST that you nag the treating physician re this, and get that foley removed ASAP. It could be placed incorrectly, irritating the tissue; does he have any renal dysfunction? Hard to say but that foley has to come out - could be an infection too.

IVs must be re-sited after 72 hours in all the large teaching hospitals I have worked in to prevent infection, phlebitis, etc.

Honestly, to me I would consider Occazm's razor until proven otherwise. As another poster mentioned it takes very little blood to discolor a lot of urine. The chances that it went from blood to no blood to blood for an entire shift requires something to be going on. The chances that it was documented incorrectly just requires someone to be lazy. Call me jaded, but I think someone just wasn't paying attention.

ETA yes it is standard to change the IV on a regular basis for infection prevention methods. If its a field start (non-hospital) we have 24 hours, otherwise 96 unless reason can be documented as to why another IV can or should not be initiated.

If the patient is a hard stick or has few good veins and will be receiving IV therapy for a significant period of time; it may be worthwhile to obtain an order for a midline or PICC. They can remain in place longer and the chances of infiltration is less.

Since we've covered the easy stuff, how about something way out of left field?

Paroxysmal Nocturnal Hemoglobinuria!

The problem with the urine is probably caused by the patient moving, tugging on the tube, causing it to bump around in the bladder. Try to secure it to her leg. Also, if your patient is on blood thinners (coumadin, heparin, even asa or plavix) is enough to cause some bleeding in that situation. Peripheral IV sites are usually only good per policy for 3 or 4 days- after that it hightens your risk of infection.