New RN with Question

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Hello Again - I am a new RN and have been working at a SNF for about one month now. I have two questions:

1) I work the NOC (night shift) and I have a patient on our med-rehab unit with a foley drainage bag filled with 300mL of red colored urine, and it was obviously r/t to blood and not a medication causing discoloration. After emptying the bag...she filled it with about 200mL clear, yellow urine. The AM shift charted she had cranberry colored urine and the EVE shift charted clear yellow urine. So, on my NOC shift she had red urine again. Does anyone know what would cause a person to pee urine with blood and then normal clear, yellow urine? Is she passing blood clots? The foley was inserted 3 days ago. Also, as far as my responsibilities go - A UA had been ordered and collected the previous shift. I received the results and faxed them to the Dr. with a note stating she had 300mL red colored urine my shift. And I charted my findings and that I faxed the Dr. the UA results and informed him of my findings. Should I be doing anything else?

2) I received an order to D/C a peripheral IV in a patient and then immediatley start a new peripheral IV. It stated the IV was placed 3-days ago. Are peripheral IV's usually replaced every 3 days?

Thanks in advance for your feedback. Being a new RN and in a SNF with limited training and nurses who rather not take a few minutes to try and answer my questions..or just don't know the answer to my questions - this communication site is so very helpful! :-)

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Specializes in ER, Trauma.

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.

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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.

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Specializes in PACU, CARDIAC ICU, TRAUMA, SICU, LTC.

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.

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^^^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.

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Specializes in LTC Rehab Med/Surg.

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.

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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.

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Specializes in Critical Care.
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. :twocents:

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Specializes in Med/Surg, DSU, Ortho, Onc, Psych.

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.

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Specializes in Med/Surg.

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.

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Specializes in Hospice, LTC, Rehab, Home Health.

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.:twocents:

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Specializes in ICU.

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

Paroxysmal Nocturnal Hemoglobinuria!

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