Re Day Surgery Unit; nurses, opinions please....

[carolmaccas66, BSN, RN]

I worked DSU at a hospital the other night. This was the first time I'd been on the DSU @ this hospital, but not my first time working in DSU.

Well a couple of things really bothered me. One patient came up from the ED, she had a disconnected IV but the bag still NS in it. Well since it was a bit slow, I said I will go get the NS to flush before we re-start her IV. When I came back, the IV was already started. I would always flush before starting fluids again. Apparently they don't bother and it wasn't so busy they didn't have time.

I also helped care for a patient who had a bladder procedures. Well he had no bladder irrigation going, he was just running to the loo showing us the colour of his urine. But - get this - nobody was even recording how much urine was coming out! I did, but nobody else was. He did go home eventually that night, but his urine was still bloody - I've never heard of this. It's supposed to run clear before d/c. We always do bladder irrigation in other hospitals to completely flush out the bladder and get rid of clots & the NS also promotes tissue healing - this is what I was taught at a major teaching hospital in their PACU.

Also had a patient who needed a drainage bottle removed, no problem there. Well, you will never believe, when I asked where all the equipment was - sterile packs etc - the RN in charge told me not to bother with sterile dressing packs etc. She said it wasn't a sterile technique! Needless to say I ignored her.

It just seemed so bizarre. I don't see the point in learning proper techniques - and then not utilising them.

What are your practices in your DSU?

[roser13, ASN, RN]

In my facility (Ambulatory Surgery Center):

Not all bladder procedures require continuous irrigation post-op. When we do irrigate, it's with LR, not NS. We do not measure post-op urine, simply ensure that its QS. Patients do go home with blood-tinged urine with instructions to call surgeon if clots appear or urinary retention occurs.

Discontinuing a drainage tube (bottle?) is not a sterile procedure.

If I understood your first point correctly - you felt they should have flushed the IV with NS before starting the NS bag? Guess I don't understand.

[DutchRN09]

I work Ambulatory in a hospital. D/C a drain is not a sterile procedure, pts are send home if they can void, after some procedures urine will be tinged for a few days. I don't understand the IV question.

[canoehead, BSN, RN]

The reason you flush an IV with NS is to ensure it's patent before infusing caustic antibiotics and such. If you can hook up the NS line, and it runs easily without swelling you can say the IV is patent, and if it's not patent you've infused a little of what you planned on flushing with anyway. It's a shortcut, and the patient gets the same fluid either way.

[brownbook]

DITTO to the replies.

The IV question isn't clear? Did they discontinue her old IV from the ER and put in a new IV? Or did they hang a new bag of fluid to the ER IV? I guess flushing a slow IV would make more sense than re-starting a new one, but not the biggest deal?

Surgeries, surgical procedures, have advanced by leaps and bounds in the past few years. Many, but not all, bladder procedures are done that do not require bladder irrigation and safely go home with their urine still bloody. Some nurses measure the amount of urine but it is not a doctor order. I just note the patient voided and patient reports it was blood tinged. We have never had a problem. We do occasionally irrigate and have had to admit patients overnight after bladder surgeries. We (I) trust the urologist to know what type of patient and procedure needs more careful watching than others.

Where I currently work we don't remove drainage bottles. I can't remember what we did at my old job? I don't remember getting any dressing packs? Some clean gloves, an unopened gauze, and some tape sounds appropriate to me?

[roser13, ASN, RN]

The reason you flush an IV with NS is to ensure it's patent before infusing caustic antibiotics and such. If you can hook up the NS line, and it runs easily without swelling you can say the IV is patent, and if it's not patent you've infused a little of what you planned on flushing with anyway. It's a shortcut, and the patient gets the same fluid either way.

I understand that, but OP seemed to be saying that she needed to flush the IV with NS before hooking up the NS bag. I couldn't quite get that point....

Oh well, hopefully OP will come back to clarify.