Straight caths - to clamp or not to clamp?

[SaraO'Hara]

Today, I had a patient retaining urine - over 1500cc out with straight cath. An experienced coworker insists that one must either remove or clamp the straight cath after 1000cc output, lest the patient descend into a hypovolemic state. Based on her statements, I monitored the pt's BP and HR for the rest of the shift - no significant change.

I have been scouring my nursing textbooks and searching online - I can't find any evidence for the need to clamp off and wait after 1000cc out. I have a few basic problems with the idea:

1. Risk of bladder damage, hydroureter, pyelonephritis, etc.

2. The bladder is just plain not part of the circulatory system.

3. Why don't I get hypovolemic letting a liter off at the end of a busy shift?

Thanks, everybody!

[BSNbeauty, BSN, RN]

https://allnurses.com/nursing-student-assistance/hypotension-its-causes-646548.html

Cites studies. This is nonsense.

Nice to have you back GRNTea!!!!

[kristyles]

I had a Hysterectomy and was sent home without a foley. I was rushed back to the hospital 3 days later with tachycardia and I was convulsing and in extreme bladder pain. The hospital cathed me and drew over 2liters off my bladder at one time. It put me into HORRIBLE bladder spasms that not even pain meds and bladder spasm medicine could stop. It was the worse pain I have ever experienced, worse than natural child birth of a 9lb baby. I know people say it doesn't matter if you clamp it off or not, but I am telling you the nightmare that happened to me. It landed me in the hospital for 3 days and I had horrible bladder spasms for 3.5 weeks!!! I don't know why you would even chance putting someone through that. I say clamp it just to be safe. I wish they had done that for me. I had spasms every couple of minutes for days! It's was a NIGHTMARE I wouldn't want anyone else to experience.

[MunoRN, RN]

I can't speak to what specifically caused your bladder retention or the spasms, there are a number of possible culprits which could have caused both, but in general spasms can be caused by basically getting overstretched (such as having 2 liters in your bladder). How quickly it's emptied has nothing to do with spasms, it's how far it got overfilled in the first place.

[Guest219794]

I've never seen it myself but I was taught the 1000cc rule to prevent hypotension. Ive probably still got the textbooks to back it up. I never was sure why, though? A vasopressin effect? Does pelvic pressure affect BP just as high PEEP does? Well then I imagine we'd all need pressors after childbirth. I think it's just another nursing "fact" that time and research has passed by. Don't be too hard on the old girl. We spend enough time keeping up with new knowledge that keeping a pet sacred cow can be forgiven. Her way is old. Time consuming. Impractical (I always thought). But not damaging.

Please do. I am curious if this practice ever had backing.

At some point somebody advocating this practice needs should show some evidence, or justification.

Would anybody want their doctor doing something despite evidence to the contrary, and explain it by saying "well, it's how I was taught."

[canoehead, BSN, RN]

Even with an overfilled bladder, you aren't removing all the pee immediately. It takes time to drain through the tubing. I've heard about bladder spasms, and about hematuria occurring when the tamponading effect of urine is removed. Every time it actually happens, the patient has a reason BESIDES retention to get those symptoms, like bladder cancer, or recent TURP. So I doubt that clamping for ten minutes would have changed the final result.

If you clamp, you risk leaving it clamped for too long, forgetting, and causing more problems. In my own practice, I ask the patient if they've been cathed before, and if there were any problems. I use the smallest catheter I can (slows emptying time) and so far no one has had bladder spasms after the cath, that wasn't having them before the catheter was put in.

If anyone ever told me they'd experienced new spasms or bleeding with a catheter, I'd be talking to the doc before the procedure.