Three-Way Foley Question

oMerMero · Aug 4, 2007

my guess is the foley had a clot in it, and needed more irrigating

Tweety, BSN, RN · Aug 4, 2007

I'm not sure I can answer your question. Sometimes there's a clot, the bladder wall adheres to it, or it collapses on itself.

But my question is the guy was on a CBI for a couple of weeks at a high rate????????? That's an awful long time.

firstyearstudent · Aug 4, 2007

Yeah, he is totally miserable. And for the nurse t's really hard to keep an eye on the irrigation to make sure it doesn't run dry or the Foley bag doesn't overflow. One of the nurses suggested we hang two 2 liter jugs of irrigant connected to a Y tube -- but the Foley bag doesn't hold more than 2 liters so what is the use. It's totally impossible to get an accurate I/O on this guy.

I really don't know what is going on with the bladder bleeding but someone told me that it isn't all that uncommon. The patient has Non-Hodgkin's Lymphoma and I was told the bleedng was due to the chemo erroding the mucosa of his bladder and his low platelet count. (One of the nurses thnks they have his platelet parameter set too low -- it's at 40 now). He bleeds so much, yet his Hgb level doesn't drop.

I guess I wanted to know why we weren't getting any clots when we irrigated/aspirated manually. Maybe there weren't any and it was just spasms?!?! I don't know.

vickynurse · Aug 4, 2007

One of the nurses suggested we hang two 2 liter jugs of irrigant connected to a Y tube -- but the Foley bag doesn't hold more than 2 liters so what is the use. It's totally impossible to get an accurate I/O on this guy.
... The y set is the best way because the irrig will never run dry. Larger collection bags are available. I & O is still difficult to measure accurately. Perhaps daily weights would be a better way to eval fluid balance.
.... The patient has Non-Hodgkin's Lymphoma and I was told the bleedng was due to the chemo erroding the mucosa of his bladder and his low platelet count. (One of the nurses thnks they have his platelet parameter set too low -- it's at 40 now). He bleeds so much, yet his Hgb level doesn't drop.
.... He probably doesn't have enough platelets to form clots. Not sure why the Hgb is steady.

BTW, hope the irrig is NS and not water.

nursemary9, BSN, RN · Aug 4, 2007

We do lots of CBI.

We have Y-tubing; Our irrigant is in 3 liter bags. We hang 2 bags & they run at he same time. We have an over-sized foley bag; can't remember how much it holds--but its BIG!!

Once, many years ago I had a similar type pt. It was a mess; she also had lymphoma & had hemorrhagic cyctitis as a result of chemo.

With our pt. ( and please remember, this was quite a few years ago), we were even irrigating with an alum solution. It was extremely painful for the pt. & she was on high doses of pain meds.

As to what is causing your problem, you can't really say. Could be a clot, could be spasms; Sorry can't help with that.

We sometimes give pt's B & O Suppositories for bladder spasms.

GadgetRN71, ASN, RN · Aug 4, 2007

We do lots of CBI.
We have Y-tubing; Our irrigant is in 3 liter bags. We hang 2 bags & they run at he same time. We have an over-sized foley bag; can't remember how much it holds--but its BIG!!
Once, many years ago I had a similar type pt. It was a mess; she also had lymphoma & had hemorrhagic cyctitis as a result of chemo.
With our pt. ( and please remember, this was quite a few years ago), we were even irrigating with an alum solution. It was extremely painful for the pt. & she was on high doses of pain meds.
As to what is causing your problem, you can't really say. Could be a clot, could be spasms; Sorry can't help with that.
We sometimes give pt's B & O Suppositories for bladder spasms.

They do make 4 liter foley bags-when we did TURP/TURB in the OR after the case we'd send the patient to the floor with such a bag..