Understanding bladder scanning

[thumperxx]

I understand that we bladder scan in order to check the post void residual urine in the bladder. So on the ward yesterday I was working with a nurse who was bladder scanning an elderly patient as he was not voiding very much. It showed up 550 mls. There was nothing done, she just took note of the volume and documented it. What do you do when you discover the patient has a large residual volume. I know he urinated later, but what would we do if he didn't? Can someone explain this to me. The patient is confused also so I guess he doesn't always know when he needs to void and maybe that is why he is retaining that amount?

[ChristineN, BSN, RN]

I am assuming that in this case the nurse might have only had an order to Bladder scan so often. Generally the orders I have seen will state to strait cath or insert an indwelling cather if the retained amount is greater than so much (generally 250ml). However if the man did not just void, then you could argue he isn't really retaining because retention is what is left after he voids and you can not get an accurate measure of retention by doing a random bladder scan.

[thumperxx]

He had just voided actually, Has a history of cva. Would he need to be catheterised if he was retaining that much? thans

[LCinTraining]

Probably, but without an order the nurse could not do anything. She probably documented it to bring it to the doctor's attention.

[Hygiene Queen]

Does have a history of BPH too?

That's the first thing I think of in men who retain urine.

[Esme12, ASN, BSN, RN]

It depends on what they are looking for.....if this is new for this pateint they are looking for a trend I am sure to see if there is residual and a pattern to the patients voiding to obtain enough information to make a decision on what to do.....going straight for the cath is not always the best practice for it poses it's own risk opr infection and complications...like you can't get the foley in because of the enlarged prostate.

[loriangel14, RN]

It may have just been that nurses judgement to not do anything. Where I work we don't need an order to do a bladder scan or a cath.I would have done an in and out with that much.Maybe she was just going to give him some time and see if he would void.

[2bmalenurse23]

Continue to monitor the patient for 8hrs. Monitor I&Os , continue to encourage the patient to void (run warm water over the perineal area, run water in the sink as sometimes this triggers the urge to void) if the patient does not void within 8hrs, complete another bladder scan - contact the physician and request an order for cath.

[RainMom]

Our post-op pts often retain urine after surgery & we bladder scan when a pt doesn't reach 240 ml output for the 8 hr shift. We have protocol orders to straight cath x1 for a scan >400. If they still don't void the next shift & continue to retain >400, the order is to insert a Foley. We try everything we can think of to avoid a cath. A lot of the time, it's just being in bed that causes the problem. Lots of ladies just can't go on a bedpan & guys like to stand or at least sit at the bedside. So if it's possible, we try to get them up & that can make the difference.

[KelRN215, BSN, RN]

If this was a true post-void residual, yes I probably would have cath'd him. If I didn't know if he had actually gone and if confuson was thought to be the reason why he wasn't voiding, I would get him up to the bathroom or commode and say "Ok, Mr. Smith, time to pee." I'd also try warm water on the belly and spirit of peppermint. If he sat there for 5-10 minutes without going, then it's probably time for the catheter.

[nurseprnRN, BSN, RN]

The old summer camp trick of putting the hands in warm water works too.