Urine output: When do you let the MD know?

Specialties MICU Nursing Q/A

Hey guys, my question is when do you let the doctor know for low urine output? I know to report less than 30ml/hr but how many hours do you go on by? do you let them know if let's say the last three hours have been

At night do you follow the same protocol? Do you wake up a doc if urine is low?

Please give me some feedback, I'm a new ICU nurse 🙂 Thank you.

6 Answers

Specializes in ER, ICU.

Depends. Definately not for a few hours. You need to think why that might be occuring and see if there is a fix within your scope. If there were no contraindications I would give a bolus of 250 and see what happened, or check labs if that was appropriate. When you do call the doc you should have at least one suggestion in mind. We use an SBAR format which works well for that.

S=situation

B=background

A=assessment

R=request

If the patient has multiple problems try to cluster your data and make one call. Do appropriate assessments and get results prior calling. This will show the doc that your are organized and professional, not clueless. Hopefully you can bounce ideas off your charge nurse or coworkers. Good luck.

Specializes in Critical Care, Progressive Care.

I agree with the above poster - although we would not give a bolus absent an order on our unit.

I ask myself. "Self, why do you think output has dropped. Are they hypotentensive? Is anuria expected? (Are they septic, and we know they they are going to be anuric.) Is their foley clogged or something like that? What has the trend been? Is this new?

If I were the resident on call I would be pretty miffed if somebody woke my up at 0300 to tell me my pt only put out 25cc of urine in the last hour, but the preceeding 12 hours were WNL.

And as a fellow new ICU nurse, I always, always, get the input of a senior nurse or charge nurse.

And SBAR works mighty fine. I am told it was developed by the nuclear power industry following 3 mile island. I use it all the time.

Specializes in critical care, PACU.

some mds are happy with any double digits though ;)

Specializes in adult ICU.

We do UO q2h. I will report consistently low UO, generally after 4 hours. I may call sooner in specific patient scenarios, especially if UO suddenly dropped off, e.g. post-op nephrectomy, renal transplant, or IABP. If my patient received lasix and did not respond after 2-3 hours, I'll usually call -- typically our docs aren't watching the outputs that closely and will need someone to suggest that they titrate the dose up or try something else if they aren't making urine.

I keep a little list in my head of things to do before I call the doc: VS, I&O flowsheet (we use computer charting, so I can pull up a list of the last few days) for a positive or negative fluid balance, manipulate Foley tubing (move it around to see if it is kinked or clogged), irrigtate it if necessary, do a bladder scan if you think for some reason the Foley is out or moved, check the meds they are on and see if there is any reason they might not put out a lot of urine, but most important CHECK THE PATIENT. Especially on nights, where some people don't urinate as much or as often. But if you are not checking hourly urine outputs (like for a pt with an IABP, or a fresh CABG), you may not notice it as quickly. And I always dig through my charts to see if the pt has a history of CHF, lots of times that gets skipped.:nurse:

Specializes in MICU, SICU, and transplants.

If I see a significant change in UO I speak up and start a fluid bolus. Had a pt over the weekend who reliably put out an average of 125ml Q2hrs, then went to 45, then 20. Gave her fluids and it picked right up.

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