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Discussion

What could have caused this?

I'm beating myself up over this, and I don't even know if I should be.

I did a foley on a male patient today, after anesthesia induction, prior to surgery start. The cath went in without any problems, no resistance. I go about 25ml of clear yellow urine in return. Sometime between that point and the start of the major surgery (one minor procedure was done prior to that), there was hematuria. A decent amount too, the urine was more than just tinged. He was still draining urine well though.

What could cause this? I would assume if there were an injury, I would have noticed blood when I first got urine back also. I'm scared to death I've caused harm to this man and it's going to bite me in the butt, and I did it all like I was supposed to!

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    You haven't mentioned what other steps were taken after the hematuria was noticed.

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    It was cardiac surgery- the physicians were aware, but it was not the priority at the time. I am not sure what was done post-op once the patient went to the ICU.

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    I wanted to add- the foley was inserted all the way to the hub before inflating the balloon, and I was able to pull back some after blowing up the balloon (it wouldn't pull back if blown up in the urethra, would it?). We also later found out the patients platelet count was crap, so I bet a minor injury would have looked bad since he wasn't clotting well. *sigh* I just need to know he is ok and I didn't do something wrong.

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    I wanted to add- the foley was inserted all the way to the hub before inflating the balloon, and I was able to pull back some after blowing up the balloon (it wouldn't pull back if blown up in the urethra, would it?). We also later found out the patients platelet count was crap, so I bet a minor injury would have looked bad since he wasn't clotting well. *sigh* I just need to know he is ok and I didn't do something wrong.

    it would seem that you did nothing wrong, but that doesnt mean he is ok, one is not contingent on the other....take care, and stop worrying.

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    If it was a cardiac surgery, they probably loaded him up with Heparin, therefore any minor wound/irritation/ulceration that was caused by a normal foley catheter insertion would start to bleed. I don't think you necessarily did anything wrong, it sounds like a complication from foley insertion and anticoagulation.

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    I'm sure you did ok. I would be worried if you didn't give a crap...the fact that you are worried if the pt is ok says volumes about you as a good caring person/nurse.:icon_hug:

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    I'm sure you did ok. I would be worried if you didn't give a crap...the fact that you are worried if the pt is ok says volumes about you as a good caring person/nurse.:icon_hug:

    (Playing devil's advocate here, LOL). How does that speak of a good caring person/nurse?It's possible the person may only be looking out for his/her license. *end*

    OP, pls ignore this.

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    (Playing devil's advocate here, LOL). How does that speak of a good caring person/nurse?It's possible the person may only be looking out for his/her license. *end*

    OP, pls ignore this.

    :lol2: Thank you for asking me to ignore this (so I'd know you weren't speaking directly of me). I feel a little bit better since I have remember his horrible platelet count that we didn't know about (insert rolling eyes here). I know if anything comes of it I have policy to back me up, but I don't want something I did to complicate this persons recovery, know what I mean?

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    More than likely he just had prostatic hypertrophy and the catheter just caused some minor trauma d/t narrowing of the urethra. I doubt it would have been d/t the heparin, because the heparin isn't usually given until quite a bit later with CABGs. I would just chart it and make sure the surgeon knew about it.

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    We do CABG's with heparin running just as an FYI to the above poster.

    However, low platelets plus any kind of anticoag could have lead to a minor irritation to a tiny capillary appearing as more than it normally would.

    Tait

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    We do CABG's with heparin running just as an FYI to the above poster.

    However, low platelets plus any kind of anticoag could have lead to a minor irritation to a tiny capillary appearing as more than it normally would.

    Tait

    So, you start the heparin before the patient ever gets to the room/or on arrival to the OR and then do you just bolus it when you need to get your ACT up past 400? I haven't seen it done that way, but I have only done hearts at two different facilities.

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    (Playing devil's advocate here, LOL). How does that speak of a good caring person/nurse?It's possible the person may only be looking out for his/her license. *end*

    OP, pls ignore this.

    I don't think its an issue of looking out for her licence, she was simpley worried that she may have caused the pt harm (If that makes any sense) People who have done something that they shouldn't have or failed to do what they should have usually know and their "worry" is much different, different enough to know not to post it on a public website that can be retrived later in a court of law....at least I wouldn't..:eek:

    just my trail of thought. :redpinkhe I try to see the good in everyone and everything :redpinkhe

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