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Thread: Foley Indwelling Catheter question

  1. #1

    Foley Indwelling Catheter question

    Apologies in advance if I posted this in wrong place but just wondering if someone can offer their opinions/knowledge about a topic which I am unable to find very much info on...

    Recently I was questioned by a colleague; after inserting a foley indwelling catheter in a male patient who had urinary retention (approximately 1 litre according to a badder scan), whether I clamped the catheter when it drained half (so about 500ml) as it drained just over 1 litre within a matter of about 3 hours. I was told by the same colleague; after inquiring why it is needed to clamp, that when volumes of such extent are drained too fast it can cause a bladder protrusion. Is this true? and if so what specific time lengths and volumes are we talking about here?

  2. #2
    I am moving this to the Care forum.

    This is an old myth that is dying a very difficult death. There is no scientific basis or evidence base for there being any ill effects of draining the complete bladder volume when catheterizing the urinary bladder. There are many rumored ill effects (hypotension, shock, etc.)...yours of bladder prolapse is a new one on me, but also without any scientific basis. You would have to rip a bunch of ligaments to prolapse your bladder in a woman, and it is nearly impossible in men. I was actually involved in a EBP study related to this in the 1980s and we not only found no evidence of any serious effects that was research based, but also did an additional study of health care provider's fixed beliefs related to this and the very weird and physiologically and anatomically impossible ill sequalae that they claimed could result.

    The only exception is when we cath patients with SCI who are having an active AD episode, as we do know that under those circumstances that rapid decompression of a very full bladder (say over 1000 cc.) can cause bladder spasm, which can worsen AD. Our protocol calls for draining 500 cc. at a time, clamping for 5 minutes, then draining another 500 cc., then clamping for 5 min. etc. etc. until the bladder is completely empty.

    (KLD)

  3. #3
    Quote Originally Posted by KLD
    also did an additional study of health care provider's fixed beliefs related to this and the very weird and physiologically and anatomically impossible ill sequalae that they claimed could result.
    I bet this was fascinating! Would you share some of the more bizarre answers you got? How is it these standards of care urban myths continue to perpetuate -- some student hears it from their mentor and then passes it on when they become the teacher?
    It is easier to find men who will volunteer to die, than to find those who are willing to endure pain with patience.

    ~Julius Caesar


  4. #4
    Quote Originally Posted by Scholar View Post
    Apologies in advance if I posted this in wrong place but just wondering if someone can offer their opinions/knowledge about a topic which I am unable to find very much info on...

    Recently I was questioned by a colleague; after inserting a foley indwelling catheter in a male patient who had urinary retention (approximately 1 litre according to a badder scan), whether I clamped the catheter when it drained half (so about 500ml) as it drained just over 1 litre within a matter of about 3 hours. I was told by the same colleague; after inquiring why it is needed to clamp, that when volumes of such extent are drained too fast it can cause a bladder protrusion. Is this true? and if so what specific time lengths and volumes are we talking about here?
    Scholar,

    As I understand it, it is important to clamp and not completely empty a high-volume bladder completely in one go is because it may cause catastrophic hypokalemia (low serum potassium). When I was in medical school at Stanford, I took care of a young woman who had severe urinary retention and a bladder that had 6 liters of urine. She looked pregnant. My teacher, a very experienced doctor, told me to be careful about not draining her bladder completely at one time and that I must check her serum potassium frequently.

    Indeed, it happened as my professor described. We took her to the operating room and placed a foley catheter. I then let up the urine 500 ml at a time every few hours. Her serum potassium level dropped very low levels. The mechanism is not clear but I think that it is related to the fact that the urinary retention is very likely to have caused significant back pressure on the kidneys. The kidney responds to the release of pressure by releasing a lot of K. The hypokalemia persisted for many days, despite my giving the patient potassium supplements and urging her to drink orange juice and other materials have high K.

    I just did a literature search to see if there has been any new studies on the subject or discussion of the phenomena. Like you, I was not able to find very much information on google. I am sure that there is a name for this syndrome.

    Wise.

  5. #5
    Thank you for the reposes. Some good points highlighted here that are worth thinking about when catheterising. The information I am finding is also not that dissimilar to the points raised here. Further talking to some of my other colleagues would also suggest that this prolapse theory is a bit of a myth and probably untrue and definetely not supported by any evidence (well nothing that any of my colleagues or myself have been able to find so far anyways). Cheers & Thanx again

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