I have a question about something that recently happened at work. I left one hospital and went to a teaching hospital and I work on a very easy slow unit. Its very different from where I was. We do not do drips or have any progressive type patients. Basically, its boring and I do not think i can learn anything on it. I did not realize that I would not like to slow things down. The experience of the nurses and docs around me is just different, probably because most are new or residents. We had a very very bad code yesterday. The situation was a patient was inadvertantly sent to our unit yesterday, day five post CABG. He had continuous bladder irrigation, however the night shift nurse, did not check on him or empty his foley out all night, but did continue to provide the fluid. The thing clotted off and the bag was so full it almost broke, the patient's body was ice cold and his bladder was full of 1500 cc of fluid. I am amazed it did not break. Well, a new nurse called for assistance, declotted the patient and emptied his foley and bladder out, the patient coded. I remember a doctor stating that one could never change fluids in the body rapidly. Could the bladder irrigation issue be the reason that this patient coded? Just wondering. The body of the man was ice cold when I ran to the code. He felt hypothermic to me. I have done many bladder irrigations, but never let mine clot off. I feel that the complacency of always having walky-talky's on this unit contributed maybe as well. I appreciate any input. Thanks.
It does sound like it was an ugly code. Who knows exactly why the patient coded. He could have bled out, but the most likely possibility is that the pressure from the built-up urine taxed his heart, maybe excessive vagal stimulation too. Obviously if he was post-CABG and had CBI, he had multiple issues going on. Hope you all have recovered from the incident; I hate messy codes too.
Wow, I had a similar issue with CBI. Thankfully my patient didn't code, but I remember getting report from the night shift and the entire foley bag was full and he his bladder was completely distended. She hung the CBI bags and just opened it and let it flow not really paying attention to the I&Os... sad that some nurses are so neglectful :-/
Did the patient have a 3 way foley? If not, the irrigation never gets to the bladder unless you clamp it off, allow the fluid to run into the bladder and then unclamp so the irrigation can run back out. Is it possible the irrigation fluid never got into the bladder which allowed clots to form and prevented urine from draining? Sounds elementary but I've had several occasions when nurses didn't understand that the patient didn't have a 3-way foley and the bags were there for irrigation but weren't really "continuous."
It is as well a lot easier on the agents if you put the irrigation band-aid on set, so you can available up the extra bag while you change the first. As well attach the arising tubing there is a appropriate set of tubing for that has the arrival tubing narrower no charge to be beyond to agree for clots to canyon and the address tubing-larger so clots will not arrest the tubing to a 3 Liter arise canteen have to be vented to allow aqueous to move the air.