Reproductive System Disorders Q 2

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After having transurethral resection of the prostate (TURP), Mr. Lim returns to the unit with a three-way indwelling urinary catheter and continuous closed bladder irrigation. Which finding suggests that the client’s catheter is occluded?

  

    A. The urine in the drainage bag appears red to pink.

    B. The client reports bladder spasms and the urge to void.

    C. The normal saline irrigant is infusing at a rate of 50 drops/minute.

    D. About 1,000 ml of irrigant have been instilled; 1,200 ml of drainage have been returned.

    

    

Correct Answer: B. The client reports bladder spasms and the urge to void.

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Reports of bladder spasms and the urge to void suggest that a blood clot may be occluding the catheter. Bladder blood clot formation is a common emergency in urological practice. Severe hematuria can lead to blood clot formation in the bladder cavity and consequent urinary retention. Patients may develop pain if the clots cannot be evacuated in a timely manner.

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Option A: After TURP, urine normally appears red to pink. Within the first few weeks after surgery, the scab where prostate tissue has been removed may sometimes loosen and cause some bleeding. By resting when this happens and drinking plenty of fluid, the bleeding will usually stop.

Option C: The normal saline irrigant usually is infused at a rate of 40 to 60 drops/minute or according to facility protocol. Manual bladder washout using a Foley catheter and syringe is the most common method of removing such blood clots. However, this method fails in some patients.

Option D: The amount of retained fluid (1,200 ml) should correspond to the amount of instilled fluid, plus the client’s urine output (1,000 ml + 200 ml), which reflects catheter patency. Immediately after the operation, the catheter is connected to irrigation fluids to wash blood and blood clots out of the bladder. As the urine clears the irrigation will be slowed and eventually stopped. The catheter will be removed when the urine is clear and this will usually occur on the second morning after the surgery.

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