During a client’s urinary bladder catheterization, the bladder is emptied gradually. The best rationale for the nurse’s action is that completely emptying an overdistended bladder at one time tends to cause:
A. Renal failure
B. Abdominal cramping
C. Possible shock
D. Atrophy of bladder musculature
Correct Answer: C. Possible shock
Rapid emptying of an overdistended bladder may cause hypotension and shock due to the sudden change of pressure within the abdominal viscera. Previously, removing no more than 1,000 ml at one time was the standard of practice, but this is no longer thought to be necessary as long as the over distended bladder is emptied slowly.
Option A: Hematuria, hypotension, and postobstructive diuresis can occur after bladder drainage by catheter, and the risk of these complications has been thought to be increased when the bladder is rapidly decompressed; however, there are reports supporting gradual bladder decompression to avoid hematuria, hypotension, and post obstructive diuresis, the evidence is overall weak.
Option B: A Foley was used for urethral catheterization. The bladder is catheterized in the normal way under aseptic conditions using a two-way Foley catheter. Patients were evaluated for pain (treatment success), hematuria, and hypotension. Pain was assessed as present or absent. The assessment was done using pain analog scores.
Option D: Gradual release of the obstructed bladder continues to be recommended as the method of choice based on a theory that slow decompression of the intrabladder pressure will reduce the rate of complications, specifically hematuria, and hypotension.
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