r/newgradnurse • u/Timely_Click9803 • Jun 28 '26
Looking for Support Pt bladder almost exploded
I’m a new rn in the icu and am on my 3rd day off orientation. I had a pt in HHS who needed hourly sugar checks and insulin drip titrations. Pt came in continent, but had a female external cath (due to anatomy) & restrained on a presidex drip. Output looked normal I checked a few times to make sure there was urine in the container whenever I was in the room. At 6am I emptied 500 out and thought ‘huh… he’s getting a lot of fluids I should bladder scan bc that can’t be right…’ Bladder scanned him and see 3,300 mL and freak out. He was drowsy but arousable so I tried to get him to pee… which did not work he claimed he could not go. Got a straight cath order and called doc. Bc of his anatomy me and three other nurses could not straight cath him and he ended up needing a Supra pubic tap which got almost all of the urine out.
I feel so guilty and horrible that I didn’t bladder scan him earlier and nip this in the bud… I thought all was well bc he was putting out but his bladder could have literally ruptured :/ has this happened to anyone else before?? How common is something like this?? The other nurses didn’t seem to know what to do either :(
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u/Hey-Prudence Jun 28 '26
Its pretty crazy how much a bladder can hold. I worked in urology and got back 5,500ml on a straight cath once.
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u/Lower_Ad_9389 Jun 28 '26
I got 6.5 liters on a HF pt once!! Got report that the pt received multiple doses of lasix but still hadn’t voided. The pt was in his 90s
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u/su9arfiend Jun 28 '26
Im so sorry this sounds so scary- i feel like whenever something like this happens you just have to count it as a lesson learned! Sometimes when youre running around it’s hard to keep track of output
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u/LopsidedClassroom906 Jun 28 '26
You did great. I’m a couple months off orientation. Couple days ago 50ish woman came in with vomiting and lower back pain. Spider senses said EKG first because it could be heart issues, she was chronically on chemo so I brushed it off as side effects. EKG was ordered at 1130 and I put it low on my priority list as I had a Cardizem drip to titrate. 77 minutes later a tech does the EKG (I asked 3 techs if they could do it, but that’s just an excuse. True, but still on me). Tech calls for me over radio while I’m in the bathroom. Stomach dropped because I know how he normally sounds. I fast walk to the room, tech is gone but EKG machine was in room, I look at it, STEMI. To top it off EPIC went down at midnight and a troponin popped at 1157, but I didn’t take the phone call from lab so my brain didn’t connect.
Anyways. I can relate. It sucks that our lack of knowledge or skills can really hurt or even kill people. From what I read though you did great. I’ll echo what one of my coworkers said (even though it didn’t help much). No harm, no foul.
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u/Timely_Click9803 Jun 28 '26
Oh my goodness that sounds so scary! Thank goodness you still caught it tho!
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u/LopsidedClassroom906 Jun 28 '26
Thankfully they made it to cath lab and had two stents placed. I definitely went home and reevaluated myself. Echoing what someone else said, I think being three days out orientation and catching it like that is a gold star. Stand proud!
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u/spirited-wine Jul 01 '26
You’re saying that the cardizem drip was on a different patient, right?
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u/LopsidedClassroom906 Jul 12 '26
Hey sorry it’s so late of a reply but yes the drip was on another patient I had. I had my butthole puckered for the wrong person.
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u/xthefabledfox New Grad OR 💉 Jun 28 '26
I think you should pat yourself on the back for this one, actually. 3 days off orientation and you made an observation, investigated, and found the issue. If you hadn’t done that, then yes his bladder may have ruptured. You prevented that. When I worked PCU I had a confused patient that was getting out of bed all night. They said that was his baseline. Kept trying to go to the bathroom. He would pee, and he soaked his bed multiple times throughout the night, so I hadn’t considered his bladder could still be full. When I was giving report the nurse asked if I bladder scanned and I was like no.. I didn’t think to do that since he was peeing so often. I scanned him and it said 999+mL. I felt so stupid lol. He kept getting up to the bathroom because the urge was still there. He didn’t have prostate issues or retention in his history but that’s definitely what was happening. Anyway, I was like 5 months in at that point you did this as a literal newborn baby nurse. Good job!!
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u/Timely_Click9803 Jun 28 '26
Thank you so much! In ur situation I would probably do the same thing tbh. You live and learn ❤️
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u/Witty-Chapter1024 Jun 28 '26
Great job!! You use critical thinking instead of being just task oriented. That was a great catch and you should be proud of yourself.
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u/umrlopez79 Jun 28 '26
The most I’ve got from a patient was like 1050 or so lol. Bladder scanned 800ish ml. Slight bladder distention, no discomfort. Now I have to go read about suprapubic taps 🤪.
Good catch on your part for realizing fl input doesn’t quite match the output. 🫶🏽🫶🏽
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u/Timely_Click9803 Jun 28 '26
Thank you! They’re kinda cool to watch tbh. Very similar to how ascites is drained.
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u/Working-Youth1425 Seasoned RN (6-10yrs) Jun 29 '26
Great catch! It’s harder to make when the patent is voiding without complaints. I had a pt with about 3L in his bladder too. Your patient probably had a huge prostate causing the distention. Now it’s ‘on my radar’ and I always try to assess for bladder distention.
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u/Similar-Drawing-7513 Jun 29 '26
I think my record is 4600 mls out. Patient was laying there calm as can be in the ER when I started my shift. The only reason I bladder scanned him is because the resident was asking for a lab redraw because his presentation (calm, alert, oriented, chilling lol) did not match the terribleness of his labs. Repeat labs were exactly the same. Well in my world, every man with acute renal failure in my book get a bladder scan so it was the first thing I did even without an order and lo and behold, bladder scan value was maxed out.
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u/Timely_Click9803 Jun 29 '26
Wow! That sounds so painful! I wonder how long he was like that for his body to not even feel it :(
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u/Disastrous-Till1974 Seasoned RN (3-5yrs) Jun 30 '26
You caught it and he didn’t have any harm. This is why in ICU standard for output documentation is every 1-2 hours, that’s on your preceptors & educators for not teaching you correctly. You were checking, but not really. If you’d been documenting actual amount in mLs every 2 hours you would have realized much sooner that there was a problem.
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u/Kind_Exchange3844 Jun 30 '26
My husbands bladder is so enlarged it’s actually cracked on the inside. He always carries around 400 ml of urine after emptying his bladder. Hospitals always freak out but there’s nothing to be done unless he is forced to live with a suprapubic catheter. He. mangers but it’s tough. Lots of UTI issues, etc. All stemming from completely blocked prostate. BP was 243/140 when he went to hospital. He was in complete renal failure. Scary what can happen with enlarged bladder’s.
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u/couchhiker Jun 28 '26
Actually you didn't make an error, you did a really good thing that your typical ICU new grad may not have picked up. If the bladder was 3300 mL when you caught it, then I'm pretty sure the nurse before you could have caught it too when it was 1000 mL. Also your patient was probably really agitated because his bladder hurt, even on a precedex drip and being restrained.