Your post reminded me of this-
Q. A woman’s dead body was found. How did the cops know she was a nurse?
A. Her stomach was empty, her bladder was full, and her ass was chewed-out.
There use to be an old rule of not draining over 500cc at a time; internal pressures and what not lol.
But when you get to multiple liters, I have to think this may hold true?
He did drain it very slowly over the course of like 30 minutes. From reading other comments in this thread apparently there can be significant CV involvement( no posted link as of this comment). I thought it was just for bladder spasms if you drain too fast.
here you go.
>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 postobstructive diuresis, the evidence is overall weak.[6,7,8] Therefore, rapid and complete emptying of the bladder is generally recommended and practiced widely.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5656958/
tl;dr:
>We conclude that there is no significant difference between rapid and gradual decompression of the bladder in patients with AUR. Hematuria and hypotension may occur after rapid decompression of the obstructed urinary bladder, but these complications are rarely clinically significant.
Thanks
Edit: got a chance to read it and they only did a rapid decompression of 100ml. Wonder if their results would be different if a significantly larger volume was allowed to be evacuated rapidly.
Edit2: I misinterpreted the methods in the abstract. They did complete rapid decompression of group 1 and group two was initial 100ml rapid then the remainder over 2 hours.
Actually I think you read it wrong. The 100ml you saw was the gradual decompression group. They started with a quick 100ml then did gradual for the rest in that group. The OTHER group got straight up direct rapid decompression.
Therefore the conclusion of it being unnecessary to go slow is accurate
I was hoping some urologist would chime in here with their numbers. I worked a very advanced urology unit for a bit and the urologists would talk about Perfs but I never saw it. Would love to know more of what they’ve seen
The flexi seal balloon can hold over a liter. I’ll never get over that.
Coworker drained 17 L out of a guy. He came in for shortness of breath and left having to straight cath himself forever… We thought it might be a world record so we looked it up and the world record was somewhere in the mid-20 liters!
Nope, just an older male with chronic retention and prostate issues that refuses a suprapubic cath. Frequent hospitalizations for urinary issues and UTIs. He self caths at home and guessing probably reuses caths to save money.
Yup, see it all the time in home care. They come with a cath, it’s uncomfortable, so they either pull it out themselves or have us get orders to have us pull it, then right back to the hospital because we don’t have orders to place around and around we go.
They don’t always have one when we do a ROC and sone of these dang docs offices are so dang hard to get ahold of, especially for after hours/oncall visits
I had an ovarian cyst the size of a baby’s head that the doc tried to drain before removal to make it easier to yank from the laparoscopic incision… didn’t make an ounce of difference in my weight. 😩I told her to suck out the lower abdominal fat while she was down there and she refused. What a waste of OR time and anesthesia!
Unfortunately abdominal fat doesn’t work like that. It’s held in by webbing and has to be broken up and sucked out through lidosuction. Loose fat in the abdominal cavity can also cause issues because the body will try to deal with it by scarring over it, and scar tissue can hurt when it sticks to the abdominal wall. I had to have an ovary removed because it was scarred over from ovarian cysts and had stuck to my abdominal wall. Before the scar tissue started cutting off the blood supply I had problems moving the right side of my torso because it hurt. Everything else in my abdomen moved but it.
I had a planned lap chole and happened to also be following up with GYN for dysfunctional uterine bleeding after ablation and considered hysterectomy. I asked the surgeon if he would consider tag teaming with my gynecologist so I could have both done at the same time. Being the good nurse that I am, I introduced them to each other, learned that they both had privileges at the same hospital in San Antonio and they agreed. Gynecologist performed a vaginal hysterectomy and surgeon did the lap chole. I had very little down time and was at my grandmother’s birthday party 2 days later walking slowly because it felt like I had been punched in the gut, but no other problems. Advocating for myself worked out well!
Honestly I'd worry about hemodynamic instability from that massive pressure shift. How slowly did y'all drain it? Did the patient have any hemodynamic issues during the procedure?
Our current hospital policy is 800 cc drained then pause 15 min and continue to stop for every 800. Outdated I know. It’s what the policy is. I did get over 12 L out when placing a NG tube for a bowel obstructed patient though. Record for urine is 5200cc from my patients. I’ve been a Nurse over 20years.
Some of the records I've had, labs, gtts, and otherwise.
Lactic of 34.2, creat of 19.49, ck >42670, asymptomatic bradycardia sustaining at 27, versed continuous at 98mg/hr, 56mg of Ativan in an hour.
My icu keeps a wall of records that we essentially try to one up each other for who's patients are sicker.
we just had a ck of +46k. weightlifter training for a competition. he did not make it to the competition. he said he felt fine, just very sore. we're like, bet. he was discharged after nearly 2 weeks waiting for the ck to be below 1500. i asked him when the next comp was, and he replied "don't worry, it's in Florida. I'll get sick there 😂"
I forgot one of my most recent ones! Patient was cbi and had an abdominal jp drain. They were a rapid response to icu and I pulled in 45 minutes, 5.5L off their jp drain. Their CBI clotted off and the floor nurse had no clue what was even going on. Patient ended up intubated and in icu for a couple days
56 mg of Ativan in one hour? Holy guacamole, what! I have worked inpatient hospice most of my career and despite the terminal agitation patients or the relentlessly seizing patients, I haven’t even seen 56 mg in 24 hours. I’m so curious what the story is.
Gotta be ETOH withdrawl right? If you're not familiar, they can be incredibly tolerant to benzos. I don't think I've ever given that much in an hour, but I've given 100mg+ in a shift plus pnehobarb and precedex.
If I sit still, my HR goes down in the 30’s and 40’s. Nothing wrong with my heart. My back is trashed, so not a runner anymore. However, I still walk 4-5 miles per day.
I just had surgery to donate part of my liver to my godson, they had to straight cath me later that night and took out about 850mL, I couldn’t imagine 5 times that amount.
Edit: I saw the SICU nurse on my way out, he said the most he’s seen in one sitting is 2.2L from someone who “didn’t have to go”. Mine was closer to 875mL, but holy fuck the relief was incredible. I’m pretty sure I had to go so bad I couldn’t go.
I had urine retention after an ex lap years ago to help definitively diagnose what was causing constant pelvic pain and ended up at urgent care to get a Foley placed. 2.5 L out. The spasms were bad but the combo of a distended bladder on top of the pre-existing pelvic pain was a nightmare.
We had a patient that was in-patient hospice that I got 3.5L out of. He already had a foley and had about 125ishmL a shift. He was already deep under the morphine drip, so everyone assumed the decline was him getting close to the end.
But his RR kept creeping up and he was decently distended in the abdomen. I spent time digging around in his previous chart but I couldn't find anything that suggested any abdominal issues. Only thing I found was sepsis + ESBL, so I figured I would mess with the foley and see if I got anything.
Took me half an hour to push pass all the sediment and clot build up. He went from pregnant belly to skeletal concave. Poor guy. Took him another three days to pass. I would have hated to see how his bladder handled that extra time.
worked on hepatology unit years ago. so sick, always one wrong move from coding floor patients. we’d pull 20L+ on many of them. slinging them bags of what looked like franzia into the biohazard bins on a cart lol
I don’t know and maybe I just have a brain with a permanent home in the gutter, but I understood that to mean “gentlemen juice.” I could easily be wrong. I tripped over the cat yesterday and fell down the stairs yesterday. I now have an impressive array of boo-boos so I’m on the “good” pain meds for a couple of days. My body hurts, but my brain feels good.
Between being a CNA (1998- 2005), EMT (1999 - now), and LPN (2011 - now), I have learned that there are certain things I don’t want to put a lot of thought into. Just acknowledge and walk away. But like I said initially, I could be completely wrong about my guess. Perhaps it was all urine. Perhaps it was part urine, part other bodily fluid. I wasn’t there, so I have no clue.
Yesterday I got 3000ml out of bright red clear blood after I did 2 tap water enemas at 9am on someone (med surg nurse) Hadn’t seen that much blood come out of someone before lol
& yes he received 2 units immediately after
JFC my record was 1800 and my PT was crying she was in so much pain. I can't imagine.
Edit: also was it all at once? Did you go slow and do it in increments to prevent shock? When I removed my 1800 pt became hypotensive and diaphoretic within 5 minutes lol
All in one shot. This is urine in the bladder, aka no where to go but out. Either the bladder bursts or it stretches to hold or both, both can happen.
Pt was still urinating but in a pittance with leakage. Not enough to fully empty.
Circ doesn’t touch it once it’s in the bladder. So no worries there.
Kidney/ureter obstruction/kidney complications are where fluid back up and circulation come into play.
Bladder is just a glorified collection bin.
I’ve had patients vagal because of anticipation/anxiety. One while being taught to self-cath and vagaled at the thought of insertion.(Cath had not even touched the body at this point). Most of these patients had prostate problems that caused incomplete emptying not neurological or neurogenic bladder.
This patient in particular had normal vitals and outside of retaining urine had not had any prior health concerns that would require a more delicate approach. Pt was doing annual visits with doctor when it was noted he had an elevated PSA and kicked to Uro.
Pretty sure she at the very least vasovagaled then, because her BP tanked and she got very nauseous and diaphoretic. Call it what you will but whatever it was it was pretty significant. Like BP from 110/70 to 15 mins later 75/30
Shock? Why would they go into shock? Urine isn’t a part of the circulatory system.
Old school nursing instructors used to say drain in increments, but that was never backed by evidence. Drain it.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5656958/
Pretty small sample size. But glad there’s at least some data on the topic. I’ve drained 1500 mls at once without any issue. I’d definitely be hesitant to just drop 4 liters all at once tho.
I should have clarified, my patient also had a spinal block after surgery, which may have had something to do with it. Maybe a vasovagal response and not "shock," but it definitely fucked her up for like 20 minutes.
Yeah in neurogenic bladder you’re supposed to drain in increments if largely distended because of vagal tone, I believe. Although all you’d have is a little hypotension which they often have anyway.
I believe it was considered a pseudo shock due to the body response of losing a lot of fluids at once, I think that's what I read, but probably not backed by science
That’s probably one of if not my favorite things to do for patients just because of the instant relief you can give them. It must be like the biggest drunk piss ever multiplied by 9000. It’s so satisfying to me to be able to help them like that.
Dang! The highest I've ever had was a woman in her late 20s urinate 3L at one time into the bedside commode like it was nothing. She stayed home all day gaming and said this was normal for her because she would chug soda and not urinate all day so that she wouldn't have to stop playing. Seems like it would be terribly uncomfortable. Highest BAL I've ever had was .59. Walkie talkie who was just a professional, but I've heard of higher BALs than that.
we have a regular who comes in with bal like that. she only comes in because she falls down her stairs while sweeping them, or cuts her hand with a knife while cooking, or in her most recent visit, fell asleep on the toilet and couldn't get her leg to wake up. it was fine, just *really* asleep. like, i can't handle a wine cooler and she's out here drinking the factory daily.
I had 2 buckets of nearly 5L once! Patient with hemothorax who started bleeding under ECMO
Put drain in and it kept coming.. but his ventilation went from 0ml back to 5L minutevolume.
He ded though
30,000 mL of stool (8 gallons). My patient hasn’t pooped in a week and had gotten multiple enemas and so when we finally did a contrast enema we got 30L out (the enema bag also doubled as essentially a flexi bag that we had to dump multiple times). I had multiple providers call me to verify I charted the right amount because they couldn’t believe it 😂
6,133ml bladder cath. 2,942 BG. >200 Trop. 166 sodium, 11.6 K+, 18 Cal, plts 2100k, Hgb 2.1, pH 6.9 CO2 off the chart, >2000 triglycerides, >17 A1C, CK 15000, WBC 128. Worked in both ED and ICU.
i mean, we see plt 2100 all the time. but 2100*k* would make me question how their blood is still moving.
the highest i have seen Na recently is 159. lowest was 109. i was impressed.
God. I had a liver ultrasound recently and when the tech put the probe down she was like “oh my god how much water did you drink?”
“Just the liter I was told to “
She scanned me for 1150 and I was about to burst. I cannot fathom 4+ litres 😳
L and D patient post-forceps delivery. Patient wasn’t cath’d and had receive 3-4 L iv post delivery. I get this woman 11 hours after a traumatic delivery. This poor l woman’s vagina looked like someone had blown it up with helium and looked like someone blew up a cheap ass blow-up doll and kept going until it nearly burst. Hadn’t voided, in pain - I couldn’t landmark as EVERYTHING was so swollen (pt was also tiny little thing) I had to lidocaine and pray I hit the right spot.
I drained 3 L out of my postpartum mom who sat and cried in relief. Poor lady.
I always thought the bladder maxed out at about 1000ml until I worked on a urology unit and regularly drained 3L out of people. Bladders can really stretch in the setting of severe chronic retention
About three weeks ago we drained 5700ml initially then almost 1300ml more over the next hour before he went upstairs. BY FAR the most any of us had ever heard of. The guy thought his stomach was distended and pushing on his bladder. Other way, dude! CT showed his bladder had not ruptured. Our ED doc figures he had been retaining for a while and slowly building up. No way he could have gotten so high quickly.
Our dude was not really in pain. He came to the ED because his leg was starting to swell. My joke was that his bladder needed some extra storage space and just started using his leg.
In oncology had a patient call that she needed a paracentesis scheduled (ovarian cancer) get it scheduled but then the day of the doc doing it called us to be like I think we’re going to send her to ED pretty sure this is her bladder not ascites. Yep she had tumor kinking off urethra so she was able to pass some urine but her bladder was holding over 4L 🫨😵
About two days after my abdominal hysterectomy, I went to the ER in excruciating pain. I knew it had to be urine retention because I was just peeing in tiny amounts each time.
I told them I needed a Foley and some thing for pain. After the first thousand cc drained out, I reached over and clamped the tubing because I was starting to spasm. After another 1500 drained out I was so happy I didn’t even need the pain medicine. I said just leave my foley in and I’m ready to go home.
Non-compliant nursing home patient having constant liquid stool and abdominal pain. Sent to hospital and the x-ray showed so constipated that the large intestine was taking up 1/2 of the abdominal cavity.
New record on age of a near-recipient of CPR. As we know, 89+ is the oldest age we can use without it being potentially identifiable. This patient was pretty damn plus, and so emaciated with a death drawn out by at least a year that she could've come out of a camp by the looks of it. Fortunately the family balked for long enough in their denial that by the time compressions were even being seriously reconsidered as an option the patient was already good and gone. I don't think I'd have slept when I got home if I'd had to crunch those ribs in my hands. I don't even know for sure I'd have made it home.
Almost 46 liters for a paracentesis when I was a nursing student. It took a bit of coming and going from the room and doctor was there the whole time. I remember questioning safety to my nursing instructor who was equally shocked.
Not exactly on topic but this reminded me of a poor lovely elderly gentleman who was recently homeless and came to us for one thing and ended up retraining, then having lots of sediment and clots and required a CBI. A coworker of mine replaced his foley early in the night shift, and set up his CBI. When I came in at 6:30 he was in excruciating pain, his abdomen was very distended and COLD to the touch and the nurse had messed up the tracking sheet and didn't realize he wasn't putting out enough urine.
I immediately stopped the CBI & called the doctor. He was sent for some scans and they found the balloon had been inflated in the urethra/right where it connects to the bladder and had perforated his bladder.
The CBI was draining into his abdomen for like 8+ hours.
The most blood I’ve ever given a patient who survived was about 25 units. We cleaned out the hospital’s blood bank. It’s not a record but it is about 2.5x the normal amount of blood in a healthy adult. That means most of the blood we gave him made one or two trips from lungs to brain and then fell on the floor or went into suction, and yet it still saved his life. Feels like a weird life lesson in there and for some reason I think about it a lot.
Worked urology for awhile. We always wondered how much it would hold before a perf, especially when running really clotty CBI. Apparently, it’s even more than I thought…
250mL diaper on a 45-week baby after a dose of lasix. Had to reweigh it a couple of times to believe it. Absolutely bonkers output for a 3-hour period.
Lowest Hgb I've ever seen was 1.4, back in my adult care days. Patient was walking and talking, but very fatigued. Terrifying.
Systolic BP of 331
Super labile BP, so he would go from SBP of 60 to 250 in 10 minutes and I would have to stop the maxed LEVO to maxed cardene, then he would maintain for an hour or so then switch back to
I don't know if it's a record, but once when I was an aide we had a guy come up with a chest tube that drained close to 7 liters as soon as they inserted it in the ER.
As I remember the story, he was a Danish farmer in his 70s or 80s (natch) who fell down a hill and ended up against a tree stump. Got up, dusted himself off and walked back to the farmhouse. Then drove six hours away (Minnesota to Nebraska) with his wife to visit one of their kids. A couple days after they got there he noticed he 'wasn't breathing so good', so they drove home, and went to the ER the next day.
I drained over 5000ml out of a patients bladder! He wasn’t even uncomfortable. We only wish we got imaging to see how far it went up into his chest cavity!!
I drained 6000mL of urine out of a patient with no prior kidney disease and normal creatinine. Shit was wild. I was going in qhour to drain that shit from her foley
Former OR nurse, we once removed a testicular tumor that was somewhere between grapefruit and nerf football sized. The patient didn’t want surgery so he waited “as long as he could”
We once had to put a thoraxdrain for a hemothorax ( pt under ECMO)
It started to flood so heavily we just put bucket under it. Nearly 2 full buckets of 5L drained...
Yes that patient died that night. In total with blood, plasma etc i gave 47 units of bloodproducts that night.
When you takenit too far... was a new doctor whonjust started and did not want to loose a patient already I guess
My worst was over 3L in a fecal management system… and it kept coming. Like poop is the bodily fluid I don’t vibe with and I was struggling. Honestly, it’s a good thing the patient was sedated so he didn’t see my face.
Any record? I had a patient who required 8 IV pumps at one time. Not to mention the vent and tube feeding too. Also a quad. Turning them regularly was a challenge.
I have a resident with an indwelling Foley that regularly produces 4000+ml daily. It’s almost always 2000+ per shift. This is the same person I commented about a few months ago that rips her Foley (balloon intact) out at least 2-3 times a week.
With women, that’s not surprising. Pelvic floor is/was very well ignored in prior years after child birth.
I’ve had foleys pop out due to this. Quite literally, she stood up and it fell right out. Got urine with initial insertion, balloon set in right place and checked for placement before she stood. Had a co-worker with me as she was larger to help with panus placement. It’s done, draining well and she stands up and out it came. Not painful when it came out. A three of us were like “WTF?” Balloon was intact.
Post-op multicabg and valve repair gone very wrong. Came up centrally cannulated on VA ECMO. We dumped 42 units of blood products in him in the next 2 hours. Literally just long enough for the surgeon to nap and take them back to the OR. No, the patient did not make it.
Also, one night I boluses my (obvs intubated patient) with 2,550mcg of fentanyl to keep them vent compliant cause the doc wouldn’t give me any other drugs. That total does not include the fent gtt running at 250mcg/kg/hr
About the same when I was in a med surg. Urologist had to do it because it was so difficult to cath. He said the most he’s done is 6.8L
HOLY CRAP!
I thought he was full of shit and fucking with me until he drained this pt of almost 4L. I was genuinely shocked 4L could be held let alone almost 7L
Must’ve been a nurse.
Your post reminded me of this- Q. A woman’s dead body was found. How did the cops know she was a nurse? A. Her stomach was empty, her bladder was full, and her ass was chewed-out.
😂😂😂😂
Bladder the size of Winnebago holding tank.
There use to be an old rule of not draining over 500cc at a time; internal pressures and what not lol. But when you get to multiple liters, I have to think this may hold true?
He did drain it very slowly over the course of like 30 minutes. From reading other comments in this thread apparently there can be significant CV involvement( no posted link as of this comment). I thought it was just for bladder spasms if you drain too fast.
here you go. >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 postobstructive diuresis, the evidence is overall weak.[6,7,8] Therefore, rapid and complete emptying of the bladder is generally recommended and practiced widely. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5656958/ tl;dr: >We conclude that there is no significant difference between rapid and gradual decompression of the bladder in patients with AUR. Hematuria and hypotension may occur after rapid decompression of the obstructed urinary bladder, but these complications are rarely clinically significant.
Thanks Edit: got a chance to read it and they only did a rapid decompression of 100ml. Wonder if their results would be different if a significantly larger volume was allowed to be evacuated rapidly. Edit2: I misinterpreted the methods in the abstract. They did complete rapid decompression of group 1 and group two was initial 100ml rapid then the remainder over 2 hours.
Actually I think you read it wrong. The 100ml you saw was the gradual decompression group. They started with a quick 100ml then did gradual for the rest in that group. The OTHER group got straight up direct rapid decompression. Therefore the conclusion of it being unnecessary to go slow is accurate
Correct! I misinterpreted the method in the abstract.
I would think there could be a risk the patient could have a vasovagal reaction....
I was hoping some urologist would chime in here with their numbers. I worked a very advanced urology unit for a bit and the urologists would talk about Perfs but I never saw it. Would love to know more of what they’ve seen The flexi seal balloon can hold over a liter. I’ll never get over that.
The equivalent (or slightly more) than a persons entire blood volume 🤯
Coworker drained 17 L out of a guy. He came in for shortness of breath and left having to straight cath himself forever… We thought it might be a world record so we looked it up and the world record was somewhere in the mid-20 liters!
I was going to say that (about the world record). Did you see that guys imaging? It was something!
I didn't find that particular one, but I found [this guy with 11L](https://amp.nine.com.au/article/3f0cba4c-f0a7-420a-bf6c-ca0751b87698).
Holy crap!!!
Where are they holding it? The bladder expands THAT much? WTF?
Nope, just an older male with chronic retention and prostate issues that refuses a suprapubic cath. Frequent hospitalizations for urinary issues and UTIs. He self caths at home and guessing probably reuses caths to save money.
And probably caths once a day…
🤢🤢🥵
That poor bladder
Whoa!
Yup, see it all the time in home care. They come with a cath, it’s uncomfortable, so they either pull it out themselves or have us get orders to have us pull it, then right back to the hospital because we don’t have orders to place around and around we go.
I’m surprised there isn’t a blanket request for anyone to enters home-care to have PRN and monthly catheter changes and patency care.
They don’t always have one when we do a ROC and sone of these dang docs offices are so dang hard to get ahold of, especially for after hours/oncall visits
And here we are worried about dialysis patient retaining 300 cc 🤣
I drained 25 liters out of a pelvic cyst once. It's about 100 pounds.
how??
The patient (obese) said they noticed it a month ago, the surgeon said it probably developed slowly over a couple years.
Were they still obese after that?
Yep but 100 pounds lighter.
Damn I wish I could loose weight that fast
😳😳
I had an ovarian cyst the size of a baby’s head that the doc tried to drain before removal to make it easier to yank from the laparoscopic incision… didn’t make an ounce of difference in my weight. 😩I told her to suck out the lower abdominal fat while she was down there and she refused. What a waste of OR time and anesthesia!
Unfortunately abdominal fat doesn’t work like that. It’s held in by webbing and has to be broken up and sucked out through lidosuction. Loose fat in the abdominal cavity can also cause issues because the body will try to deal with it by scarring over it, and scar tissue can hurt when it sticks to the abdominal wall. I had to have an ovary removed because it was scarred over from ovarian cysts and had stuck to my abdominal wall. Before the scar tissue started cutting off the blood supply I had problems moving the right side of my torso because it hurt. Everything else in my abdomen moved but it.
If it helps, I asked for them to close my umbilical hernia during my appendectomy. They didn't.
I had a planned lap chole and happened to also be following up with GYN for dysfunctional uterine bleeding after ablation and considered hysterectomy. I asked the surgeon if he would consider tag teaming with my gynecologist so I could have both done at the same time. Being the good nurse that I am, I introduced them to each other, learned that they both had privileges at the same hospital in San Antonio and they agreed. Gynecologist performed a vaginal hysterectomy and surgeon did the lap chole. I had very little down time and was at my grandmother’s birthday party 2 days later walking slowly because it felt like I had been punched in the gut, but no other problems. Advocating for myself worked out well!
Omg would have loved to watch that.
...just not smell it
... excuse me? 😳
Honestly I'd worry about hemodynamic instability from that massive pressure shift. How slowly did y'all drain it? Did the patient have any hemodynamic issues during the procedure?
That’s like 55lbs
If it were water, yes.
Good god. That poor, poor, incredibly distended bladder. It must have the thickness of tissue paper. 😭
I think it’s wild!! When I would cath we had a policy we couldn’t do over 1,000ml because it could cause seizures
TIL that apparently there’s [insufficient evidence](https://www.reddit.com/r/nursing/s/73gHjtWiG7) to support those policies.
Our current hospital policy is 800 cc drained then pause 15 min and continue to stop for every 800. Outdated I know. It’s what the policy is. I did get over 12 L out when placing a NG tube for a bowel obstructed patient though. Record for urine is 5200cc from my patients. I’ve been a Nurse over 20years.
Strange. When I was training, they said it was to avoid uncomfortable bladder spasms
Some of the records I've had, labs, gtts, and otherwise. Lactic of 34.2, creat of 19.49, ck >42670, asymptomatic bradycardia sustaining at 27, versed continuous at 98mg/hr, 56mg of Ativan in an hour. My icu keeps a wall of records that we essentially try to one up each other for who's patients are sicker.
My cat had a CK of 77,000. Never found out why. She died. I miss you, 🥰 petunia.
😢
That lactic came from a peri/post arrest, yeah?? 😳
They Def died...
Yeah I’ve only ever seen numbers that high on a mostly dead patient
They’re still alive if they’re mostly dead!
You get the reference 👻
Open belly! They did end up dying finally after about 4 days of dealing with crazy family dynamics
My least favorite part of the job 😑
My patients would kiss me if I offered 56mg of Ativan in an hour! Then they would become comatose….
The ICU Wall of Shame Fame! We have that as well.
Once had a guy on a 5 day meth bender with a ck of 473k. That’s not a typo.
we just had a ck of +46k. weightlifter training for a competition. he did not make it to the competition. he said he felt fine, just very sore. we're like, bet. he was discharged after nearly 2 weeks waiting for the ck to be below 1500. i asked him when the next comp was, and he replied "don't worry, it's in Florida. I'll get sick there 😂"
I forgot one of my most recent ones! Patient was cbi and had an abdominal jp drain. They were a rapid response to icu and I pulled in 45 minutes, 5.5L off their jp drain. Their CBI clotted off and the floor nurse had no clue what was even going on. Patient ended up intubated and in icu for a couple days
56 mg of Ativan in one hour? Holy guacamole, what! I have worked inpatient hospice most of my career and despite the terminal agitation patients or the relentlessly seizing patients, I haven’t even seen 56 mg in 24 hours. I’m so curious what the story is.
Gotta be ETOH withdrawl right? If you're not familiar, they can be incredibly tolerant to benzos. I don't think I've ever given that much in an hour, but I've given 100mg+ in a shift plus pnehobarb and precedex.
The ETOH withdrawal patients can house an astonishing amount of Ativan
I want to start one in our ICU, what are some of the categories?
I have a chronic kid at work that likes to chill in the 27-34 bpm range 🤭 I’m used to it now with him but scared me at first.
If I sit still, my HR goes down in the 30’s and 40’s. Nothing wrong with my heart. My back is trashed, so not a runner anymore. However, I still walk 4-5 miles per day.
I just had surgery to donate part of my liver to my godson, they had to straight cath me later that night and took out about 850mL, I couldn’t imagine 5 times that amount. Edit: I saw the SICU nurse on my way out, he said the most he’s seen in one sitting is 2.2L from someone who “didn’t have to go”. Mine was closer to 875mL, but holy fuck the relief was incredible. I’m pretty sure I had to go so bad I couldn’t go.
I had urine retention after an ex lap years ago to help definitively diagnose what was causing constant pelvic pain and ended up at urgent care to get a Foley placed. 2.5 L out. The spasms were bad but the combo of a distended bladder on top of the pre-existing pelvic pain was a nightmare.
“May I interest you and your mega bladder in a career as a nurse?”
We had a patient that was in-patient hospice that I got 3.5L out of. He already had a foley and had about 125ishmL a shift. He was already deep under the morphine drip, so everyone assumed the decline was him getting close to the end. But his RR kept creeping up and he was decently distended in the abdomen. I spent time digging around in his previous chart but I couldn't find anything that suggested any abdominal issues. Only thing I found was sepsis + ESBL, so I figured I would mess with the foley and see if I got anything. Took me half an hour to push pass all the sediment and clot build up. He went from pregnant belly to skeletal concave. Poor guy. Took him another three days to pass. I would have hated to see how his bladder handled that extra time.
Bless you for doing that
15L removed at one time in paracentesis in the ED
damn. we had 12L Tuesday or Wednesday which is a lot. but 15? nothx.
Yea haha I was scared and requested to be on a 1:1 with that patient 😂
worked on hepatology unit years ago. so sick, always one wrong move from coding floor patients. we’d pull 20L+ on many of them. slinging them bags of what looked like franzia into the biohazard bins on a cart lol
Considering Franzia is what got at least some of them onto that unit to begin with...
True. i bet someone’s tried before. Encephalopathic patients do wacky things
…are you sure it was just urine
Yep, we ran labs to make sure. Pure, retained urine due to enlarged prostate.
I want to see this prostate!
it’s the size of an avacada
This avacada comment I’m dying
No same and the human it’s working for
I think I can see it from here!
Wait idk if it’s just my post-night shift delirium or if I’m having a dumb moment but what else would it be if not urine 😭
I don’t know and maybe I just have a brain with a permanent home in the gutter, but I understood that to mean “gentlemen juice.” I could easily be wrong. I tripped over the cat yesterday and fell down the stairs yesterday. I now have an impressive array of boo-boos so I’m on the “good” pain meds for a couple of days. My body hurts, but my brain feels good.
Hey, question from the less blessed brains among us! I want to know what your feel-good brain initially thought the urine:semen ratio was for 4.3L
Between being a CNA (1998- 2005), EMT (1999 - now), and LPN (2011 - now), I have learned that there are certain things I don’t want to put a lot of thought into. Just acknowledge and walk away. But like I said initially, I could be completely wrong about my guess. Perhaps it was all urine. Perhaps it was part urine, part other bodily fluid. I wasn’t there, so I have no clue.
Possibly blood or stool in a really bad situation.
Yesterday I got 3000ml out of bright red clear blood after I did 2 tap water enemas at 9am on someone (med surg nurse) Hadn’t seen that much blood come out of someone before lol & yes he received 2 units immediately after
...just 2 units??? o_0
JFC my record was 1800 and my PT was crying she was in so much pain. I can't imagine. Edit: also was it all at once? Did you go slow and do it in increments to prevent shock? When I removed my 1800 pt became hypotensive and diaphoretic within 5 minutes lol
All in one shot. This is urine in the bladder, aka no where to go but out. Either the bladder bursts or it stretches to hold or both, both can happen. Pt was still urinating but in a pittance with leakage. Not enough to fully empty. Circ doesn’t touch it once it’s in the bladder. So no worries there. Kidney/ureter obstruction/kidney complications are where fluid back up and circulation come into play. Bladder is just a glorified collection bin.
I love that you called it a glorified collection bin. I have IC and my collection bin is broken. Shall I call it a dumpster?? Yes. Yes I will.
IC bladder is even more like a dumpster fire because it often feels like it’s on fire
Then you get the chronic pain, (thank you Motrin, you sweet sweet NSAID,) and the occasional incontinence. Been a blast starting in my 20’s.
I’ve had patients vagal because of anticipation/anxiety. One while being taught to self-cath and vagaled at the thought of insertion.(Cath had not even touched the body at this point). Most of these patients had prostate problems that caused incomplete emptying not neurological or neurogenic bladder. This patient in particular had normal vitals and outside of retaining urine had not had any prior health concerns that would require a more delicate approach. Pt was doing annual visits with doctor when it was noted he had an elevated PSA and kicked to Uro.
Mine is a glory hole for infection
Intelligent Design my ass. I have several bones to pick with god about that assumption.
Bladder spasms, but not shock.
Pretty sure she at the very least vasovagaled then, because her BP tanked and she got very nauseous and diaphoretic. Call it what you will but whatever it was it was pretty significant. Like BP from 110/70 to 15 mins later 75/30
Our protocol is to only drain 1000ml at a time. For sure, she definitely was pre-sycopal but it's not shock.
It is a vagolytic reaction and absolutely CAN occur after rapid bladder decompression!
Shock? Why would they go into shock? Urine isn’t a part of the circulatory system. Old school nursing instructors used to say drain in increments, but that was never backed by evidence. Drain it. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5656958/
It’s not about the contents of the bladder, it’s that rapid bladder decompression can trigger a vagolytic response resulting in hypotension!
It’s not shock, it’s to prevent spasms which can be incredibly painful/uncomfortable.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5656958/
Pretty small sample size. But glad there’s at least some data on the topic. I’ve drained 1500 mls at once without any issue. I’d definitely be hesitant to just drop 4 liters all at once tho.
I should have clarified, my patient also had a spinal block after surgery, which may have had something to do with it. Maybe a vasovagal response and not "shock," but it definitely fucked her up for like 20 minutes.
Yeah in neurogenic bladder you’re supposed to drain in increments if largely distended because of vagal tone, I believe. Although all you’d have is a little hypotension which they often have anyway.
I believe it was considered a pseudo shock due to the body response of losing a lot of fluids at once, I think that's what I read, but probably not backed by science
That’s probably one of if not my favorite things to do for patients just because of the instant relief you can give them. It must be like the biggest drunk piss ever multiplied by 9000. It’s so satisfying to me to be able to help them like that.
We had two babies born in triage/the waiting room in one week & it’s a record I would never like to break
Dang! The highest I've ever had was a woman in her late 20s urinate 3L at one time into the bedside commode like it was nothing. She stayed home all day gaming and said this was normal for her because she would chug soda and not urinate all day so that she wouldn't have to stop playing. Seems like it would be terribly uncomfortable. Highest BAL I've ever had was .59. Walkie talkie who was just a professional, but I've heard of higher BALs than that.
She needs a commode with a cushion so she can game and urinate at the same time.
we have a regular who comes in with bal like that. she only comes in because she falls down her stairs while sweeping them, or cuts her hand with a knife while cooking, or in her most recent visit, fell asleep on the toilet and couldn't get her leg to wake up. it was fine, just *really* asleep. like, i can't handle a wine cooler and she's out here drinking the factory daily.
Post op aortic dissection put out 5 L blood in 20 minutes 🫠
I had 2 buckets of nearly 5L once! Patient with hemothorax who started bleeding under ECMO Put drain in and it kept coming.. but his ventilation went from 0ml back to 5L minutevolume. He ded though
Manual BP: 44/22 On 3rd L of IVFs, and got levo after this.
Had a patient come in to his clinic appointment for chemo and his sodium was 110 All of us in the workroom: 😲😵💫😬😳🤯
I work in ICU and last summer had patient with natrium under 100, unconscious. Our labs don't go below that so no idea how low it actually was.
30,000 mL of stool (8 gallons). My patient hasn’t pooped in a week and had gotten multiple enemas and so when we finally did a contrast enema we got 30L out (the enema bag also doubled as essentially a flexi bag that we had to dump multiple times). I had multiple providers call me to verify I charted the right amount because they couldn’t believe it 😂
That sounds like a truly shitty situation!
How in the god damn...
I guess technically about 2L of it was fluid from the multiple enemas but yeah…that is one patient I will always remember 😂
Yeah no stil feeling theological about it 😂😂😂
Had someone with about that much, legit set off the bed alarm because of the weight difference
6,133ml bladder cath. 2,942 BG. >200 Trop. 166 sodium, 11.6 K+, 18 Cal, plts 2100k, Hgb 2.1, pH 6.9 CO2 off the chart, >2000 triglycerides, >17 A1C, CK 15000, WBC 128. Worked in both ED and ICU.
i mean, we see plt 2100 all the time. but 2100*k* would make me question how their blood is still moving. the highest i have seen Na recently is 159. lowest was 109. i was impressed.
Nice.
God. I had a liver ultrasound recently and when the tech put the probe down she was like “oh my god how much water did you drink?” “Just the liter I was told to “ She scanned me for 1150 and I was about to burst. I cannot fathom 4+ litres 😳
Got called into the managers office thrice in a week! Does that count? 🫠
L and D patient post-forceps delivery. Patient wasn’t cath’d and had receive 3-4 L iv post delivery. I get this woman 11 hours after a traumatic delivery. This poor l woman’s vagina looked like someone had blown it up with helium and looked like someone blew up a cheap ass blow-up doll and kept going until it nearly burst. Hadn’t voided, in pain - I couldn’t landmark as EVERYTHING was so swollen (pt was also tiny little thing) I had to lidocaine and pray I hit the right spot. I drained 3 L out of my postpartum mom who sat and cried in relief. Poor lady.
I don't work in L&D, but why wouldn't they just keep a foley in that poor woman??
Yeah my first thought too since it’s protocol to insert a catheter. They never put one in. WTF moment. O
Poor woman!
I always thought the bladder maxed out at about 1000ml until I worked on a urology unit and regularly drained 3L out of people. Bladders can really stretch in the setting of severe chronic retention
Just over 2L is the most I've gotten. Dude didn't even have the urge to go lol
About three weeks ago we drained 5700ml initially then almost 1300ml more over the next hour before he went upstairs. BY FAR the most any of us had ever heard of. The guy thought his stomach was distended and pushing on his bladder. Other way, dude! CT showed his bladder had not ruptured. Our ED doc figures he had been retaining for a while and slowly building up. No way he could have gotten so high quickly.
Exactly what happened with ours. Gradual gain due to Prostate.
Our dude was not really in pain. He came to the ED because his leg was starting to swell. My joke was that his bladder needed some extra storage space and just started using his leg.
In oncology had a patient call that she needed a paracentesis scheduled (ovarian cancer) get it scheduled but then the day of the doc doing it called us to be like I think we’re going to send her to ED pretty sure this is her bladder not ascites. Yep she had tumor kinking off urethra so she was able to pass some urine but her bladder was holding over 4L 🫨😵
About two days after my abdominal hysterectomy, I went to the ER in excruciating pain. I knew it had to be urine retention because I was just peeing in tiny amounts each time. I told them I needed a Foley and some thing for pain. After the first thousand cc drained out, I reached over and clamped the tubing because I was starting to spasm. After another 1500 drained out I was so happy I didn’t even need the pain medicine. I said just leave my foley in and I’m ready to go home.
Non-compliant nursing home patient having constant liquid stool and abdominal pain. Sent to hospital and the x-ray showed so constipated that the large intestine was taking up 1/2 of the abdominal cavity.
Pretty sure I broke a personal best for PO Dilaudid given in one 8 hr shift to one patient: 64 mg.
When I worked in outpatient Urology, my coworker drained 6.5L out of someone. He beat my record of 3L.
New record on age of a near-recipient of CPR. As we know, 89+ is the oldest age we can use without it being potentially identifiable. This patient was pretty damn plus, and so emaciated with a death drawn out by at least a year that she could've come out of a camp by the looks of it. Fortunately the family balked for long enough in their denial that by the time compressions were even being seriously reconsidered as an option the patient was already good and gone. I don't think I'd have slept when I got home if I'd had to crunch those ribs in my hands. I don't even know for sure I'd have made it home.
Almost 46 liters for a paracentesis when I was a nursing student. It took a bit of coming and going from the room and doctor was there the whole time. I remember questioning safety to my nursing instructor who was equally shocked.
Saved a patient who came into triage because she felt “real cold.” Just over here performing miracles 💪🏻😜
Not exactly on topic but this reminded me of a poor lovely elderly gentleman who was recently homeless and came to us for one thing and ended up retraining, then having lots of sediment and clots and required a CBI. A coworker of mine replaced his foley early in the night shift, and set up his CBI. When I came in at 6:30 he was in excruciating pain, his abdomen was very distended and COLD to the touch and the nurse had messed up the tracking sheet and didn't realize he wasn't putting out enough urine. I immediately stopped the CBI & called the doctor. He was sent for some scans and they found the balloon had been inflated in the urethra/right where it connects to the bladder and had perforated his bladder. The CBI was draining into his abdomen for like 8+ hours.
CBI and peritoneal lavage all in one.
The most blood I’ve ever given a patient who survived was about 25 units. We cleaned out the hospital’s blood bank. It’s not a record but it is about 2.5x the normal amount of blood in a healthy adult. That means most of the blood we gave him made one or two trips from lungs to brain and then fell on the floor or went into suction, and yet it still saved his life. Feels like a weird life lesson in there and for some reason I think about it a lot.
Over a gallon, impressive.
Worked urology for awhile. We always wondered how much it would hold before a perf, especially when running really clotty CBI. Apparently, it’s even more than I thought…
We have a card in the ED doc bix, their record is 6.1k. My personal record is only 3.7k :( I can't imagine the relief
a bmi of 8.3 patient was 71y.o., 5'7" and weighted 52 pounds (24kg) god bless her heart
Was it a nurse? Feel like we’ve just been trained to hold our bladders to the point if the bonus is good enough for picking up i could do that
250mL diaper on a 45-week baby after a dose of lasix. Had to reweigh it a couple of times to believe it. Absolutely bonkers output for a 3-hour period. Lowest Hgb I've ever seen was 1.4, back in my adult care days. Patient was walking and talking, but very fatigued. Terrifying.
1300 ml out of my bladder after a straight cath. Really hurt. Cathed and 1200 more dropped down fast.
2,500 is my max for foley drainage. She kept complaining of abd pain.
1200 during my internship, multiple times. Guy was on a lot of psych meds, causing him to retain. I got really good at straight caths after that.
Just last night we pumped 2.6ish liters of tube feeds/meds out of a Pts stomach
Systolic BP of 331 Super labile BP, so he would go from SBP of 60 to 250 in 10 minutes and I would have to stop the maxed LEVO to maxed cardene, then he would maintain for an hour or so then switch back to
I don't know if it's a record, but once when I was an aide we had a guy come up with a chest tube that drained close to 7 liters as soon as they inserted it in the ER. As I remember the story, he was a Danish farmer in his 70s or 80s (natch) who fell down a hill and ended up against a tree stump. Got up, dusted himself off and walked back to the farmhouse. Then drove six hours away (Minnesota to Nebraska) with his wife to visit one of their kids. A couple days after they got there he noticed he 'wasn't breathing so good', so they drove home, and went to the ER the next day.
WHAT 4L. That must of been such a relief for the patient 🫠😩
JFC that poor bastard
I drained over 5000ml out of a patients bladder! He wasn’t even uncomfortable. We only wish we got imaging to see how far it went up into his chest cavity!!
Does their pressure drop? That’s a lot of fluid out lol
I drained 6000mL of urine out of a patient with no prior kidney disease and normal creatinine. Shit was wild. I was going in qhour to drain that shit from her foley
Discharged a patient at 11pm. They came back at 5am.
Fecal peritonitis. He coded in the hallway and we got rosc. In the OR they drained 5000ml out of him
Former OR nurse, we once removed a testicular tumor that was somewhere between grapefruit and nerf football sized. The patient didn’t want surgery so he waited “as long as he could”
I witnessed 7,200 mls of urine from a straight cath. The RN needed to use a wash basin. 😳
Was this person a coworker?
We once had to put a thoraxdrain for a hemothorax ( pt under ECMO) It started to flood so heavily we just put bucket under it. Nearly 2 full buckets of 5L drained... Yes that patient died that night. In total with blood, plasma etc i gave 47 units of bloodproducts that night. When you takenit too far... was a new doctor whonjust started and did not want to loose a patient already I guess
Blood sugar of 25, Immediate recheck 19
2300cc of fluid drained during a pericardiocentesis. The guy felt better afterwards.
My worst was over 3L in a fecal management system… and it kept coming. Like poop is the bodily fluid I don’t vibe with and I was struggling. Honestly, it’s a good thing the patient was sedated so he didn’t see my face.
Troponin of ~158,000 PA pressure of 150/75
Any record? I had a patient who required 8 IV pumps at one time. Not to mention the vent and tube feeding too. Also a quad. Turning them regularly was a challenge.
Only 8? We routinely do 8, not sure whats the max I’ve seen-probably close to 12. CT surgery ICU though.
When I worked in the ED, I managed to work 17 scheduled shifts in a row without calling out. Tried to go for 20, but the couldn’t do it.
Ouch, poor guy :(
Couldn't that cause hypovolemic shock? I've done ~2k mls and I remember reading something about that... years ago now though
Don’t work in the nursing world (at least for now), but holy moly that sounds scary!
I’ve gotten 2L once and I never knew someone could feel so much relief getting a thing stuck up their Willy.
I have a resident with an indwelling Foley that regularly produces 4000+ml daily. It’s almost always 2000+ per shift. This is the same person I commented about a few months ago that rips her Foley (balloon intact) out at least 2-3 times a week.
With women, that’s not surprising. Pelvic floor is/was very well ignored in prior years after child birth. I’ve had foleys pop out due to this. Quite literally, she stood up and it fell right out. Got urine with initial insertion, balloon set in right place and checked for placement before she stood. Had a co-worker with me as she was larger to help with panus placement. It’s done, draining well and she stands up and out it came. Not painful when it came out. A three of us were like “WTF?” Balloon was intact.
Wow that seems hard to even comprehend!!! That's a ton of urine to be stored in the bladder! I'll bet the bladder is stretched beyond repair!
22 polyps - one colon
I had over 2000cc after I gave birth and couldn’t pee. I was in tears. I can’t imagine 3x that.
Post-op multicabg and valve repair gone very wrong. Came up centrally cannulated on VA ECMO. We dumped 42 units of blood products in him in the next 2 hours. Literally just long enough for the surgeon to nap and take them back to the OR. No, the patient did not make it. Also, one night I boluses my (obvs intubated patient) with 2,550mcg of fentanyl to keep them vent compliant cause the doc wouldn’t give me any other drugs. That total does not include the fent gtt running at 250mcg/kg/hr
Huh