Post-it Sunday 6/5/22- estimating urine output with a straight cath

This is a lighter side of the OR post. Some levity must be had.

The post-it reads ‘watching the urine pour out using a straight cath and the surgeon telling the room at large that the urine output was 200 when it was obviously at least 400, makes you realize they can’t do estimated blood loss either.’

First of all, the surgeon insisted on doing the straight cath. I guess we weren’t moving fast enough and they wanted to get the case started. This is rich coming from that surgeon.

The surgeon had trouble finding the meatus and asked for the spot to be redirected, which I did. When they put the straight cath, a stiffened catheter not meant to be anything other than a temporary outlet of the bladder, they had to had to switch sides of the bifurcated container from the prep kit. Each side holds about 400. They switched before the side was full, that’s true.

They pulled the catheter out of the bladder and coiled it neatly into the container. Looking to pass off the container, they announced to the room that the urine output was 200 cc.

The scrub tech and I looked at each other and laughed with our eyes.

Doc, if you think that filling the container that easily holds 800 cc half way on both sides equals 200 cc total your reasoning on estimated blood loss makes complete sense now.

Because it is consistently wrong.

There are memes about the surgeons inability to correctly estimate blood loss. The estimates are always woefully inadequate.

For example, a case can be an absolute blood bath; blood on everyone’s gown, blood on the drapes, blood on the towels that have been used to stem some of the bleeding, on the floor, on the sponges that were thrown off. Blood everywhere. And that surgeon will claim an EBL of 100 cc. There is 300 cc of blood in the suction.

No, doc, no.

The 300 cc in the suction, the blood decorating yourself, the scrub tech, and the drapes is probably more like 500 cc. And that is before I calculate the amount on the soaked sponges.

But it made us laugh when the surgeon said that what was obviously at least 400 cc was only 200 cc.

It is no wonder that the CRNA asks us what our estimate is.

And uses that one for the paperwork.

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