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Olive View-UCLA Medical Center

TURP Syndrome

... and because

Questions?

References:

  • http://www.mayoclinic.com/health/prostate-gland-enlargement/DS00027
  • http://bja.oxfordjournals.org
  • http://surgery.about.com/od/aftersurgery/g/TURPSyndrome.htm
  • http://www.rph.wa.gov.au/anaesth/downloads/TURP_Titze.pdf

Pictures from Google

Treatment for prostate gland enlargement include medications, lifestyle changes and surgery.

…procedure of choice…

Transurethral Resection

of the Prostate

Because...

Prevention...

always better than cure

Operating Room Nursing Education

  • Limit duration of surgery
  • Watch for changes in patient’s behavior, vital signs
  • Select the correct irrigation
  • Communicate with the surgeon

Keep your eyes on the fluids

  • Be as accurate as possible – write it down
  • Monitor the bottle/bag height
  • Use the yard stick – measure it
  • Any height greater than 60 cm – time it (15 minutes max)
  • Report fluid balance in a timely manner

Prostate gland enlargement

is a common condition as men get older. Also called benign prostatic hyperplasia (BPH) and prostatic hypertrophy. Prostate gland enlargement can cause bothersome urinary symptoms. Untreated prostate gland enlargement can block the flow of urine out of the bladder and can cause bladder, urinary tract or kidney problems.

U

P

R

T

B. Rattler, November 2016

Transurethral resection of the prostate consists of removal of prostatic tissue by means of electro-cautery. The electro-cautery wire loop is positioned in the patient’s urethra through a special sheath. The surgical field is visualized through a scope. Irrigation solution is used to distend the bladder, clear the surgical site, and remove blood and resected tissue.

Limit height position

of irrigation

Measure it !

Keep track of fluid

Limit the height of the irrigation to a

maximum of 60 cm above

the surgical field in order to minimize hydrostatic pressure of the fluid

Treatments:

  • Start without delay
  • Inform surgeon immediately of a TURP syndrome and surgery should be completed as quickly as possible.
  • Send for lab values: electrolytes, blood gas analysis, hemoglobin and hematocrit, coagulation profile, glucose and ammonia level.

Nurse's Responsibility

Where did it all go?

  • Switch irrigation to warm normal saline for continuous bladder irrigation
  • Report lab results to MDs ASAP
  • Arrange for ICU bed

What can happen?

During a TURP-procedure 20 ml/min of irrigation solution is normally absorbed. This is a total of 1-1.5 liters for the average case.

Nursing Considerations:

Fluid Overload

Keep your eyes on the flow

Absorption of 3 to 4 liters of bladder irrigation leading to:

  • HYPERvolemia
  • HYPOnatrimia
  • HYPOthermia
  • HYPERammonemia

  • Must be non-conductive so that diathermy current is concentrated at the cutting point.
  • Irrigation fluid has to be non-hemolytic so that hemolysis does not occur if it enters the circulation.
  • Must have neutral visual density so that the surgeon’s view is not distorted.

Irrigation Solution:

Electrolytes Imbalance

TURP Syndrome

Water Intoxication due to excessive absorption of irrigant fluid.

Keep in mind:

Potential Complications:

  • Confusion to coma
  • Blurred vision to blindness
  • Pulmonary edema
  • Cyanosis, hypoxemia
  • Bradycardia or other arrythmias
  • Hypertention followed by hypotention
  • Heart failure

Intake & Output

  • Dilutional anemia
  • Hyperkelimia (hemolysis)
  • Coagulopathy, bleeding
  • High glycin and ammonia levels
  • The most common irrigants used are HYPOtonic solutions that absorption of water can occur.

And example of this is a Glycine 1.5% in Water

(239 mOsm/L)

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