Lasix and Foley for female patients..automatic ?

Specialties Emergency

Published

We had a busy, but not crazy day in the ED on NY. I had two ladies who were in CHF and were given IV lasix in the ER. Both of these ladies were semi-mobile, but needed a bit of assist in getting up to the bedside commode. Needless to say, they kept me running for the few hours they were held in the ED (we had no tech on duty).

I heard a bit of grumbling from one nurse that I should just put in a foley for these patients. I tend to think it is an unnecessary introduction of a potential infection source and can prolong hospital stay for patients who are mobile enough to get up and go to the bathroom with minimal assist. I despise nurses who get the foley order simply for their own convenience on lasix cases like this.

So what are your opinions ? Get a convenience foley or dig in and be prepared to be helping these patients in and out of bed and be busy ?

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Foley's for the sake of convenience is frowned upon. If the patient can't get up, has no ability to control urine and is at risk of skin breakdown, then a Foley is in order.

Overuse of Foley's causes an increased risk of infection, even with short term use. Yes, it is a pain to try to get someone up frequently. Men have it a lot easier because even if they have limited mobility they can usually use a urinal. Unfortunately women have no good noninvasive alternative.

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Convenience foleys are a common problem. They are a source of infection and uncomfortable to some patients. It is a non-indicated procedure that should be avoided.

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Specializes in Inpatient Acute Rehab.

A foley is for the benefit and treatment of the patient. It is not for the benefit and convenience of the nurse.

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Specializes in Psych, M/S, Ortho, Float..

I hear you guys on the not putting in a foley for the convenience of the nurse.

Having worked Ortho for 6 years, however, I never understood why they didn't put a foley into our elderly hip replacment patients. They would come up to the floor with the order to insert a foley, but they wouldn't do it when the patient was still under anesthesia in the OR. So one of the first things we had to do was get it in so that in their post-op confusion, they wouldn't try to climb over the bedrails to get up to the bathroom. Some new nurses didn't want to have to hurt the patient putting in a foley, so they would put it off, but this would put these LOL at a huge risk. One did fall on her new hip and it required a second trip to the OR. By the time I left, the OR was putting in the foleys before they started the surgery. I had mentioned to the surgeons that it would be much less invasive if it was done downstairs rather that waiting till they woke up and having to insert the foley on the floor. The foley would stay in for only 2 days. After that they had to get up to the bathroom. And it did take 3 staff 15 minutes to get them there, (sometimes at 3 in the morning we wanted to put the foley back in...) but up they got!!! By day 5 most patients could get there on their own. Foleys are good things when used appropriately.

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Specializes in Utilization Management.
Foleys are good things when used appropriately.

We get those CHF'ers from the ER, and I prefer to have a Foley in. This is not for MY convenience, but because that patient's breathing is already compromised, and believe me, there's not a LOL in the world who won't get OOB to the bedside commode, even if it means dropping her sats to zero to do it!

So much better for that patient to rest up and BREATHE than to be watching the patient struggle for air all night.

The Foley can come out in a day or two and by then, the patient's CHF is pretty much resolved.

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Specializes in ER.
We get those CHF'ers from the ER, and I prefer to have a Foley in. This is not for MY convenience, but because that patient's breathing is already compromised, and believe me, there's not a LOL in the world who won't get OOB to the bedside commode, even if it means dropping her sats to zero to do it!

So much better for that patient to rest up and BREATHE than to be watching the patient struggle for air all night.

The Foley can come out in a day or two and by then, the patient's CHF is pretty much resolved.

I am in total agreement. Most of our LOLs prefer to have a foley for their OWN convenience, as it is extremely exhausting for them to be getting OOB or on a bedpan every five minutes for the next umpteen hours. Not only does it make the pt. more comfortable and able to rest, but it is a relief to the nursing staff. I always (if the pt. is mobile and not having too much difficulty breathing) give the pt. the choice, and there are always a few who prefer not to, and that's perfectly fine by me. I know if I were in their position, I would prefer to have a foley, because it's no fun getting up to pee every five minutes, and a lot of them have limited bladder control to begin with. Just my $0.02

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I'm prone to put the foley in for a few reasons. When it is a very busy day and there is not a good gaurentee that someone will be "johnny on the spot" when the patient has got to go, the foley saves a potential fall from trying to get to the bedside commode. Secondly, if the patient is in a lot of respiratory distress as angie O'plasty notes, getting them up and down to BSC is not always the easiest thing, and not always beneficial for the patient. So, while the foley is beneficial for the Nurse, it is also beneficial for the patient, as they won't fall, or soak themselves trying toget out of bed. I'd feel pretty stupid if a CHF patient sufferred a hip fracture because I couldn;t get to them on time (Say I'm giving Cardiezem in the next room and the aide is off the floor transporting, etc).

The other very simple reason to use a foley with a CHF'er is to get an accurate idea of how mucht he patient actually is putting out. Yes, the stuff can be measured, but often someone (Family member) dumps it without measuring or telling, and then we are left with the patient saying, "Well I went 4 times..." This happens to me even after I repeatedly educate family and patient not to do this....

Thing is, I have seen mostly horrible technique for putting foleys in women.So, I'm dead set now about doing my own foley's....rather than delegating it.

People who don't clean appropriately, nurses who let go of the labia after cleaning and then open it up again to insert the foley, forget sterile technique entirely...

It isn't that hard to put a foley in properly, but I'd bet most of the time they aren't.

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Specializes in Occ health, Med/surg, ER.

OK, I have a question for you all. I had a patient who is completely immobile due to multiple sclerosis, has a g-tube. She leaks urine constantly. During my clinical rotation I changed the lady every hour (it seemed like) and it smelled so strong and she was soaked everytime. She is immobile, so she is at risk for breakdown. She did not have any decubs; the staff was really careful about keeping her dry and turned. They didnt want to put a foley because of infection. So, if they dont want to put a foley in her, who would they put a foley in due to immobility?

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Needless to say, they kept me running for the few hours they were held in the ED (we had no tech on duty).

What does having a tech on duty have to do with anything?

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Needless to say, they kept me running for the few hours they were held in the ED (we had no tech on duty).

What does having a tech on duty have to do with anything?

\

When a tech is on duty, they can at least help out with getting patients in and out of bed, eh ?

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All our ortho hip patients come back to the floor with a foley - it is placed in surgery.

I've never heard of waiting until after and trying to pry legs apart with a new hip. Crazy! :confused:

steph

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