Originally posted by Tory
We had a discussion at work tonight about the legal issues involved for RN's and UAP. I posted more specific details on this subject on the renal board. But, one of the things we were discussing is IF a PCT (who's done many in the past) inserts a foley into a pt (and works at a facility that provides training for this and it is part of their job description) ends up inflating balloon in the pt's urethra causing bleeding, etc., is the RN the one who is ultimately legally responsible for the PCT's error?
Some RN's said yes, others said no and the rest didn't know (with me among them).
Gee, I wonder why the PCT didn't wait for urine return, even a drop, as we have all been taught to do?
I have to say, though, that I don't always wait for urine return, especially if there are no risk factors (i.e., BPH, previous prostate surgery, adhesions from previous instrumentation or gonorrhea, etc.--) but I always insert the full syringe of KY directly into the urethra and then insert the Foley CLEAR TO THE HUB, inflate with the full 10 cc, not 5cc, of water, then pull the catheter back until it stops on its own (can't pull back any further.)
Usually the KY alone can impede urine flow for a while, so you won't get an immediate return--if you are concerned, though, you can flush the catheter with H2O or NS, which will quickly remove the KY "plug" and allow immediate urine return.
Are you absolutely certain that the balloon was inflated in the urethra, and that is what caused the bleeding?
This is why I ask: a couple of years ago, several experienced OR nurses, myself included , had immediate frank blood return despite atraumatic insertion of a Foley--it happened to us when we were using a pre-packaged Foley kit that we had just started stocking. I cannot remember the manufacturer--it may have been Bard--and I think it was a silicone foley, not a latex one, as I believe we had gone to all silicone foleys to simplify things (getting rid of latex.)
When it happened to me, I knew I was "in the right place, " but there just happened to be a urologist out by the scrub sink, so I had him come in, just to double check. He checked, and agreed it was in the right place--irrigated, it was fine; left it alone.
Shorytly after, and in quick succession, it happened to several other nurses. I think they sent the remaining Foley kits back.
I stopped working there soon after (travel assignment) but I do stay in touch with the nurses there, so could probably find out what Foley kit this was for sure, so that you could check and see if it was the one used in the incident you wrote about.
p.m. me if you need this info.
And yes, I do think, at least legally, the nurse would be held ultimately responsible, if indeed this was an act that caused any permanent harm and was not due to a problem with the product--since we generally are responsible for the actions of those under our supervision. What does it say about the PCT/RN relationship in the P&P for this institution and for that unit, as well as according to the state nursing law of the state involved?