Long term foley use

  1. 0
    How long have you seen a foley stay in a patient? I know they aren't meant for long term use, but in a dying patient it is there for comfort reasons and skin breakdown issues.

    He has had the foley for 5 months and now is on continuous antibiotics. Problem is, now he is having bladder spasms more frequently. We just initiated B&O suppositories yesterday. Tried pyridium, ditropan, and antibiotics.

    We may have to take out the foley to make him more comfortable??? Is there anything else I can do besides remove the foley?
  2. Get the Hottest Nursing Topics Straight to Your Inbox!

  3. 7,320 Views
    Find Similar Topics
  4. 19 Comments so far...

  5. 3
    I've seen pts w/foleys for years and years and years. Seriously. Without major complications. Some needed to have the foley changed q2weeks to prevent infections.
    Good hygiene is a must - it is imperative!

    You don't mention what the dx is and whether or not it may play a role in the complications.

    Be certain that the caregivers are taught about keeping the bag below the level of the bladder, how to empty the tubing, and good hygiene.

    Best wishes!
    GrnTea, loriangel14, and Altra like this.
  6. 3
    When I was a CNA in LTC there was a patient (morbidly obese, no bed mobility, major skin breakdown) who had a foley for several years. I don't know the exact number of years. Foley was changed monthly and the bag weekly. She eventually ha need request issues with infection and leaking around the foley and had a supra pubic inserted.

    Would a condom catheter be an option for this patient? Perhaps just frequent changing and a good skin barrier cream. Is his prognosis good enough that he would benefit from a supra pubic? It might help to remove the catheter for a week or two and then reinsert.

    As you mentioned, foleys in dying patients are for comfort. It doesn't sound like this catheter is giving him comfort anymore, in fact it's the opposite. So it sounds like its time to consider pulling it.
    maelstrom143, GrnTea, and michelle126 like this.
  7. 0
    Quote from Ashley, PICU RN
    When I was a CNA in LTC there was a patient (morbidly obese, no bed mobility, major skin breakdown) who had a foley for several years. I don't know the exact number of years. Foley was changed monthly and the bag weekly. She eventually ha need request issues with infection and leaking around the foley and had a supra pubic inserted.

    Would a condom catheter be an option for this patient? Perhaps just frequent changing and a good skin barrier cream. Is his prognosis good enough that he would benefit from a supra pubic? It might help to remove the catheter for a week or two and then reinsert.

    As you mentioned, foleys in dying patients are for comfort. It doesn't sound like this catheter is giving him comfort anymore, in fact it's the opposite. So it sounds like its time to consider pulling it.
    You still get bladder spams and infections with a supra pubic , also the supra pubic hurt after they are put in for weeks and there is a LOT of pain where changeing them I am in tears when my is done
  8. 2
    Check to see if the foley is the correct size and that the balloon is not overinflated. This can cause spasms, very few patients actually need the balloon to be inflated with more than 10 to 15 cc. and unless the patient is prone to passing blood clots (i.e. ES Bladder CA) the smaller the foley the better. Also suggest using Levsin for spasms, it is often helpful when other meds quit working.
    GrnTea and michelle126 like this.
  9. 0
    The foley must be changed monthly. Bags can be cleaned with vinegar/water or diluted bleach solution. Sadly, every patient I have had with a long term foley has had issues with UTI's most of them resistant to conventional antibiotic. Many ended up with suprapubic catheters which are worse in some ways when it comes to infections.
  10. 0
    You could take it out and see if it helps. Suprapubic catheter is not necessary if he is dying. Sometimes irrigating the catheter can help-if there is blood or sediment that is clogging it then it may be the cause the of the spasms. Also Lasix can cause bladder spasms. Hope you find a way to get your patient some peace.
  11. 0
    Foley's can stay in years. Also, evidence-based research now recommends NO routine catheter changes. Weird to get my mind around that one but my friend just did her ARNP thesis on long-term cath mgmt and they state to leave the same cath in indefinitely and only change if occluded or when you need to get a UA. Also recommending NO flushing. Apparently changing the cath is a better option if occluded then flushing. Crazy. But FYI - cath placement for comfort in dying patient is totally legit reason for cath. But you have to weight the comfort of cath vs bladder spasms.
  12. 0
    I agree.changing a catheter every month is not necessary and only serves to expose the patient to a higher risk of infection. After 5 months of a catheter, the poor man's bladder won't be working all that well. Take it out and make sure he can void without it.
  13. 0
    Quote from Northwest_Jenn
    Foley's can stay in years. Also, evidence-based research now recommends NO routine catheter changes. Weird to get my mind around that one but my friend just did her ARNP thesis on long-term cath mgmt and they state to leave the same cath in indefinitely and only change if occluded or when you need to get a UA. Also recommending NO flushing. Apparently changing the cath is a better option if occluded then flushing. Crazy. But FYI - cath placement for comfort in dying patient is totally legit reason for cath. But you have to weight the comfort of cath vs bladder spasms.
    This flies in the face of every text that I know of. I would love it if you could post a link to this evidence-based study.

    Thanks


Top