Foley in patient with undiagnosed urinary crystals

[notanumber]

Advice needed, because I'd rather not shred a woman's urethra again unless super-duper necessary. D/C'd a cath on a LTC resident (MRP left it up to her to decide if/when she wanted it out at approx 3 weeks post-insertion) which resulted in a lot of pain and urethral bleeding. Foley tip heavily crystalized on inspection - like tiny razor blades. Fortunately bleeding stopped on its own and MRP ordered abx. Now res is retaining again, and we have another order to insert foley if it continues 12hrs post I&O cath - little more than one week after the incident. No urinalysis, C&S, any other workup was ordered to investigate the underlying cause of said crystals. Comfort-care, yes, but res still wants treatment in-house and repeating this incident is not exactly in line with our ethos or the idea of 'comfort'. Am I correct in being concerned regarding the lack of follow-up? How would you approach the MRP after already asking for further investigation the first time and being ignored?

- Concerned LPN is Concerned

[Here.I.Stand, BSN, RN]

I've actually never seen that before; did she have pain as the urine was crystallizing, or only when the foley was removed? Urinary retention isn't comfortable either, nor is repeated straight cath'ing. So I can see how a foley could be the most comfortable action. I would think a urology consult is in order.

[NurseSpeedy, ADN, LPN, RN]

I second the urology consult. I've removed many Foley catheters that were left in long term when a patient was sent the the hospital that I worked at with UTIs (we are going back a long time when Foley catheters were actually common outside of ICU). I have never seen this either. Gross, mucousy junk around the cath, yes, but never hard crystallized stuff.

[notanumber]

First I'd ever seen it too; pain only during removal. Fortunately we've dodged the foley for now, not sure how long that will last though. I'll ask for a urology consult but doubt it will be seriously considered. LTC + comfort care orders = not a priority for most physicians. I was hopeful the foley would be an ideal comfort measure for the resident (bed-bound, incont, chronic pain), but it hasn't turned out that way unfortunately.

[amoLucia]

Am curious as to how long that foley had been in place. I've seen heavy crystallization & crusting when the cath was in for a while. That's why we used to have those old orders to change re-cath monthly.

[notanumber]

Am curious as to how long that foley had been in place. I've seen heavy crystallization & crusting when the cath was in for a while. That's why we used to have those old orders to change re-cath monthly.

About 3 weeks.