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| No. 10 | 
Feb 25, 2005, 01:25 PM
Originally Posted by SmilingBluEyes Well, that truly depends on the length of time and the overall density of the epidural Are yours very light that patients void on their own? Not ours. Ours are such that ladies can move their legs, but can't feel anything much else, including their bladder fullness/urge to void.
Having an indwelling cath is safer than multiple straight-cathing is as a practice (infection control concerns come to mind). And our patients can't pee voluntarily when they receive epidurals, so what would you suggest we do then? Cath them how many times til they deliver? That would increase chance of infection. Or do you suggest they only be cath'd on delivery? Bad move, also as there can be in excess of 500cc or more of urine in there---- I have emptied in excess of 1500 cc of urine during the labor/delivery of a patient with epidural anesthesia. That is way too much to "let go" til cath time. It's NOT good for the bladder, obviously.
As long as the bulb is emptied at pushing, what is the harm in having a foley in versus letting the bladder distend, or cath more than ONE time?
Probably part of it is that we do not do huge numbers of epidurals and they are not done early on in labor very often. I have never cathed a patient more than twice. I understand the rationale for having one but we are not into mechanized labor/birth at my place. None of our practitioners order routine foleys. Personally, I might choose to put in a foley if I have cathed my patient a couple of times and it seems as if we might be heading to the OR, but that's it.
other than that, we try to keep labor as "normal" as possible.
 | | Advertisement Sponsored Links | | | | No. 11 |
Feb 25, 2005, 01:29 PM
Well our epidural rates are through the roof, and therefore foleys are warranted and used often. I guess it's a difference of frequency and timing. If our epidural rates were lower and they were done later in labor, I would not place a foley either.
| | No. 12 |
Feb 25, 2005, 01:38 PM
Originally Posted by SmilingBluEyes Well our epidural rates are through the roof, and therefore foleys are warranted and used often. I guess it's a difference of frequency and timing. If our epidural rates were lower and they were done later in labor, I would not place a foley either.
Why would you have an epidural if you were NOT in active labor? We try NOT to place epidurals until we have seen good cervical change, but it isn't always the case, of course.
| | No. 13 |
Feb 25, 2005, 03:04 PM
Updated
Feb 25, 2005 at 03:15 PM by SmilingBluEyes
Sigh, where did I say we do epidurals on NON-active labor patients? Labor can be quite protracted, as you know, especially in inductions and primip cases.
So sue me or shoot me; I can't see straight-cathing people over and over after hours of labor when a foley will do the trick with less chance of infection and trauma of repeated instrumentation of the urethra.
Differences exist in many places; let's just leave it at that--- In a perfect world we would all have it like where you are, no one getting epidurals til later in labor and rarely getting them at all at that! Even better, they would all give birth drug-free and interventions (like caths) would be virtually non-existant.
Sadly, I live a long way from "Perfect". So, yes, It varies, and where we work (which apparently differs from where you are) epidurals are very common (despite childbirth and lamaze classes), tending to run over hours, requiring bladder hygiene, simple as that.
That is the beauty of these threads; we get to learn from others what practices are common and what are not and compare notes. Does not make others "wrong" necessarily, but doing it differently, with the hopefully same good outcomes. Have good day now.  | | No. 14 |
Feb 25, 2005, 04:34 PM
Originally Posted by BETSRN Probably part of it is that we do not do huge numbers of epidurals and they are not done early on in labor very often. I have never cathed a patient more than twice. I understand the rationale for having one but we are not into mechanized labor/birth at my place. None of our practitioners order routine foleys. Personally, I might choose to put in a foley if I have cathed my patient a couple of times and it seems as if we might be heading to the OR, but that's it.
other than that, we try to keep labor as "normal" as possible.
ditto in my place of work. Our Infection Control officer actually states that is preferable from an IC standpoint to straight cath 2-3 times than leave an indwelling cath as that is a direct path for bacteria to migrate into the bladder. We always place Foleys in pts on Mag. I believe our guidelines state that if we need to straight cath more than twice (in labor or pp) than it is recommended to insert a Foley at that time.
In the rare cases where a patient not on Mag has a Foley in labor (such as a prolonged induction) the Foleys are pulled before pushing to avoid damage, although I think Deb's practice of leaving the deflated balloon in place is brilliant.
At any rate, we encourage all of our patients, epiduralized or not, to get up within 2 hours of birth to void and shower. It's rare that one of our patients does not "have her legs back" by then. Very few of our pts have trouble voiding post delivery too; if they can't "go" on the toilet many are able to pee in the shower- works even better than using a peri bottle!
| | No. 15 |
Feb 25, 2005, 04:54 PM
Originally Posted by SmilingBluEyes Answer is you can't prevent it falling out fully. Just make sure it's taped well to the leg, let it empty passively by attaching a 10cc syringe to it, (leaving the syringe in place), and hope it does not....fact is, 50% of the time, the foley falls out. So obviously, about 50% of the time it stays in. This makes it worth it to try.
If it stays in, we reinflate it. If not, it comes out, IV fluids are slowed, epidural turned off and voiding is urged within 2-3 hours after birth. It works fine where I work doing it this way. I RARELY have to do PP straight caths unless the labia are extremely edematous..
I am learning so much on this board! I am curious, SmilingBluEyes, if the patient doesn't push it out during pushing, when do you routinely d/c the Foley? For us, we d/c the Foley on everyone at some point during the pushing phase, and everyone, epidural or not, is escorted to the bathroom at 2-2 1/2 hours post partum (unless there are complications). So I am just wondering how long your Foleys are left in. Thanks in advance!
| | No. 16 |
Feb 25, 2005, 05:11 PM
the foley's only remain until a patient can ambulate and take PO fluids.
usually this is less than 2-3 hours post-delivery, but if an epidural is particularly dense, it may be 4 or more hours. It depends on patient and the anesthesiologist's epidural. Some are more dense than others.
| | No. 17 |
Feb 25, 2005, 05:11 PM
Originally Posted by palesarah At any rate, we encourage all of our patients, epiduralized or not, to get up within 2 hours of birth to void and shower. It's rare that one of our patients does not "have her legs back" by then. Very few of our pts have trouble voiding post delivery too; if they can't "go" on the toilet many are able to pee in the shower- works even better than using a peri bottle!
same here. early ambulation is ALWAYS encouraged where we work, as is showering when the patient can stand and walk on her own.
| | No. 18 |
Feb 25, 2005, 05:14 PM
Originally Posted by BETSRN Probably part of it is that we do not do huge numbers of epidurals and they are not done early on in labor very often. I have never cathed a patient more than twice. I understand the rationale for having one but we are not into mechanized labor/birth at my place. None of our practitioners order routine foleys. Personally, I might choose to put in a foley if I have cathed my patient a couple of times and it seems as if we might be heading to the OR, but that's it.
other than that, we try to keep labor as "normal" as possible.
We do lots of epidurals and NO foleys. We get them up before epidural placement to void and then if need be, straight cath.
Come to think of it I cannot remember ever placing a foley for a laboring woman.
Deb is right . . . . this is a manifestation of the regional differences, nothing more. As an example, I use phenergan all the time IV and have never had it cause pain or phlebitis.
steph
| | No. 19 |
Feb 25, 2005, 05:15 PM
touche steph. I kinda wondered when you would be bringing that up.
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