Catheter Came out. Should I reinsert it?

Nurses General Nursing

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I was working overnight in a retirement home and it was reported to me that a patient had pulled out their catheter. When I went to assess them I noted that they had no output in the catheter bag and their urethra was bleeding. I drained the balloon to help relieve pressure, but I didn't take the catheter out because I was scared of causing more damage. I wanted to reinsert a new catheter but I wasn't sure if I was going to cause harm to the patient, so I decided to send them to the hospital. Please help, I'm not sure if I made the right choice, I know it's better that I was overly cautious by sending them, but I never like to send people to the hospital unless it is absolutely necessary. I didn't feel comfortable reinserting it but I had to do something. Did I make the right choice?!

I think the loop hole for LTC although is that is says RNs and Physicians must provide on-call coverage, it does not say however that a physician has to be on call as opposed to and RN. At night in LTC where I work an RN is always on call, but the physician is only on call during the day

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Specializes in Emergency, Telemetry, Transplant.
Retirement homes in ontario are licensed under the Retirement homes act, they are separate and are not funded by the government. So it is licensed just not under and LTC regulations.

I know nothing of the regulations in Canada/Ontario. However, I would have to believe there is some physician guiding the patients'/residents' care. Even if it is not an on call physician for this facility, there has to be an on call physician for the pt's PCP. If you are giving meds, managing Foleys, etc., then there should be a provider directing the treatment. Right? I honestly don't know, so correct me if I am wrong. But if this resident does have a person in charge of his/her care, I would think this is the person who should be called.

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You need to be in a more supportive place.

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Of course they have a doctor, but the doctor only comes once a week and if it is not urgent, I usually leave a note for the doctor to assess them when they come in. Sorry what does PCP stand for? And the doctor is not on call, so if somethings happens it is often based solely on my judgement. (which can be a lot of pressure) The only person I can call for advice (which doesn't mean they can order me to re insert the catheter, or order medications) is my boss who is a nurse as well, and they often don't answer the phone.

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agreed

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Specializes in Pediatric Critical Care.
Of course they have a doctor, but the doctor only comes once a week and if it is not urgent, I usually leave a note for the doctor to assess them when they come in. Sorry what does PCP stand for? And the doctor is not on call, so if somethings happens it is often based solely on my judgement. (which can be a lot of pressure) The only person I can call for advice (which doesn't mean they can order me to re insert the catheter, or order medications) is my boss who is a nurse as well, and they often don't answer the phone.

PCP = primary care provider. The person you go to for well-person checkups, annual exams, as well as when you are sick (and refer you to a specialist if needed).

It sounds like where you were is more like what would be called an "assisted living" home here in the U.S.

If there is no on-call doctor for your facility, I wonder if you could call that resident's PCP. Or does this one doctor act as everyone's PCP?

Regardless, it doesn't seem right that you don't have a clear way to escalate concerns without calling 911 (I guess it wouldn't be "911" in Canada, would it? Well, calling an ambulance to take him to the hospital.)

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Specializes in Travel, Home Health, Med-Surg.
I think the loop hole for LTC although is that is says RNs and Physicians must provide on-call coverage, it does not say however that a physician has to be on call as opposed to and RN. At night in LTC where I work an RN is always on call, but the physician is only on call during the day

Yes, it looks like the MD agrees to the Home's policies which could mean anything the Home wants it to be, not necessarily on call 24/7.

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Specializes in Travel, Home Health, Med-Surg.
Of course they have a doctor, but the doctor only comes once a week and if it is not urgent, I usually leave a note for the doctor to assess them when they come in. Sorry what does PCP stand for? And the doctor is not on call, so if somethings happens it is often based solely on my judgement. (which can be a lot of pressure) The only person I can call for advice (which doesn't mean they can order me to re insert the catheter, or order medications) is my boss who is a nurse as well, and they often don't answer the phone.

Is your boss (RN) supposed to be on call and doesn't answer? If so I would want to know why and start documenting these issues as well, not sure if you are easily sued there but still CYA.

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The doctor at the facility acts as the PCP, so still I don't have anyone to call, and in Canada it is 911.

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We are definitely not the experts on your situation/laws/loopholes, but fergsu22 I have to say that assuming your understanding is accurate, it is not a situation I would want to be involved in as an RN. As a lay person or unlicensed care worker, maybe, but not with a license that can be taken away.

I guess my final encouragement would be this: I personally would lay eyes on whatever regulations do apply to your work situations(s). That's what I'd do. Again, not disbelieving you here, but it's not uncommon for employers to tell nurses a lot of things, nor for them to put their own twist on things. Muno and I have posted links to LTCHA information, which yes, does appear to say that a nurse (advanced nurse?) can be on call. The kicker being, of course, that they must be on call (answer after-hours calls). As to your other work situation in which this incident arose - I can only encourage making sure your understanding of the applicable laws/regulations is correct. Someone ordered that foley and there is some route through which you are carrying out all your other orders. Maybe those are medical director approved protocols or the like, but it is never wrong to verify.

Best to you! :up:

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Specializes in Pediatrics Retired.

I love pediatrics...:woot:

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You did the right thing in that situation. You tired calling the on-call boss and they didn't answer. The resident's output was low and there was some bleeding/trauma. Instead of risking further trauma you sent them to the hospital to get checked out. No one can fault you in being too careful. I would probably have done the same in your situation. I do find it however, surprising that you do not have an on call doctor. At the nursing home where I work I am sometimes the only RN in the building on nights but I do have two RPNs. But we have a schedule in our med room of on-call doctors, when they are on call and the number to reach them at. Don't beat yourself over not reinserting a catheter.

Also by sending them to the hospital they might figure out/have figured out why the resident's output was low and corrected it.

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