D/C Foley when patient is sitting?

[htg722]

I am a student and have never removed a Foley until today. I needed guidance and was instructed and watched by my clinical instructor. The patient was elderly but sitting in chair just finishing his lunch. Under my clinical instructors instruction as she watched, she said it is fine to remove a foley when a patient is sitting up in a chair. My instructor is a hot mess so I think that we shouldn't have. However, the policy does say to remove while patient in bed. I am thinking no because my clinical instructor is a short cut person and always always in a hurry. A real hot mess. Thanks!

[oceangirl1234]

If the policy says to remove it while the patient is in bed, then that is what you should have done.

Also, sometimes people can be very tender and sore and removing the catheter can be uncomfortable. A bit inconsiderate to remove it while someone is enjoying their lunch...

[___Mimi__]

I have done this numerous times. I had the most patient shift his pelvis forward, get all tubing loose, and remove.

I did it this way per patient request/agreement. The gentleman did not want to get back in bed, so we improvised!

[marienm, RN, CCRN]

I'm not sure that it's medically contraindicated to remove a Foley while up in a chair, but it would make it harder to do perineal care afterward (which I always do because there's usually a bit of dribbling). I always put a towel between the pet's legs as a landing pad for the catheter, but I'd still want to wash them up afterwards (or let them do it). Maybe pitch this patient-centeted idea to your instructor next time?

[Nightmaren, BSN, RN]

This is the sort of thing that truly depends on your clinical instructor. I will say first off that clinical instructors are not always 100% reliable when it comes to policies and procedures -- they often are, but not always. At the hospital where I work, sometimes the clinical instructors really seem to be out of touch with proper skill procedure and advise questionable techniques to their students.

Now, as for your question, it truly depends on how willing your instructor is to throw you under the bus. In your case, I don't think it was that major of a mistake that you should be worried -- the most you probably have to fear is an unfavorable grade from the instructor. But I think you'll be fine. I have seen some cases however where a student violated privacy in a manner that was deemed "ok" by the instructor and had to get disciplined by the institution -- they were not allowed to complete clinicals at the hospital.

You've learned a valuable lesson as you will encounter situations like these as a nurse. Sometimes a doctor will ask you to do something and you have to respectfully decline and fill out an incident report. In the future, do not hesitate to say, "I'm sorry but I do not feel comfortable performing this procedure."

[YumCookies, BSN, RN]

I would've waited until the patient was back in bed for the above reasons.

[ilovebirds]

I've actually d/c'd a Foley when someone was sitting in a chair, but I would generally advise against it (especially if it is against policy!!!). It's a bit messier and more difficult to clean a pt in that position.

Also, if you can avoid it, please don't do stuff like that when someone is trying to enjoy their food.

[TessLJ]

I would have let him finish lunch first, then get back in the bed. Nursing instructors for the most part are amazing and know their stuff, but you do get the occasional squirrel.

[KelRN215, BSN, RN]

In peds, you remove it wherever you can get to the kid. If the kid is jumping on the bed, you may have to reach up and do it while they're doing that. I don't really see the issue. I've had patients with spina bifida who self insert Foleys at night and they remove them however they please in the morning. Many of these patients chronically straight cath and do that while sitting/into the toilet as well. I've had a Foley and my only focus when I woke up the morning after surgery was getting it out. I very well may have been sitting up when it was removed. I cared only that it was removed, not what position I was in.

[aprilmoss]

Oddly, I often remove them from the kids while standing. You're right, their primary concern is getting it out. I always have them lying down when I put them in.