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Do you need a doctors order for this?

Posted

Do you need a doctors order to change a foley catheter? This is a LTC facility. Lets say the foley is clogged after irrigating it per physician's orders. Ive heard yes and no. Thank you

The answer is found in your facility's policy manual. You might, or you might not. But you need to look to your own facility to know what you can do there. You've heard both yes and no because it varies from place to place, and situation to situation.

I've seen it happen that a nurse removes a foley to change it, only to NOT be able to get it back in (prostate issues, etc). NOT a happy urologist who gets called in the wee hours to come in for that.

Just know what your workplace allows, AND what the hx of this patient is.

Silverdragon102, BSN

Specializes in Medical and general practice now LTC. Has 33 years experience.

Depends on the policy of the facility.

Also depends on the orders in place for a particular individual.

Karou

Specializes in Med-Surg. Has 1 years experience.

Agree with other posters that it depends on your facilities policy. Some LTC facilities have orders to replace foleys monthly or on a schedule. So maybe you have a policy on changing them on a PRN basis.

When in doubt, call the doctor. I second another poster that I would be worried that were you to take it out without an order, then be unable to replace it, you could be in a very sticky situation.

If urology placed it yes. If nurse placed no, catheters must be changed every 30 days for infection control

Been there,done that, ASN, RN

Has 33 years experience.

The answer is found in your facility's policy manual. You might, or you might not. But you need to look to your own facility to know what you can do there. You've heard both yes and no because it varies from place to place, and situation to situation.

I've seen it happen that a nurse removes a foley to change it, only to NOT be able to get it back in (prostate issues, etc). NOT a happy urologist who gets called in the wee hours to come in for that.

Just know what your workplace allows, AND what the hx of this patient is.

Oh well, we can't go around having unhappy urologists.:rolleyes:

In the case of a Foley not draining, it is a medical emergency. Treat the problem not the doctor.

Oh well, we can't go around having unhappy urologists.:rolleyes:

In the case of a Foley not draining, it is a medical emergency. Treat the problem not the doctor.

Obviously! I never suggested otherwise. But if a foley is in place that can only be replaced BY the urologist, it just might change how one approaches the situation.

The OP asked a policy question, so....given the response to check her policy.

Been there,done that, ASN, RN

Has 33 years experience.

Obviously! I never suggested otherwise. But if a foley is in place that can only be replaced BY the urologist, it just might change how one approaches the situation.

The OP asked a policy question, so....given the response to check her policy.

I hear what you are saying. In this case , there is no time no check policy. The patient's condition needs immediate action. Urology and policy be damned.

As professionals, we must make this kind of call every day.That is what makes us accountable in the nursing profession.

Yes you do need an order. The only question is do you have a standing order that you can implement in place by the policy of your facility or do you have to call and get an order.

Take the time to look over the facility policies where you work. Not knowing if you have an order and doing something, no matter how well intentioned, is fine and dandy right up to the point that something goes wrong and you have practiced outside of the legal scope and you get fired and reported to the board of nursing.

ChristineN, BSN, RN

Specializes in Pediatric/Adolescent, Med-Surg.

I work in the hospital setting where we do have protocols about replacing the foley. That being said, there has been more emphasis on getting a physician's order. With hospital acquired UTI's being something we don't get reimbursement for from Medicare, it is good to have an order just so if something happens, pt gets a UTI, at least you are covered

tyvin, BSN, RN

Specializes in Hospice / Psych / RNAC.

I haven't met a foley I couldn't change except in one case. Older very thin man at a SNF with indwelling foley supposedly resting in his room; I was the charge and the RN came and told me she was going to change the guys foley per order...OK. Over 30 minutes later the RN comes strolling down the hall swinging the foley like a flag, complete with tubing which was filled with a beautiful shade of FRANK BLOOD!

As she yells down the hallway "I can't get it in him, I tried several times; it keeps rolling" ... OMG; I'm surrounded by morons! I exit stage left and as I stand at the bedside of the man I found him sweating profusely with an extended abd (looked about a good 5 months if you know what I mean) and when I looked straight into his eyes they told me with a desperate plea I swear I could hear; "pleeeeease help" (and keep that nurse away from me).

Without hesitation I called 911 stat.

One hour later I called the ER to check on him and the nurse giving me report was giving me razz about how the nurses at the SNF couldn't change a foley. Found out later from a friend in the ER that the nurses at the ER couldn't do it either, that a doc finally came in and showed the nurses how to put a coude catheter in him.

Of course we all know why the doc decided on a coude...When the, hmmm, RN was trying to put in the foley, she said it rolled. The rolling indicates prostrate concerns and the coude is a special foley that is specific for that due to it's stiff nature. After that incident the facility ordered coudes to keep in stock. I've never seen a doc change a foley. Not saying there is a case where only a doc can do it; but I live on a small island ...:roflmao:

FYI, I may have had only a few years of experience at the time this happened, but the RN who attempted to change the foley had 20 years in the field...I expected a little more from her.

I would say get an order unless you have an order that specifically covers you. Inserting a Foley is an invasive procedure, which usually requires some type of order (although this may vary from state to state, also LTC vs. acute setting.) CYA.

In the LTC facilities I have worked in, you need an order to even apply lotion... get an order for EVERYTHING.

Here is the bottom line...can you decide to insert a foley catheter as a portion of your nursing assessment and plan of care? Is a foley catheter a nursing intervention? Does the initiation of a foley require a medical order? Can the nurse decide to discontinue the foley independently?

While we may enjoy work environments with standing orders and relationships which allow us a reasonable amount of autonomy in these areas we are still not allowed to write medical orders without consulting a medical provider.

CapeCodMermaid, RN

Specializes in Gerontology, Med surg, Home Health. Has 30 years experience.

It is NOT necessary to change a catheter every 30 days. You're more likely to develop an infection if you change a catheter that is functioning well.

Karou

Specializes in Med-Surg. Has 1 years experience.

As she yells down the hallway "I can't get it in him, I tried several times; it keeps rolling" ... OMG; I'm surrounded by morons! I exit stage left and as I stand at the bedside of the man I found him sweating profusely with an extended abd (looked about a good 5 months if you know what I mean) and when I looked straight into his eyes they told me with a desperate plea I swear I could hear; "pleeeeease help" (and keep that nurse away from me).

Without hesitation I called 911 stat.

One hour later I called the ER to check on him and the nurse giving me report was giving me razz about how the nurses at the SNF couldn't change a foley. Found out later from a friend in the ER that the nurses at the ER couldn't do it either, that a doc finally came in and showed the nurses how to put a coude catheter in him.

Of course we all know why the doc decided on a coude...When the, hmmm, RN was trying to put in the foley, she said it rolled. The rolling indicates prostrate concerns and the coude is a special foley that is specific for that due to it's stiff nature. After that incident the facility ordered coudes to keep in stock. I've never seen a doc change a foley. Not saying there is a case where only a doc can do it; but I live on a small island ...:roflmao:

FYI, I may have had only a few years of experience at the time this happened, but the RN who attempted to change the foley had 20 years in the field...I expected a little more from her.

How long did he go without a foley? Why was he already distended? If she quickly removed and went to reinsert then he couldn't be distended that much from a few hours of retention.

I deal with a lot of urology patients, and have seen many that are difficult to catheterize. Like you describe, men with prostate problems can be tricky, including post TURP patients. I have seen women that locating their meatus is like finding a needle in a haystack! I've had women who had theirs below the vagina, next to it, or once a crazy fistula where the patient urinated feces. That wasn't a sterile insertion....Then there are the morbidly obese patients (500lb +) that take multiple staff members and flashlights.

Often when I receive an order to insert a foley I will have a discussion with the urologist over what size, type, ect... And what to try if that doesn't work. It is not common, but not unheard of, to have to grab the urology cart and the urologist has to come to the bedside to insert the foley. They do this in the ED if necessary and occasionally on my unit.

A coude is preferred for patients with prostate problems, but in some settings this must be specifically ordered by the physician. Had this patient been there for a while, and already had a coude? If so, why weren't there any in stock already? As an aside, Frank blood should always be investigated, but can be normal after a difficult insertion/attempt and monitored as long as the physician is aware.

Sounds like this guy was actually a really difficult insert if the ED nurses had trouble as well, and the doc had to do it. So perhaps your coworker wasn't as incompetent as you think.

CapeCodMermaid, RN

Specializes in Gerontology, Med surg, Home Health. Has 30 years experience.

We usually write discontinue orders: Remove foley catheter at 6am. Due to void in 8 hours. If no void, may reinsert foley #_____French with____cc balloon.

That way we don't have to call the doctor back. AND....we've had plenty of old guys who had to have a urologist place/replace a foley. Don't blame the nurse because you didn't have the right equipment or the guy's parts weren't exactly like everyone else's.