a dumb author question about Foley catheters..

[dumbquestion]

Please excuse the strange question from a non-medical person who slipped in here.. I'm putting this in humour because I hope this is at least kinda funny!

I'm working on a story where a character has a pelvic fracture, and no, it's not one of those weird medical fetish things, I promise! But I need to mention him getting a pelvic binder (which he gets prehospital) and a foley catheter. My research says that combination makes sense? It'll likely be in dialogue of a Dr ordering it and then it's just implied that this works out, or otherwise a short mention- so I don't need to describe the details. I could hand-wave it away entirely, not mention it at all. But now it's like this annoying brain gremlin I can't shake: I've been obsessively looking at pictures of these binder things, scratching my head, thinking "How- physically, logistically, spiritually, how?" Have I lost all understanding of male anatomy? Some of those binder things are wide! It's been driving me nuts for weeks and I can't just ask someone without sounding like a weirdo. 😅 Help!

And while we're here, feel free to hit me with your biggest pet-peeves when it comes to medical stuff in media, I'm trying not to sin too badly here.

Please forgive my transgression in joining under false pretences and delete if not permissible.

[Rose_Queen, BSN, MSN, RN]

Pelvic binders are an emergency device, and aren't intended for long term use. It's all about stopping bleeding until the patient can have a more definitive fixation, either an external fixation device (pins get drilled into the bones and attached to rods outside the body to hold the bones in place and can be done relatively quickly) or an open reduction/internal fixation surgery (plates and screws to put the bones back together, usually not done until around 72 hours after injury with the orthopedic surgeons I've worked with, and only after the patient has stabilized and other more life threatening injuries taken care of).

The pelvic binder should only be used during the resuscitative phase of care, which can be only until they reach the trauma center and OR or may be longer if they're too unstable to have the ex-fix placed. Depending on the patient's status, the binder may be opened long enough to perform an assessment - if you're badly injured enough to need a pelvic binder, you're very traumatically injured and need a full assessment to determine what are the life threatening injuries. Part of standard trauma care is placement of a foley in the trauma bay when warranted, although urology may be involved if there's a ruptured bladder. It takes a lot of force to fracture a pelvis and there are usually other injuries.

Pelvic ex fix:

Pelvic ORIF:

[dumbquestion]

Rose_Queen said:

Pelvic binders are an emergency device, and aren't intended for long term use. It's all about stopping bleeding until the patient can have a more definitive fixation,

 

Oh yes, he's had a fall from a great height...  gonna come to the hospital and get sent for imaging and surgery, which thankfully I can mostly "fade to black" for. These images are amazing though. So he's not gonna just hang out in a binder for very long, but my understanding was that even till OP, that'd still be kind of a long time to not be able to move (and therefore can't pee), plus they'd want to check if there's blood in the urine? (at least that was my thought). Are you saying they just wouldn't get a foley until after the binder was no longer needed (or they open the binder for it)?

[Rose_Queen, BSN, MSN, RN]

Foley placement is rarely an emergency. If the patient is so unstable that they need a pelvic binder and are showing bleeding on imaging tests, they're heading to the OR. Once they're in the OR, that pelvic binder has to come off to allow access for surgery. Generally, if they're stable, ortho can be consulted to see if the binder is even needed.

This may help.

[dumbquestion]

Rose_Queen said:

If the patient is so unstable that they need a pelvic binder and are showing bleeding on imaging tests, they're heading to the OR.

So I don't have to mention it or worry about it! I can just ship him off to surgery. The brain gremlin is not satisfied though...

also, man I wish I could find these pdfs 👀 very useful thank you!

[MaxAttack, BSN, RN]

dumbquestion said:

So he's not gonna just hang out in a binder for very long, but my understanding was that even till OP, that'd still be kind of a long time to not be able to move (and therefore can't pee), plus they'd want to check if there's blood in the urine? (at least that was my thought). Are you saying they just wouldn't get a foley until after the binder was no longer needed (or they open the binder for it)?

He's going to head to the trauma bay first where the binder would be removed to allow for a complete assessment and a foley would be inserted (good research - part of that is checking for blood) before the binder is reapplied. 

I don't know what you mean about anatomically. Foley goes in and it points downward and the binder goes on. IDK it might be the way you're visualizing it but it works.

[dumbquestion]

MaxAttack said:

I don't know what you mean about anatomically. Foley goes in and it points downward and the binder goes on. IDK it might be the way you're visualizing it but it works.

I wasn't aware that the binder could be temporarily removed (I thought that'd hurt a lot, risk bleeding, dislodging a clot or something) before surgery to get fixation, so basically imagine me image-googling "pelvic binder" and thinking "wouldn't that belt-the-size-of-a-miniskirt kinda be in the way?" OK, excuse me while I facepalm in embarassment 🤦‍♀️

[MaxAttack, BSN, RN]

dumbquestion said:

I wasn't aware that the binder could be temporarily removed (I thought that'd hurt a lot, risk bleeding, dislodging a clot or something) before surgery to get fixation, so basically imagine me image-googling "pelvic binder" and thinking "wouldn't that belt-the-size-of-a-miniskirt kinda be in the way?" OK, excuse me while I facepalm in embarassment 🤦‍♀️

Ahhhh gotcha. Yep, it's not ideal but typically the physicians want to see what's going on for themselves and evaluate for any missed injuries.