Lasix and Foley for female patients..automatic ?

Specialties Emergency

Published

We had a busy, but not crazy day in the ED on NY. I had two ladies who were in CHF and were given IV lasix in the ER. Both of these ladies were semi-mobile, but needed a bit of assist in getting up to the bedside commode. Needless to say, they kept me running for the few hours they were held in the ED (we had no tech on duty).

I heard a bit of grumbling from one nurse that I should just put in a foley for these patients. I tend to think it is an unnecessary introduction of a potential infection source and can prolong hospital stay for patients who are mobile enough to get up and go to the bathroom with minimal assist. I despise nurses who get the foley order simply for their own convenience on lasix cases like this.

So what are your opinions ? Get a convenience foley or dig in and be prepared to be helping these patients in and out of bed and be busy ?

All our hips Pt.s also get foleys in the OR. Its the best time to put them in.

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We usually place it in the ED for hip fracture. SInce our protocol requires a UA before surgery it is usually just easier to place it, than to try to get the fx on and off the bedpan, especially if they are not going to surgery in the next 8 minutes...

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We get those CHF'ers from the ER, and I prefer to have a Foley in. This is not for MY convenience, but because that patient's breathing is already compromised, and believe me, there's not a LOL in the world who won't get OOB to the bedside commode, even if it means dropping her sats to zero to do it!

So much better for that patient to rest up and BREATHE than to be watching the patient struggle for air all night.

The Foley can come out in a day or two and by then, the patient's CHF is pretty much resolved.

I have to agree with you. Well said.

:)Super

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Not an ER nurse but many times the minimal risk of a Foley is out weighed by the benefits. It's been a while sense I took care of a CHF'er or a LoL but some of the benefits I can think of are.

1. Patients get tired walking to the BR every 15-min, that energy might be better spent on healing/copping with their condition.

2. For some patients every time they get out of bed they are at risk for a fall/injury. What if they get out of bed without you there?

3. I/O's are much more accurate with a Foley

4. If your spending that much time ambulating 1 patient to the BR who is watching and caring for your other patients?

Foleys are often used for the wrong reasons, still you should be careful not to let that blind you to their benefits to patients. As someone already said, "A Foley is for the benefit and treatment of the patient" many times they can be just that.

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Specializes in Cath Lab, OR, CPHN/SN, ER.
We get those CHF'ers from the ER, and I prefer to have a Foley in. This is not for MY convenience, but because that patient's breathing is already compromised, and believe me, there's not a LOL in the world who won't get OOB to the bedside commode, even if it means dropping her sats to zero to do it!

So much better for that patient to rest up and BREATHE than to be watching the patient struggle for air all night.

The Foley can come out in a day or two and by then, the patient's CHF is pretty much resolved.

My thoughts exactly. There is no way I'm having a pt move all about the bed, or try and get up OOB when they need all the oxygen they can get. Their hearts are taxed enough as it is, I don't need to go increasing that O2 demand more. -Andrea

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I have to agree with you. Well said.

:)Super

This is a very good point and definitely one I consider in the big picture. For my CHF'ers who are desaturating or short of breath, I will make sure I keep this in mind. These two ladies would not fit in that picture though. I think sometimes it is going to be hard (I am new to the ER remember) to make an objective decision...you guys are giving me lots to consider.

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Specializes in Psych, M/S, Ortho, Float..

Stevie,

That's why I made it an issue. One day I got 3 LOL back from the OR with no foley. I was really mad. I went to the floor manager and spoke to the surgeon the next day in a "by the way" kinda way. The rational was that with the new hips the patient was up sooner and they thought that only having one day on the bedpan was a better alternative to a foley. After explaining that some of these people still had significant confusion once they were returned to the floor, he understood what I and other nurses where saying and 2 days later they had changed the policy and pts were coming back on the floor with the foleys in.

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This is a very good point and definitely one I consider in the big picture. For my CHF'ers who are desaturating or short of breath, I will make sure I keep this in mind. These two ladies would not fit in that picture though. I think sometimes it is going to be hard (I am new to the ER remember) to make an objective decision...you guys are giving me lots to consider.

Being new to the ER you shouldn't rely on your Techs to do your work. They are there to be part of your team. In my ER they phased out the Techs and brought in Paramedics that have a identical job description as us nurses. They take there own Pts, admin meds, admit, and D/C there own Pts. (not to mention the stuff the can also perform under the MD License.) By doing this it brought down the Nurse to Pt ratio. And now you have to take care of everything for your Pts. :lol2:

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Being new to the ER you shouldn't rely on your Techs to do your work. They are there to be part of your team. In my ER they phased out the Techs and brought in Paramedics that have a identical job description as us nurses. They take there own Pts, admin meds, admit, and D/C there own Pts. (not to mention the stuff the can also perform under the MD License.) By doing this it brought down the Nurse to Pt ratio. And now you have to take care of everything for your Pts. :lol2:

I don't and never have relied on techs to do my work. They are a nice extender for tasks that can be delegated and they sure come in handy to get the lady onto the bs commode while I am going with my new stroke patient to CT, you know ?

Wow...the next thing they'll be doing in your ER is laying off the RN's since I imagine paramedics are cheaper ?

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I don't and never have relied on techs to do my work. They are a nice extender for tasks that can be delegated and they sure come in handy to get the lady onto the bs commode while I am going with my new stroke patient to CT, you know ?

Wow...the next thing they'll be doing in your ER is laying off the RN's since I imagine paramedics are cheaper ?

No not laying off... LOL, But they have cut back on RN hiring. They pay the Medics of the same pay scale as the Nurses, due to the fact the they are Licensed and have a AS Degree. If you came to our ER you wouldnt be able to tell if you had a nurse or a medic taking care of you.:lol2:

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Specializes in ICU,ER.
No not laying off... LOL, But they have cut back on RN hiring. They pay the Medics of the same pay scale as the Nurses, due to the fact the they are Licensed and have a AS Degree. If you came to our ER you wouldnt be able to tell if you had a nurse or a medic taking care of you.:lol2:

Wow.

That's kind of scary. I have worked a couple of places where we had Paramedic/techs that performed the basic skills that RN's did but were never solely assigned rooms! NOT trying to start a tired old medic vs. RN thing but it is a fact that the training IS different. I loved the medics I used to work with...they were great... but MANY times they would defer things to me. Not saying RN's are "better", just different.

And as far as saying that nurses shouldn't reply on techs to do their jobs for them...ummm....I am only asking the techs to do THEIR jobs. I know that we are all a team...but at the risk of sounding un-PC.... the plain and simple fact is...we ALL have our "jobs". I don't ask a tech to give an emema or dig out impactions. So no... I have NO problem whatsoever asking a tech to help someone without a foley to the BR...IF I am too busy doing "nurse jobs". And another thing... it seems like with most techs, you have to walk on eggshells and ask them just the right way to do something. When I take a doctor's ORDER, he doesn't ask pretty please with sugar on top....sheesh. It's my job.

OK, I know wayyy off subject...but I did make a point to mention Foleys....:wink2:

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No not laying off... LOL, But they have cut back on RN hiring. They pay the Medics of the same pay scale as the Nurses, due to the fact the they are Licensed and have a AS Degree. If you came to our ER you wouldnt be able to tell if you had a nurse or a medic taking care of you.:lol2:

Wow...that is interesting.

Back to your original point about me ditching tasks off to the tech..your original post makes it sound like you think I was sitting on my butt wishing I had a tech to do my job for me. Nothing could be further from the truth. I am very much a believer in techs being part of our team...part of their function in such a team is doing tasks that can be safely delegated so the RN can be freed up for tasks that cannot. Transporting a new stroke patient to CT or assessing a new chest pain patient are not tasks that can be delegated but they were functions that were not done as timely that day as they could have been had we had a tech to do the other tasks. Is that point understood ?

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