Jump to content

Epidurals and caths

I'm having a disagreement with someone about this and wanted input from current L&D nurses. Is it standard procedure to have a foley with a laboring patient that has an epidural?

I worked in L&D for years (but haven't for the past 18years), and unless mom had been laboring for a long time and needed repeated straight caths, or was a likely c/s, we rarely put a foley in. We did straight cath some patients, but not the majority from what I recall.

I've had epidurals with 6 of my own kids, and was straight cathed twice, but also had pretty short labors.

So, what percentage of your epidural patients get straight cathed? How many of them get a foley?

Where I delivered that was the protocol. Hence why when I had my first two I didn't get an epidural until the last minute literally without any time to Cath me, and my third without anything. That's right, I chose a natural labor just so I wouldn't get a piece of plastic shoved in my meatus :) they freak me out!

Fyreflie

Has 4 years experience.

Both of my last jobs we automatically did Foleys with most of our epis--exceptions were short labors/fast progressing multips and if they declined. My current job does in and outs the majority of the time--I find they're overused though. I assess bladder every two hours but I don't routinely do a straight cath every 2 hours. If I have a pt with an early epi--especially primes--I'll ask for an order for a Foley.

Katie71275

Specializes in L&D. Has 2 years experience.

Where I delivered, unless you were getting a c/s, you didn't need a Foley. You either get a bedpan or can get an I/O cath. After screwing up the whole bedpan thing several times, I went with getting an I/O cath as it was easier.

No, we don't routinely put in caths for laboring moms with epidurals.

We do I/O caths but not routinely either - we assess for need.

klone, MSN, RN

Specializes in Women's Health/OB Leadership. Has 14 years experience.

We do I/O caths but not routinely either - we assess for need.

Yep, this - depends on the woman and the labor, no set policy.

melmarie23, MSN, RN

Specializes in L&D/Maternity nursing.

we usually just straight cath our epidural pts

serenity1

Specializes in labor & delivery. Has 7 years experience.

We used to put foleys in all epidural patients, but policy changed a few months ago to straight caths as needed. The docs are adamant about keeping the bladder empty, and some will still order the foley.

HeartsOpenWide, RN

Specializes in Ante-Intra-Postpartum, Post Gyne.

Unless the mom is going fast after the epidural, we do a foley. For those of you that do straight caths, what is the reason behind this policy? Isn't repeated in and out caths introduce more infection than a short term indwelling? Also seems more cost effective to do an indwelling since an in ad out can only be used once for sterility. I am always interested in doing Evidence based. We just don't see that many epidurals in the hospital based birth center that I work at, less than 20%

All of our patients automatically get a foley catheter with an epidural. We remove it when she's complete and ready to push.

hecallsmeDuchess

Specializes in LTC, Acute care. Has 6 years experience.

Had a baby some months ago, got a foley with my epidural and I thought it was the norm so didn't even think to question it. The one thing I'm never gonna have anyone do to me is place a foley bulb on my cervix as I thought (after the fact) it was totally unnecessary.

Fyreflie

Has 4 years experience.

Our policy is apparently based on research showing that indwelling caths carry a higher risk of infection than straight caths--but I don't really believe that applies to LD, where even our Foleys aren't usually in for that long. I haven't read the studies yet.

All of our patients automatically get a foley catheter with an epidural. We remove it when she's complete and ready to push.

This is the same policy where I work. They have 6 hours to void after the foley is removed, or they get straight caths. I think the reasoning behind straight caths is to decrease risk of bleeding, but not sure.

HeartsOpenWide, RN

Specializes in Ante-Intra-Postpartum, Post Gyne.

This is the same policy where I work. They have 6 hours to void after the foley is removed, or they get straight caths. I think the reasoning behind straight caths is to decrease risk of bleeding, but not sure.

I uterus doesn't contract well with a full bladder.

jodyangel, RN

Specializes in L&D.

Full bladders keep babies head from desending nicely too.

Personally? I Love foley's. One time in and done.

But I'm at a new job..so we'll see how they do it..

melmarie23, MSN, RN

Specializes in L&D/Maternity nursing.

Unless the mom is going fast after the epidural, we do a foley. For those of you that do straight caths, what is the reason behind this policy? Isn't repeated in and out caths introduce more infection than a short term indwelling? Also seems more cost effective to do an indwelling since an in ad out can only be used once for sterility. I am always interested in doing Evidence based. We just don't see that many epidurals in the hospital based birth center that I work at, less than 20%

straight cath's are associated with lower CAUTIs I believe. The only patients that routinely get a foley are are section patients.

and I think its awesome that you have such a low epidural rate! How refreshing!

here is some good reading:

r.e. infection

http://www.ncbi.nlm.nih.gov/pubmed/22284373

http://onlinelibrary.wiley.com/doi/10.1046/j.1464-410X.1997.30018.x/abstract

http://www.ispub.com/journal/the-internet-journal-of-family-practice/volume-3-number-2/urinary-catheters-a-review.html

r.e. labor duration and post partum urinary retention

http://www.ncbi.nlm.nih.gov/pubmed/19100928

http://www.ncbi.nlm.nih.gov/pubmed/19100928.1

http://journals.lww.com/greenjournal/Citation/2005/09000/Postpartum_Urinary_Retention.25.aspx

Edited by melmarie23

×

By using the site you agree to our Privacy, Cookies, and Terms of Service Policies.

OK