Foley Cath Insertion

[sammiesmom]

I work in a Med-Surg ICU and I got a septic patient refusing foley cath. I thought ethically I could not insert it due to his refusal and patient is AOX4. Now, nurses in my place argues it is part of ICU care and "everyone" inserts foley cath even without order and we should just need to get the order later. I am confused. So should I just insert foley in each admission?

[Ruby Vee, BSN]

Even with an order, you cannot place a Foley in a patient who is refusing one. If patient teaching doesn't convince him, speak to the provider. Sometimes the white coat will convince a recalcitrant patient, and sometimes the provider can come up with a more palatable alternative such as a condom catheter. And once I saw the surgeon tell a man "That's just craziness. If you want the surgery, you get the Foley. Decide now, because I only have the one slot today and the next one is December 24."

[Salter444]

The patient has the right to refuse care and tom insert against his consent is assault. No, the catheter insertion is not a nursing judgement it should require an order from a provider. back in the old days nurses went ahead and did things like that at will, but things have changed and the autonomy of the bedside nurse has all but evaporated.

[Nalon1 RN/EMT-P, BSN, RN]

So are you asking if you can insert a foley without an order or can you insert a catheter against patients will?

To insert a foley without a physician's order is practicing without a license and you can lose your job and license for that. No different than giving meds to a patient without an order.

If you insert a foley catheter in a patient that is medically competent you can be charged with assault and battery, go to jail and be sued,as well as lose your job and license. It is not "unethical" to do this, it is illegal.

[offlabel]

Just wait until the patient is obtunded and intubated and then do it. Can't refuse it then.

[Ruby Vee, BSN]

The patient has the right to refuse care and tom insert against his consent is assault. No, the catheter insertion is not a nursing judgement it should require an order from a provider. back in the old days nurses went ahead and did things like that at will, but things have changed and the autonomy of the bedside nurse has all but evaporated.

The autonomy of bedside nurses has not evaporated, but that's another thread. I'm an old(er) nurse, and I don't remember a time when we inserted Foleys without an order. Often, it would be on a protocol or a pre-printed set of orders, but we didn't place them without something. And no, we don't insert them against the patient's will.

[chare]

Just wait until the patient is obtunded and intubated and then do it. Can't refuse it then.

Assuming that the patient previously made her or his wishes known, the fact that he or she is now "obtunded and intubated" doesn't negate the previous refusal.

[Ruby Vee, BSN]

Assuming that the patient previously made her or his wishes known, the fact that he or she is now "obtunded and intubated" doesn't negate the previous refusal.

It kind of does if his status has changed to the point of making accurate I & O imperative, if incontinence is threatening his skin integrity and if a relative gives permission after he becomes obtunded.

[chare]

It kind of does if his status has changed to the point of making accurate I & O imperative, if incontinence is threatening his skin integrity and if a relative gives permission after he becomes obtunded.

I agree, in this sotuation. However, and I might have misread, this was not how I read the quoted post.

[offlabel]

Assuming that the patient previously made her or his wishes known, the fact that he or she is now "obtunded and intubated" doesn't negate the previous refusal.

It sure as heck does. In fact, you're now obligated to place a Foley in that scenario. You've taken away every independent function the patient has by sedating, mechanically ventilating and maybe even paralyzing him. If he's sick enough to require that, he's sick enough for a Foley.

[Here.I.Stand, BSN, RN]

It is not a standard part of ICU care. In the interest in preventing CAUTIs, every insertion must have a clinical justification, e.g. GU/pelvic procedure, urinary retention, acute hemodynamic instability, etc.

But in any case, the pt refused. To insert one would be considered battery.

[offlabel]

It is not a standard part of ICU care. In the interest in preventing CAUTIs, every insertion must have a clinical justification, e.g. GU/pelvic procedure, urinary retention, acute hemodynamic instability, etc.

But in any case, the pt refused. To insert one would be considered battery.

Nah...in this case, the physician thought the guy needed a foley when he was awake, and that would only become more urgent intubated and ventilated. If he accepts medical care by his admission consent, all bets are off when he deteriorates. Say something declared itself after he was intubated that required going to the OR. If they need to put a foley in, its going in refusal or not. And that isn't assault, battery or otherwise.