Foley Cath Insertion

BSN16 · Oct 25, 2016

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.

lol exactly, i have never once seen a intubated/sedated pt w/o a foley.

Sometimes in report the receiving nurse will ask if they have a foley, and it takes all my will power to not just say WELL DUH

William2 · Oct 25, 2016

Intubate, sedate, and insert that foley

Julius Seizure · Oct 25, 2016

f he's sick enough to require that, he's sick enough for a Foley.

lol exactly, i have never once seen a intubated/sedated pt w/o a foley.
Sometimes in report the receiving nurse will ask if they have a foley, and it takes all my will power to not just say WELL DUH

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.

I'd have to agree with Here.I.Stand. Increasingly, being intubated and sedated is no reason enough to justify placing a foley. It is not an "ICU standard" for every patient. Continence garments/briefs, condom caths, even straight caths in some instances are alternatives. Placing a foley in each ICU patient just because they were intubated would be inappropriate.

sjalv · Oct 25, 2016

I'd have to agree with Here.I.Stand. Increasingly, being intubated and sedated is no reason enough to justify placing a foley. It is not an "ICU standard" for every patient. Continence garments/briefs, condom caths, even straight caths in some instances are alternatives. Placing a foley in each ICU patient just because they were intubated would be inappropriate.

Please, for the love of God, if I end up intubated/sedated in an ICU, catheterize me so I don't keep urinating on myself out of lack of awareness/control. To not do so would be ridiculous in my opinion.

Tenebrae, BSN, RN · Oct 25, 2016

Whats the rationale for inserting the catheter? Are they in retention?

If its to measure output and they are alert and orientated give them a urinal if they are bed bound, if they can ambulate put a bowel in the pan and measure it.

An IDC is a portal for infection. Now if there is a dam good reason eg patient is intubated and unable to control their own output then sure, or if they are in retention, fine.

Tenebrae, BSN, RN · Oct 25, 2016

Placing a foley in each ICU patient just because they were intubated would be inappropriate.

Imagine a nurse telling you that you are not allowed to use the toilet, and for the next 48 hours you must pee into an incontinence pull up.

To expect a patient who is in a clinically induced coma and intubated to pee in into contience pad is the height of wrongness

Julius Seizure · Oct 26, 2016

Please, for the love of God, if I end up intubated/sedated in an ICU, catheterize me so I don't keep urinating on myself out of lack of awareness/control. To not do so would be ridiculous in my opinion.

Imagine a nurse telling you that you are not allowed to use the toilet, and for the next 48 hours you must pee into an incontinence pull up.
To expect a patient who is in a clinically induced coma and intubated to pee in into contience pad is the height of wrongness

What can I tell you, guys? CAUTI recommendations straight from the CDC -

Appropriate indications for indwelling catheter:

Acute urinary retention or obstruction

Need for accurate urine output measurement in critical patients

Perioperative use for selected procedures, including GU surgery

To assist in healing an open sacral or perineal wound in incontinent patient

Patient requiring prolonged immobilization such as in a pelvic fracture

End of life comfort care

NOT appropriate indications for indwelling catheter:

Management of incontinence

Generalized use in all patients, particularly those at high risk (women, elderly, etc)

sjalv · Oct 26, 2016

What can I tell you, guys? CAUTI recommendations straight from the CDC -
Appropriate indications for indwelling catheter:
Acute urinary retention or obstruction
Need for accurate urine output measurement in critical patients
Perioperative use for selected procedures, including GU surgery
To assist in healing an open sacral or perineal wound in incontinent patient
Patient requiring prolonged immobilization such as in a pelvic fracture
End of life comfort care
NOT appropriate indications for indwelling catheter:
Management of incontinence
Generalized use in all patients, particularly those at high risk (women, elderly, etc)

An incontinent patient who is A&O x4 and can vocalize that they are soiled = not a reason to catheterize. A patient who, regardless if they're usually continent or not, is sedated and cannot verbalize they've soiled themselves = reason to catheterize. At this point, it's a dignity issue. I don't really care what the CDC says. If someone is intubated and sedated, they need a foley.

offlabel · Oct 26, 2016

What can I tell you, guys? CAUTI recommendations straight from the CDC -
Appropriate indications for indwelling catheter:
Acute urinary retention or obstruction
Need for accurate urine output measurement in critical patients
Perioperative use for selected procedures, including GU surgery
To assist in healing an open sacral or perineal wound in incontinent patient
Patient requiring prolonged immobilization such as in a pelvic fracture
End of life comfort care
NOT appropriate indications for indwelling catheter:
Management of incontinence
Generalized use in all patients, particularly those at high risk (women, elderly, etc)

Not anywhere near an inclusive list...but to the patient at hand, he was admitted to the hospital for sepsis and the physician wanted a foley while he was awake. If that were the case, he certainly needs one now. Septic patients sick enough to be intubated require accurate measurement of urine output

Nalon1 RN/EMT-P, BSN, RN · Oct 27, 2016

Imagine a nurse telling you that you are not allowed to use the toilet, and for the next 48 hours you must pee into an incontinence pull up.
To expect a patient who is in a clinically induced coma and intubated to pee in into contience pad is the height of wrongness

People wear pull up diapers 24/7 and have no problems with it. So long as it is changed appropriately there is no issue with it.

Now I agree a foley tends to go with intubation and sedation, usually being that you are usually wanting more accurate I/O. It is not automatic though, CAUTI is a big issue and if you can keep a foley out then you don't have to worry about it at all.

CCU BSN RN · Oct 30, 2016

In what instance would someone requiring mechanical ventilation NOT be unstable?

If you acutely can't respire on your own, you're hemodynamically unstable, which IS an indication for a foley.

Cowboyardee · Oct 31, 2016

In what instance would someone requiring mechanical ventilation NOT be unstable?
If you acutely can't respire on your own, you're hemodynamically unstable, which IS an indication for a foley.

I can think of many situations where a vented patient is hemodynamically stable (e.g. the patient who's been trached and on a vent for years and may seldom even have his vital signs checked). Mechanical ventilation on its own is not always a sign of hemodynamic instability.

But I would argue that anyone who is being newly intubated is prone enough to hemodynamic instability that a foley should be be placed for monitoring. Even if the reasons for intubation are purely respiratory in nature, the change in intra thoracic pressures and effects of any sedatives used for or after intubation are enough to warrant close output monitoring. Unless, of course, they're anuric in the first place.