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?

[CCU BSN RN]

Okay, I probably should have specified 'requiring mechanical ventilation and sedation/paralytics in an acute care ICU setting'

[Julius Seizure]

I don't really care what the CDC says.

Granted, who does and does not need a foley is not always a black and white issue, and there are cases that could go either way as far as if they get a catheter or not, or if it stays in more than 48 hours.

But its phrases like this that bother me.

Evidence SHOULD guide our practice.

[offlabel]

I don't really care what the CDC says.

Especially when it, as a federal bureaucracy, makes broad swathe proclamations about ubiquitous devices employed in an infinite number of applications. Wonder what they'd say about shoving a foley up someone's nose to stop a bleed?

[Salter444]

Granted, who does and does not need a foley is not always a black and white issue, and there are cases that could go either way as far as if they get a catheter or not, or if it stays in more than 48 hours.

But its phrases like this that bother me.

Evidence SHOULD guide our practice.

Yes, it should. The delivery of healthcare is guided by science and not convenience. Again, these are guidelines and in a critical care setting we look at each patient individually.

I worked as a nurse at a magnet facility where foley discontinuation was a nursing driven policy based on guidelines, but common sense was omitted. An example...a trauma patient who was to undergo multiple surgical interventions. Per the guideline the bedside nurse was removing foley next day post op only to have the patient be re-inerted the next day for an additional surgery and so on and so on.

[delphine22]

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

I've seen quite a few, especially males that we can use condom caths on.

We have even purchased 4 new scales for our units so we can weigh our chux in cases of incontinence. Foleys are nearly verboten and we take them out every chance we can. Less than 20% of our 24-bed MICU has a Foley at any given time. And yes, our CAUTI rate has dropped significantly, obviously.