Foley Cath for surgery?

caroladybelle, BSN, RN · Oct 3, 2005

Hey!
Quick question for you OR nurses! I am wondering when a patient is having surgery do they place foleys for everyone? My husband had an internal fixation for a tibial spiral fracture and the surgery was 2 hours long.....followed by 3 hours in recovery....Would they have placed a foley? He has hematuria 4 days post surgery and I have no idea why.....Any info or input would be helpful! Thx!

I used to work Ortho a number of years ago, and generally saw few if any foleys placed during surgery. If the patient has an issue with retention preop, the foley would have been placed before surgery and if he had an issue with retention postop, it would have been placed then. I only saw patients come back with a foley placed in the OR, if it was an essential part of a procedure (TURP, bladder tacking, etc.) and an ORIF (open reduction internal fixation) would not apply. And the amount of time in OR is not terribly unusual, though 3 hours in PACU is bit long - did he have any pain control issues or difficulty coming out of anesthesia?

Both might have resulted in him being cathed, but he would have most likely still had it in when returned to the floor.

Perhaps a better question would be how did he get a tibial spiral fracture? If it was from any sort of traumatic event, there might have been injury to the bladder, ureters or kidney, even if not apparent initially. In addition, blood thinners are ocasionally used in the postop period to prevent DVTs, and can result in some hematuria. The older "cellsavers" used to collect blood from the patient during surgery and returned postop also had some anticoagulant in them...though I do not know if the newer ones do nor their systemic effects.

Surely he can ask his physician/surgeon or check his medical record. Hematuria is a complication that should be reported to the MD and he should investigate the possible causes of this. Anything we post would merely be speculation.

RN 2005 · Oct 3, 2005

I used to work Ortho a number of years ago, and generally saw few if any foleys placed during surgery. If the patient has an issue with retention preop, the foley would have been placed before surgery and if he had an issue with retention postop, it would have been placed then. I only saw patients come back with a foley placed in the OR, if it was an essential part of a procedure (TURP, bladder tacking, etc.) and an ORIF (open reduction internal fixation) would not apply. And the amount of time in OR is not terribly unusual, though 3 hours in PACU is bit long - did he have any pain control issues or difficulty coming out of anesthesia?
Both might have resulted in him being cathed, but he would have most likely still had it in when returned to the floor.
Perhaps a better question would be how did he get a tibial spiral fracture? If it was from any sort of traumatic event, there might have been injury to the bladder, ureters or kidney, even if not apparent initially. In addition, blood thinners are ocasionally used in the postop period to prevent DVTs, and can result in some hematuria. The older "cellsavers" used to collect blood from the patient during surgery and returned postop also had some anticoagulant in them...though I do not know if the newer ones do nor their systemic effects.
Surely he can ask his physician/surgeon or check his medical record. Hematuria is a complication that should be reported to the MD and he should investigate the possible causes of this. Anything we post would merely be speculation.

Thank you so much for responding! We actually did try to reach the surgeon but we only got the doctor covering for him and she did not have access to his chart and did not know the specifics of his case. One of the downsides of weekends.....She said it was an issue for his primary doctor, which was really not a big help......He was in PACU for 3 hours due to blood pressure issues and his respirations were not up to par. The bleeding has since stopped, but I am so glad you posted because I never even thought about his initial injury as the cause......That may have an implication. (He fell down a hill while skateboarding....don't ask!!) I really appreciate your response...You provided excellent advice!!!

NurseyBaby'05, BSN, RN · Oct 3, 2005

Will your husband require being fitted for a brace post-op? Many of our spinal surgeries have foley's placed until they are cleared to be OOB with their brace. Some guys have a hard time voiding in a sitting or lying position. Many of our docs find it easier (on patient and nurse) to have a catheter placed when the pt's are under sedation as oppossed to cause more pressure on the back r/t urinary retention. If the patient is going to have no activity restrictions post-op, they usually don't have a cath placed.

grimmy, RN · Oct 8, 2005

hey!
quick question for you or nurses! i am wondering when a patient is having surgery do they place foleys for everyone? my husband had an internal fixation for a tibial spiral fracture and the surgery was 2 hours long.....followed by 3 hours in recovery....would they have placed a foley? he has hematuria 4 days post surgery and i have no idea why.....any info or input would be helpful! thx!

sometimes we'll put in a foley and remove it at the end of a case, particularly if the estimated case time is unknown. this is at the surgeon and/or anesthesia's discretion. our facility's policy is to not put in a foley unless it is absolutely necessary. if this was the case for your husband, a traumatic catheter insertion could be the root cause, or the trauma of the fall could be.