Foley Catheter Insertion:An independent or Dependent Nursing Role?

[agrj]

I just want to impart a situation where in a nurse inserted a foley catheter to her patient with verbal order from the resident doctor due to his busy situation in ER. After insertion, urine was noted clear yellow on the tubing but was not drained till the bag though the bladder was distended. After 30 minutes still patient complained of fullness and urine bag still empty. Catheter was removed and noted clot on the catheter tip and minimal bleeding noted on the orifice. When the doctor saw it he consulted to the Specialist surgeon and the specialist inserted. Presently the resident denied his verbal order to the nurse. The Specialist also was about to document his insertion but found out that the resident didn't make any notes. They argued and read my friend's notes that there was a verbal order of foley catheter. Do insertion of foley cath is an independent or dependent role of the nurse?My friend is so worried that the case will be investigated. Need your opinion guys. thanks

[xtxrn, ASN, RN]

Foley catheters need a MD order for the nurse to insert. If I were the nurse, I'd be peeved (no pun intended- the other "p" word always gets the *'s- LOL). But, she charted- that helps. With no history of anything like this being a pattern, she's probably fine.

Most important in all of this- including any sort of investigation, was the patient ok? :)

[tyvin, BSN, RN]

I'm not quite sure of your dialog in relation to what you want advice on. Yes, a Foley needs an order and verbal orders are given all the time but with this I would have written up the order and had the MD sign it before proceeding. What about the age, circumstances, would a straight cath sufficed initially, was the bladder scanned first, what was the initial reason for bladder distention, are you in the ER when this happens, etc ... there are too many outliers to give sound feedback IMO.

What's up with independent, dependent?

[czyja, MSN, RN]

Sound like to OP may practice outside of the US. I have heard these terms used by UK nurses.

[agrj]

TYVIN:I haven't asked my friend regarding the age of the patient since I'm on leave,she just told me the story. All she mentioned was the adult obese patient complained of bladder fullness even with catheter.The second time the patient was catheterized by the Specialist, no hematuria was seen no bleeding thereafter.nothing really serious happened to the patient.He was just catheterized due to the fact of distended bladder.I guess the issue was on documentation because the resident denies that he ordered the insertion. But I just wondered why the Specialist wrote in his notes that it was urethral rupture where in fact he didn't do any scanning,no profuse bleeding,no patient's complaints at all..

Independent nursing roles are duties that is initialized by the nurse base on her nursing findings,dependent roles are responsibilities that should be done as per doctors' order..

[Sun_danc3rRN]

Foley placement is a dependent nursing role..and this kind of seems like a homework question

[RFRN]

Not sure about what dependent/independent means here but if I had to guess I would say dependent? Just because you cannot insert a Foley on your own judgement, need an order. And yes, a verbal order counts - just need to make sure the nurse charted that she took a verbal order. From working in urogyn and inserting many many caths, I know sometimes you can get someone who seems to have a urethral obstruction or stricture and makes cathing difficult. This could be the reason for the tiny clot and minimal bleeding. I highly doubt she caused a urethral rupture with a cath - likely just a small tear in the skin that will heal on it's own.

[Esme12, ASN, BSN, RN]

Here in the US, in lieu of the reimbursement requirements, an order is necessary if not already addressed in standing orders or triage protocol. It is common practice here in the US that there are certain standards of treatment that are adhered to and a "no verbal orders" in the ED are to accepted "unless an emergency" has been adapted by many emergency department for safety reasons. Foley insertion is not necessarily an emergency or what is defined as an emergency. A clot on the end of the foley doesn't mean a rupture of any kind it can simply mean a slightly difficult insertion causing minor hematuria that will clear quickly. Urethral rupture is highly unlikely, especially in this scenario.

http://www.qualitymeasures.ahrq.gov/content.aspx?id=27521

http://www.med.uc.edu/Libraries/GME_Forms/Joint_Commission_Upd_1.sflb.ashx

[tainted1972, ASN, RN]

I am wondering if the physician specified the size of the catheter and balloon. If not, then the nurse did not get a complete order. If the physician did not specify a size I would question whether or not he/she intended to give an order for a straight cath instead of an indwelling catheter.

Whenever I receive a verbal order I get specifics, in this case I would have asked the physician what size catheter and if he/she also wanted an order to flush it ( to save a phone call later and know for sure that he/she is sure that he/she wants an indwelling cath)

Just a thought, because I have seen residents who think the term foley is used for any urinary catheter.

[ForeverQuestioning]

Tainted - I have never, ever had a physician tell me what size catheter or balloon to use unless the patient needed something like a Coude or simply wanted a straight cath. These are pretty standardlized. Another example of this nursing judgement would be an NG tube. I have never been told what size to use.

Also, just in general to the OP question, some areas in the hospital (like ER and ICU) have policies where a foley can be placed if certain criteria are met and the patient doesn't have any exclusionary reasons why it shouldn't be placed - standing orders.

[jm394, RN, CRNA]

Need order. From doc, NP, or PA.

Interesting point though, in my facility, we just instituted a policy where, if certain conditions are met, we can DC a cath as an independent nursing action. Well, not totally independent, since we need the policy, but at least we don't have to bug the doc about taking out a cath they probably totally forgot was ever inserted. A good way to reduce UTIs too.

[aprilmoss]

It's rare enough in my situation that I always write out the order (there's a form) and have the physician sign it.

Everything that's independent has a policy, or else you wouldn't know you could do it independently :)