foley catheter placement question

[rileygrl11]

We had a discussion at work tonight and thought I would ask your thoughts. Pt is @ 70 yo male with lymphoma and was started on pyridium 2 days ago. Pt c/o constant pain, burning during urination and retention for last several days. Pt voided 1000 cc on own but bladder scan showed 600 cc urine. Pt voided 400 cc on own then foley placed per orders. After inserted, no urine in bag noted. Minutes after that bright, red blood in tubing (total of 250 cc). Irrigation done with several long clots noted. Just prior to irrigation, scant amt of urine noted mixed with blood. Eventually, unable to withdraw what was put in. Pt c/o increasing pain during entire span.

Urologist mad b/c he said PCT who inserted foley probably placed balloon in urethra & then inflated it. Other RN's saying pt could have unknown prostate problem which was aggravated by foley insertion.

Your thoughts?

[caroladybelle, BSN, RN]

It depends on why he "needed" a foley. If it was to monitor urine OP accurately, it probably was unnecessary...if it was for a major obstructive issue with no other option (med didn't work), sometimes one has no choice.

If the oncologist was miffed, he would merely ordered it DC'd. As you know, while there is a risk of infection from the act of cathing the patient, much of the infection risk comes from leaving them in for longer periods of time, allowing more bladder exposure to risk with each opening of the bag. Most onco/hemos will order them Dc'd quicker than other MDs, if they had one placed on a pt.

Like intubations on the immunosuppressed, it is not optimal, but sometimes one does what one has to do...but do it in the safest manner possible and DC it as soon as one can.

And many MDs contradict each other. You get a blast crisis patient in the ER - WBCs >50,000, with significant percentage of blasts. The patient has a HCT of 23% - low but not immediately lifethreateningly so. The CXR is hazy, patient has a productive cough and c/o SOB, sats in low 90s.

Invariably with a HCT

[DeLana_RN, BSN, RN]

I thought that if the oncologist had wanted a Foley, he would have ordered it - he was present when we started dialyzing the pt. My colleague didn't think a Foley was necessary (and it's not like the pt had any bladder distention or inability to void) - until both oncologist and nephrologist had left for the day and only the on-call neph was available.

Thanks again for your input and info.

DeLana

[cardsfreak]

Generally.. I would say putting foleys in women is my forte..lately putting them in men has been difficult. Also now that I work cards we dont do it often. So, I gotta ask have any of you had this happen?

I was putting a foley in a man in his 80's with BPH. I started inserting the foley and immediately urine started shooting into the foley and around the foley. I was thinking what the...?? but also at the time the patient was cringing and bearing down so I thought maybe all that pressure it causing the urine to shoot out. Then I met resistance ( I think around his prostate) and so I back up and passed through it. Then I met resistance again but the foley was now filling with urine .. so I figured I'm in and maybe against the bladder wall...and gently started to inflate the balloon. The patient said that hurt (probably got less than 1 ml into inflating the balloon) and so I stopped backed up and manage to pass the area of resistance, then inflated the balloon, no problem.

I guess this patient ended up having issues with the foley leaking so urology came and replaced it. Then it continued to leak and leak and the patient had bladder spasms until eventually he didnt need it and it was removed. He didnt have issues with bleeding or clots to the best of my knowledge.

Do you think I inflated in the urethra? Do you think I pushed through some sort of partial obstruction?

What would you guys have done, abort once you reach resistance and let urology handle it?