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Discussion

Foley to LIS???

A few weeks ago, a patient in our Medical Surgical floor had a cystoscopy and TURP done. He came back to the floor with CBI orders from the Urologist. He was on CBI for a couple of days and one morning, the Urologist ordered "Foley to LIS". :eek:

All the RN's on the floor were dumbfounded because none of use had ever come across a doctors order like that. Even the old time RN's with 30+ years of experience.

Charge nurse called MD and he said "if we don't want to follow his orders, we can transfer the patient to the Surgical floor because they do that there". Charge nurse called the Surgical ward and found out that in fact, they had done Foley to LIS before, following the same urologists' order. Attending physician was notified of the request by Uro to transfer his patient to Surgical. The attending physician also questioned the uro's order.

The incident was forwarded to our hospital's risk manager and it was verified that the "Foley to LIS" order wasn't safe and shouldn't be done.

So had anyone here ever encountered a similar order?

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    just curious what is LIS?

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    low intermittent suction

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    Low Intermittent Suction.

    And yes, we had a case like that not too long ago. The RN questioned the order and was given the rationale. The order was carried out.

    Personally, that order scared the crap out of me and I was selfishly glad that it wasn't my patient. I suppose with CBI running as well, it would be hard to cause damage, but still....

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    I've never heard of it and would never do it.

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    Never heard of it. Doesn't sound too good.

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    Did the doc explain why they wanted it to LIS? There must be a reason and that might clear the air.

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    What did the Risk manager cite as the problem? The fact that the order was unclear or that the procedure itself wasn't safe?

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    Unlike GI tubes, Foley catheters usually only have one drainage hole, so on suction that hole would be likely to suck against the wall of the bladder, not allowing it to drain. Also, Unlike the lining of the stomach, the wall of the bladder is fragile, even on LIS a foley could damage the bladder particularly since there are no other drainage holes to vent the suction through when it gets stuck up against the bladder wall.

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    Have never heard of that or run across that on my floor. I learned something today :up:

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    I once had a very tired resident order foley to low wall suction and an NGT to bedside drainage :) A quick phone call cleared that up with no problem though.

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    MunoRN-you are exactly right. If a pt is s/p TURP, the bladder can be friable. I cannot imagine placing a foley to LIS after TURP.

    I can't wait to hear what my surgical urologists think about this. I will be in the OR with them tomorrow and I will ask them if they have heard of this.

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    MunoRN-you are exactly right. If a pt is s/p TURP, the bladder can be friable. I cannot imagine placing a foley to LIS after TURP.

    I can't wait to hear what my surgical urologists think about this. I will be in the OR with them tomorrow and I will ask them if they have heard of this.

    Me too! Please report back to us.

    I still wonder if the CBI plays a role in this - does it decrease the likelihood of bladder injury due to the influx of irrigant? Even if it does, I'm still wondering about the need/rationale for ordering LIS. I wish I could remember the rationale from my one brush with that type of order.

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