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". 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?
myk_RN 38 Posts Specializes in Medical Surgical. Has 4 years experience. Apr 4, 2011 low intermittent suction
roser13, ASN, RN 6,504 Posts Specializes in Med/Surg, Ortho, ASC. Has 17 years experience. Apr 4, 2011 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....
imintrouble, BSN, RN 2,406 Posts Specializes in LTC Rehab Med/Surg. Has 16 years experience. Apr 4, 2011 I've never heard of it and would never do it.
Isabelle49 849 Posts Specializes in Home Health. Apr 4, 2011 Never heard of it. Doesn't sound too good.
smily nurse, BSN, RN 155 Posts Specializes in Women's Health. Has 38 years experience. Apr 4, 2011 Did the doc explain why they wanted it to LIS? There must be a reason and that might clear the air.
MedSurgeMe 26 Posts Apr 4, 2011 What did the Risk manager cite as the problem? The fact that the order was unclear or that the procedure itself wasn't safe?
MunoRN, RN 8,058 Posts Specializes in Critical Care. Has 10 years experience. Apr 4, 2011 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.
Bobylon 232 Posts Specializes in Coronary Rehab Unit. Apr 4, 2011 Have never heard of that or run across that on my floor. I learned something today
KeyMaster 71 Posts Specializes in OR, CVOR, Clinical Education, Informatic. Has 30 years experience. Apr 4, 2011 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.
canesdukegirl, BSN, RN 8 Articles; 2,543 Posts Specializes in Trauma Surgery, Nursing Management. Has 14 years experience. Apr 4, 2011 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.
