Foley to LIS???

[myk_RN]

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?

[roser13, ASN, RN]

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.

[canesdukegirl, BSN, RN]

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.

Roser, if I understood the post correctly, the pt had CBI for two days post op. THEN the MD ordered foley to LIS. If the CBI were continuing with the foley to LIS, there would not be such a risk of the foley suctioning to the bladder wall. However, my understanding is that by having CBI drain to gravity, it is allowing any bleeders to tamponade gently, thus reducing the amount of clots and subsequently re-establishing normal function of the bladder and the ureters. If you were to put the foley to LIS while using CBI, there would be too much fluid movement in the bladder which would NOT allow any bleeders to achieve hemostasis. Imagine pouring some paint into a whirlpool. If you have the jets on, the paint will bubble up and stick around. If you don't introduce agitation into the whirlpool, the paint will eventually settle, and be easier to clean up. This analogy isn't the greatest, because a bleeder will continue to bleed if it is agitated, but you get the gist.

I will let y'all know what the urologist says.

[myk_RN]

Roser, if I understood the post correctly, the pt had CBI for two days post op. THEN the MD ordered foley to LIS. If the CBI were continuing with the foley to LIS, there would not be such a risk of the foley suctioning to the bladder wall. However, my understanding is that by having CBI drain to gravity, it is allowing any bleeders to tamponade gently, thus reducing the amount of clots and subsequently re-establishing normal function of the bladder and the ureters. If you were to put the foley to LIS while using CBI, there would be too much fluid movement in the bladder which would NOT allow any bleeders to achieve hemostasis. Imagine pouring some paint into a whirlpool. If you have the jets on, the paint will bubble up and stick around. If you don't introduce agitation into the whirlpool, the paint will eventually settle, and be easier to clean up. This analogy isn't the greatest, because a bleeder will continue to bleed if it is agitated, but you get the gist.

I will let y'all know what the urologist says.

*bumps for updates on what the uro says....

[canesdukegirl, BSN, RN]

When I asked the surgical urologist about this yesterday, he looked at me sideways and said, "What kind of a question is THAT?? Of course not, that is crazy! Unless you are TRYING to injure the bladder mucosa!"

When I pressed him further about why a doc would order this, he told me that he had read about a case where a pt had undergone a radical retropubic prostatectomy and the anastamosis was leaking. The urologist put the foley to suction along with placing an 18g needle on the port site of the catheter to prevent injury to the bladder wall. I thought that was kind of strange, so he went to his office, found the journal article and showed me. Apparently, it is very uncommon to have the anastamosis leak in the first place, but by using this method, they were able to prevent clotting and ensure drainage long enough to take the pt back to the OR for anastamosis repair.

Thanks for bringing this up, Myk. Your question sparked a lively debate in the OR yesterday, and we all learned from it.