Foley Phobia??

[MQ Edna]

I'm really starting to wonder if some nurses have "foley phobia". I'm finding more and more patients coming into the unit I work (ICU) soaked in urine d/t incontinence after being in ER, post-op etc. I've also had patients come to our unit after being on other non-ICU floors for days, incontinent, with saturated depends/incontinent pads and sheets/gown wet with urine. Last week I had a new-admit floor patient thank me for putting in a foley because they were sick of laying in urine all the time.

Worse than that, recently a relative of mine was hospitalized for end stage COPD, with a history of several falls, and bouts of dementia/confusion. She was being diuresed and when I visited her she had on a leaking depends and sheets wet up to the shoulders. She fell and broke her hip while trying to use a bedside commode without nurse assistance. If that wasn't bad enough, while in traction for the fracture she was still in a depends and had to endure the pain of having brief and bedding changed several times a day until I questioned the doctor about putting in a foley, which he ordered to be done.

Maybe I just don't get it?? I consider a foley a nurses "friend" for incontinent patients. Now, I know that a foley is an infection risk, but what about lying in a wet brief for several hours, and skin breakdown risks etc. In ICU we have standing orders for foley placement per nurse's discretion. Maybe this is different on other floors of the hospital. Do you have to get an order for a foley? Do doctor's discourage it . . .I just don't get it!

[caroladybelle, BSN, RN]

I'm really starting to wonder if some nurses have "foley phobia". I'm finding more and more patients coming into the unit I work (ICU) soaked in urine d/t incontinence after being in ER, post-op etc. I've also had patients come to our unit after being on other non-ICU floors for days, incontinent, with saturated depends/incontinent pads and sheets/gown wet with urine. Last week I had a new-admit floor patient thank me for putting in a foley because they were sick of laying in urine all the time.

Maybe I just don't get it?? I consider a foley a nurses "friend" for incontinent patients. Now, I know that a foley is an infection risk, but what about lying in a wet brief for several hours, and skin breakdown risks etc. In ICU we have standing orders for foley placement per nurse's discretion. Maybe this is different on other floors of the hospital. Do you have to get an order for a foley? Do doctor's discourage it . . .I just don't get it!

It is not nurses that have foley phobia.....it is MDs, agencies (like JCAHO and the CDC), and facilities. And yes, in the USA, you must have an MD order for a foley and many MDs will not permit them ordered unless absolute necessity .....and incontinence/convenience does not equal necessity.

Now, in theory, nurses have unlimited time and energy to repeatedly levitate their 350# combative dementia patients to keep them dry and clean....but we know reality. But I would have an issue with continually getting soaked transfer patients....who works anywhere where that would be permitted? Barring a major emergency, they should at minimum make sure a transfer patient to/from any unit is dry/clean.

[VivaLasViejas, ASN, RN]

The debate about Foleys is one of those in which the pendulum seems to swing from one extreme to the other, according to whatever theory is in vogue at a given time.

Even during the relatively short course of my career, I've seen this happen. When I started out, we were putting catheters in almost everybody who needed assistance with toileting, even those who were alert and oriented. Then by the middle of my final year in hospital nursing, many of our MDs wouldn't put them in at all unless the patient were post-TURP and couldn't void.........we couldn't even insert one in an incontinent nursing-home resident with a fractured hip until just before they went to surgery. Then the surgeon would order it D/C'd on the second post-op day, even if the pt. was demented, weighed 300#, and couldn't use a bedpan if his/her life depended on it.

I guess I take the middle ground with Foleys.........I think they're a godsend when you're giving 100 mg of Lasix IV every 8 hours, when the patient is totally incontinent and has skin breakdown because of it, after orthopedic surgery, and if a patient is so large that getting them up to the toilet takes six staff members and poses risks to all concerned. On the other hand, having had one on several different occasions myself, I find Foleys uncomfortable, and one's bladder tends to get lazy if it stays in too long. In addition, there's the ever-present risk of UTI, or worse.

Who knows, maybe one of these days that ol' pendulum will end up somewhere between the extremes; common sense, it seems, would be far more 'common' if healthcare providers were to exercise it a little more often!

[ERNP]

I know about the JCAHO and CDC business, but JCAHO has also taken on comfort as a medical directive. Foleys are not the most comfortable thing in the world but neither is lying in a cold, wet bed until someone has time to change it (which as previous posts have pointed out is often limited).

I always back up foleys appropriately placed. I have never had anyone place one simply for convenience. But fractured hip...... yes, place the foley. It is painful to rock and roll on and off a bedpan. This applies for other such illness and injury.

Diuresis... yes, place the foley. This promotes rest during the recuperation period. How much rest do you get if you have to pee every 10 minutes? None.

National organizations cannot replace sound bedside judgement. But I am sure they will continue to try.