Catheter Came out. Should I reinsert it?

Nurses General Nursing

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I was working overnight in a retirement home and it was reported to me that a patient had pulled out their catheter. When I went to assess them I noted that they had no output in the catheter bag and their urethra was bleeding. I drained the balloon to help relieve pressure, but I didn't take the catheter out because I was scared of causing more damage. I wanted to reinsert a new catheter but I wasn't sure if I was going to cause harm to the patient, so I decided to send them to the hospital. Please help, I'm not sure if I made the right choice, I know it's better that I was overly cautious by sending them, but I never like to send people to the hospital unless it is absolutely necessary. I didn't feel comfortable reinserting it but I had to do something. Did I make the right choice?!

Specializes in LTC, Rehab.

I would've (and maybe you did) asked the dr. on-call whether to send or not, not this group! :^) But we had a similar incident at my workplace not long ago. A guy pulled it out, balloon and all (and resulting blood), and he was sent out due to any possible damage.

Specializes in Critical Care.
Hey JKL33, there is no doctor on call. I don't know the regulations for retirement where you're from, but I'm in Ontario and health care here at the moment is very corrupt. It is not illegal to have a retirement home without an on call doctor, and I actually have never heard of a retirement home with one. I don't think it should be that way but believe me I have asked and its not an option, its a money saver unfortunately. Thanks for responding though! I feel better with my decision now.

It is actually illegal in Ontario to have a long term care home without an after hours on-call doctor. Failure to comply with this law should be reported to the Ministry of Health and Long Term Care of Ontario.

I don't know where you're finding that source of information, but from living here my whole life, I have learned that isn't true, it is also not illegal in ontario to hire one nurse for hundreds of patients, I have over one hundred at night and there is no law on the ratio of one nurse to multiple patients.

I just don't understand how a medical facility can not have an on-call doctor.

welcome to free health care lol, it's a money saver, the province is in debt

You deflated the balloon, but didn't pull out the catheter? I find that odd. Did it not just slide out after that when the resident moved? There should be an order for that catheter and a reason for insertion.

It's very normal to see bleeding after a patient has tugged at their catheter. It usually clears up in a few hours. Since it wasn't actually pulled out, I would have left it in. Especially until I knew the reason for insertion. If they had prostate issues and insertion was difficult, assuming they were male, you could have a huge issue if it was placed for urinary retention.

I would not have deflated and left the catheter in. If you deflate, pull it out. But a little blood is no reason for you to pull it.

The balloon was actually sitting in their urethra so they had almost pulled it completely out. I deflated it to try prevent further damage. I didn't pull it out cause I was worried I would make it worse, but it didn't fall out after on its own. There was no output overnight either and it was the morning at this point, so I was certain the catheter wasn't in.

Specializes in Critical Care.
I don't know where you're finding that source of information, but from living here my whole life, I have learned that isn't true, it is also not illegal in ontario to hire one nurse for hundreds of patients, I have over one hundred at night and there is no law on the ratio of one nurse to multiple patients.

It's from the Ontario Long Term Care Homes Act of 2007:

Attending Physician or RN(EC)

Every resident must receive a physical examination conducted by a physician or a registered nurse in the extended class (RN(EC)) upon admission and once a year thereafter. Written reports of the findings of the examination must be produced. Attending physicians and RN(EC)s must attend regularly at the Home to provide services, including assessments and must participate in after-hours and on-call coverage. A resident or his or her substitute decision-maker can retain his or her own physician or RN(EC) to provide the medical services required. If this is not done, the Home, in consultation with the Medical Director, the resident and the resident's substitute decisionmaker, must appoint a physician or RN(EC) to provide the resident's medical services. The Home must enter into a written agreement with every physician and RN(EC) who is retained or appointed.

Section 83 - Agreement with Attending Physician

An attending physician must enter into a written agreement with the Home that includes the term of the agreement, the Home's responsibilities and the physician's responsibilities or duties, including the physician's accountability to the Medical Director for meeting the Home's policies, procedures and protocols for medical services, provision of medical services, and provision of after-hours and on-call coverage.

http://health.gov.on.ca/en/public/programs/ltc/docs/ltcha_guide_phase1.pdf

This is for long term care, I work in retirement which is separate in Ontario. Although I do have another job in LTC and at night there is no on call physician so there must be some kind of loop hole.

Specializes in Critical Care.
This is for long term care, I work in retirement which is separate in Ontario. Although I do have another job in LTC and at night there is no on call physician so there must be some kind of loop hole.

If the facility itself provides any sort of nursing or other healthcare services then it must be licensed as a long term care home, a retirement home not licensed to provide health or nursing services cannot provide those services. Are you caring for these residents as a private duty nurse?

Retirement homes in ontario are licensed under the Retirement homes act, they are separate and are not funded by the government. So it is licensed just not under and LTC regulations.

I have worked in skilled nursing in the US, and you generally can't call an on-call MD for Foley problems. What you didn't include in your original question is other assessment data: What was his output in the last shift? Why does he have the Foley? Any bladder distention? Any discomfort? You may want to flush the Foley next time, to make sure it's patent. If you have access to a bladder scanner that would be a helpful tool. You also don't mention if there is an order to reinsert the Foley if it becomes dislodged or clogged. This might be helpful in the future.

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