Catheter Came out. Should I reinsert it?

  1. 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?!
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    About fergsu22

    Joined: Jul '18; Posts: 12; Likes: 24

    52 Comments

  3. by   JKL33
    It'll be okay.

    Question, though: Is there no physician/provider responsible for this patient - to whom you might have been able to report this change in condition and receive orders how to proceed if you were unsure?
  4. by   fergsu22
    The physician only comes once a week on the day shift. I do have a boss that is supposed to be on call 24/7 but they didn't answer the phone. I am the only nurse for the building at night and I'm also a new nurse which is tough cause I often rely on nurses with more experience in situations like this. So if I'm not sure I have to send to the hospital but sometimes it feels like a waste of services.
  5. by   Davey Do
    Yeah, under the circumstances you made the best decision, fergsu.

    This could be a great learning experience- you know- what did the hospital do, what would the physician recommend in the future, etc.

    The best to you.
  6. by   JKL33
    Quote from fergsu22
    The physician only comes once a week on the day shift. I do have a boss that is supposed to be on call 24/7 but they didn't answer the phone. I am the only nurse for the building at night and I'm also a new nurse which is tough cause I often rely on nurses with more experience in situations like this. So if I'm not sure I have to send to the hospital but sometimes it feels like a waste of services.
    The physician may only visit the facility once a week on the day shift but that doesn't mean that's the only time frame in which a provider is responsible for the patients.

    Your boss is not the medical provider responsible for the patients. Who would you call if you really needed an order for something? That's who you call when your patient has a change in condition and you need help figuring out what to do.

    I understand that because of various policies, practices and arrangements the fact that there is a medical provider responsible for all of these patients becomes less clear. But it's a fact; at least it better be.

    Next time you go to work, make a point of finding out which provider is on call just so you know this person/role exists so you have an additional route of assistance in mind for the future, should you need it.

    I agree that under the circumstances it wasn't wrong to send the patient to the ED.
  7. by   fergsu22
    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.
  8. by   TriciaJ
    Quote from fergsu22
    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.
    Yikes! I know health care has never been great in Ontario but I didn't realize it was this bad. Theoretically, everyone should have their own doctor and that is who should be called (or whomever is covering). For example, your patient with a Foley: on whose order was that even placed? That physician should be the one to call.

    Otherwise, you absolutely did the right thing. No way do you just reinsert a Foley that has been pulled out and caused damage. If that means racking up ER bills, so be it.

    Please keep us posted on what happened. I have a feeling your administration won't even bat an eye.
  9. by   Here.I.Stand
    WOW...that is nuts.

    If you had no access to a provider yeah you do what you have to do... but it would have been better to have someone who could tell you for sure. An on-call provider could at least access the resident's EMR, read his urology notes, and decide if it's something that could wait until a.m. Or that it's ok for a nurse to re-insert (vs a urologist... I've seen orders for urology only to insert)

    But that's not your fault.

    One thing I would have done differently is after deflating the balloon, ever so gently tug on it -- if the catheter was sliding easily with no resistence it should just come out. My thinking is it's an infection risk. (Obviously had you felt resistance, better to leave it alone.)
  10. by   JKL33
    Quote from fergsu22
    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.
    Yes, I wouldn't worry about it any more if I were you.

    Now, not to keep going off-track here (especially with the good chance I'm wrong, lol) but are you not subject to the LTCHA at your facility? It appears to specifically address the issue....

    (Part II Medical Services, sections 80-84...)
  11. by   Have Nurse
    Quote from JKL33
    The physician may only visit the facility once a week on the day shift but that doesn't mean that's the only time frame in which a provider is responsible for the patients.

    Your boss is not the medical provider responsible for the patients. Who would you call if you really needed an order for something? That's who you call when your patient has a change in condition and you need help figuring out what to do.

    I understand that because of various policies, practices and arrangements the fact that there is a medical provider responsible for all of these patients becomes less clear. But it's a fact; at least it better be.

    Next time you go to work, make a point of finding out which provider is on call just so you know this person/role exists so you have an additional route of assistance in mind for the future, should you need it.

    I agree that under the circumstances it wasn't wrong to send the patient to the ED.

    Excellent advice.
  12. by   Daisy4RN
    Quote from fergsu22
    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?!
    So, the patient pulled out the catheter and the other nurse had already reinserted it when you came on duty or had just left it in place? If you did not have access to an on call MD for instruction than I agree with others that you did the right thing by sending the patient for further evaluation. As someone else stated I might have troubleshooted to see what could be wrong first but if you didn't know what to do, and had no one to ask, then you did the right thing. I don't know your policies but in most places you cannot insert a catheter without a MD order, even if it is because the previous one came out. Also, the patient may have a condition or history that would require the catheter to be placed by Urologist. Very scary situation that you have no on call MD.
  13. by   rockyroad#
    First and foremost, you should have called the PCP and report the incident and let him or her to put it back. You said it was bleeding , that's trauma and you shouldn't insert it not knowing how much damage to the urethra.. Always ask if you don't know. It's better to look like you don't know something because you ask than to do the wrong thing! My moto is ask not one , but more than two.
  14. by   djh123
    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.

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