Feel traumatized

  1. The other day the doctor ordered a pt.'s Foley changed out. I didn't feel good about it going in, because the last time the Foley was placed the urologist had to do it. Also, the pt. had been confused and had pulled it out three times before. It was a struggle to get it in and when I finally did, there was A LOT of blood (this is a heme unit). I just can't stop feeling horrible about injuring this patient and I can't get the picture out of mind of the blood coming out of his urethra.
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    About firstyearstudent

    Joined: Nov '05; Posts: 893; Likes: 260


  3. by   JennRN65
    Why wasn't the urologist called to replace the foley if it was so difficulty putting in to begin with?
  4. by   roser13
    I would not even have attempted to place the foley under those circumstances. If a urologist had previously been required, then a urologist certainly should have been required this time around, after even more possible trauma has taken place.
  5. by   firstyearstudent
    I don't know. I guess my rationale was that a month had passed since the last Foley was placed and the previous problems were probably due to trauma/inflammation from pulling the Foley out. Do you think I should have refused? I feel like you're blaming me. Doesn't the MD who ordered this have any responsibility? This is the first time I had this patient.
  6. by   RunnerNurse09
    I dont think anyone is blaming you. You should not have been asked to put it in if the urologist had to put it in before. You learned from your experience, and will know better. You have the right to ask that someone else do a procedure if you dont feel comfortable for some reason.
  7. by   JRD2002
    I would probably have gone ahead and replaced the Foley without talking with the urologist. Just because they had to consult one for Foley placement the last time does not mean that the patient will need a urologist every time it needs to be changed. Also if you did call the urologist they would probably want to know if you had attempted to place it and what problems you encountered. If you told them that you had not even tried I think they would probably be a little upset.

    I understand feeling bad about causing some hematuria. It occasionally happens and I usually feel bad about it myself. Hopefully though with a little irrigation and some time the bleeding won't be too severe. Don't beat yourself up over it.
  8. by   firstyearstudent
    I feel terrible about this. I know this doesn't excuse anything, but I probably would have discussed this if it had been another doctor, but this particular doctor is always such as a jerk. He really treats all the nurses like their idiots if they questions anything he orders. Frankly, I don't even know what the rationale for changing the Foley was, except it had been in a while and was leaking a little.
  9. by   Kooky Korky
    Where was your Instructor in all of this?

    Doctors who treat nurses like they're idiots should have Foley's inserted in them selves, don't you think? By first year students, no less. Ok, ok, just joking. Sort of.
  10. by   JRD2002
    It is most facilities P&P to change a Foley every 30 days. You gotta get over that fear about talking to jerky doctors especially when it is a safety issue with a patient.

    Chances are that if a urologist did come and place the Foley he would still be having hematuria. Sometimes there is just nothing you can do to avoid it.

    I just now realized you are a student which really helps explain why you are beating yourself up so much. When we start out in nursing we are focused on helping people so much that whenever you have to cause pain to a patient it makes you feel like a scumbag. You changing the Foley caused the patient to have some temporary discomfort and some bloody urine. If you had not changed it the patient could have developed an urinary tract or bladder infection or even worse his next Foley change would have to be done in the OR when they surgically remove it.

    You are also going to have to learn to leave work issues at work. You can't make it in nursing when you go home and obsess over what happened during your last shift.
    Last edit by JRD2002 on Feb 19, '10
  11. by   firstyearstudent
    I'm not a student. I'm a nurse who has been practicing for three years.
  12. by   rn4life2009
    I had this happen to me twice in a row. I felt terrible and I had been a lpn for a yr and a rn for a yr. It can shake your confidence but if you know you did it correctly then you have nothing to feel bad about. Recently I watched a urologist place a foley and he did things you can never imagine doing to a pt and yes there was lots of blood. Give yourself a break and move on. You care about your pts and there is nothing wrong with that.
  13. by   firstyearstudent
    This was not just bloody urine. It was about a cup of frank bleeding from the urethra. His platelet count was 30 and he was on Amicar already. But we've done Foley's on the unit under these circumstances before. I just was not expecting this amount of blood. I called the doctor (who then yelled at me for not calling the NP first) and he order a unit of platelets. Then three hours later he was still having some frank bleeding from the urethra and hematuria. Then I had to call the oncall who ordered a PT, PTT.

    Unfortunately, because of HIPAA issues, I cannot even legally find out how this patient is doing now.
  14. by   firstyearstudent
    Things on the unit have been bothering me more late. I am 45 and just had a baby eight months ago. Maybe it is hormonal. PPD or menopause (or both, ha!).