very general question...

[ender]

Hey, I'm a new nurse. today, i was positioning a resident alongside another nurse when she put the catheter tubing under the resident's leg and a pillow under his foot. i was trained to place catheter tubing over resident leg, securing to either thigh or abdomen depending on gender and having catheter bag on the side of bed resident is facing...rationale being that tubing won't get kinked/compressed, prevents skin breakdown, and less likely to get pulled. the other nurse stated that "urine doesnt go uphill." as for positioning of feet, resident on a roho mattress. I'd place under legs to off load pressure from hells; however, other nurse stating there is peripheral vascular risk, though res has no dx of PVD. having said that, a cushion under heels doesn't seem to protect heels, esp if a roho mattress is already in use. It would seem more reasonable to avoid use of said pillow in the case of PVD. Is there any right answer?

[xtxrn, ASN, RN]

Check your policy and procedure manual :)

[agldragonRN]

i would put the foley tubing under the legs because i would not want the urine to back flow. the foley tubing we use is very thick and very hard to bend so no issue with the kinking.

[wooh, BSN, RN]

Depends on the patient. EVERYTHING depends on the patient in question.

[Anna Flaxis, BSN, RN]

I'm with you.

I would drape the foley tubing over the leg, securing the tubing to the thigh, so as to minimize risk of tubing being pulled. The urine will drain into the collection bag, provided it is placed below the level of the bladder. Anyone who has ever had to clean a fish tank or siphon a gas tank knows this!

To truly "float" a heel, the support is placed underneath the calf, so that nothing is touching the heel, because it is suspended above the level of the mattress by the support underneath the calf. Placing a pillow underneath the heel just adds a pressure point to the heel, contributing to skin breakdown.

Also, by placing a pillow under the heel but not the lower leg, this creates hyperextension of the limb at the knee. This places undue stress on the joint.

To minimize risk of DVT, pillows should not be placed under the knee, because this can obstruct venous return due to increased joint flexion. If pillows are used, they should be under the calves with minimal knee joint flexion.

Just curious, did they not teach you this in nursing school?

[wooh, BSN, RN]

I would drape the foley tubing over the leg, securing the tubing to the thigh, so as to minimize risk of tubing being pulled. The urine will drain into the collection bag, provided it is placed below the level of the bladder. Anyone who has ever had to clean a fish tank or siphon a gas tank knows this!

I don't know, this is why I said it all depends on the patient. I've had patients that the only way to get them to drain was to have the tubing going down. Probably different from fish tanks and siphoning gas because in general, I don't suck on the end of the foley tubing to get it started. There are some foleys you just have to play with to get them to work. I do try to avoid having a leg resting on it. If there's a gap where the leg is raised up, and they have good skin, I might go through there, but in general I prefer to run it down the length of the bed and then have the bag hanging off down at the foot. But like I said, it all depends.

[Anna Flaxis, BSN, RN]

I don't like to have the tubing anywhere near the foot. You can probably imagine why!

You don't have to suck on the tube to get a fish tank cleaner going! You just have to prime it by submerging it and filling it with water. When you place the open end into the bucket that is lower than the tank, it wants to flow. A urinary catheter is no different. As the tubing fills with urine, it is priming itself and will drain. In theory, you could prime the hose before siphoning the gas tank and avoid having to suck on it, too.

[wooh, BSN, RN]

Which works at first, but once it's been in for a while, often not so much. Perhaps the tubing gets "un-primed"? But maybe you just have better luck with them than I do.

[merlee]

ARRRGGGHH!!! The tubing goes on top of the leg, the urine will eventually fill the tubing and flow downhill. Do you see the big groove in the leg where the tubing was under the leg??? YEOUCH! I am in pain even thinking about it!

And the pillows? With a Roho mattress, probably not needed, but if desired, the pillow should be high enough so that the heels are free of the mattress. I know this from personal experience. My left heel became quite reddened after a cardiac cath and I now cannot tolerate it rubbing on the sheets at all. I even use pillows on the leg rest of my recliner to 'float' my heels.

But then, I AM the Princess in the story 'The Princess and the Pea!!"

[aubrn]

Hey, I'm a new nurse. today, i was positioning a resident alongside another nurse when she put the catheter tubing under the resident's leg and a pillow under his foot. i was trained to place catheter tubing over resident leg, securing to either thigh or abdomen depending on gender and having catheter bag on the side of bed resident is facing...rationale being that tubing won't get kinked/compressed, prevents skin breakdown, and less likely to get pulled. the other nurse stated that "urine doesnt go uphill." as for positioning of feet, resident on a roho mattress. I'd place under legs to off load pressure from hells; however, other nurse stating there is peripheral vascular risk, though res has no dx of PVD. having said that, a cushion under heels doesn't seem to protect heels, esp if a roho mattress is already in use. It would seem more reasonable to avoid use of said pillow in the case of PVD. Is there any right answer?

I am a new nurse too. Sure we taught to do things a certain way in school and it all makes sense. I was taught what you were taught. Whose patient was it? Was the nurse you were working along side an experienced nurse with years of experience?

If someone is doing something differently than I learned it, as they often do as experience provides wisdom, I ask them why they are doing it like that and seek their rationale instead of telling them my way and why my way is right. ESPECIALLY, if the other nurse is experienced. They tend to be correct more often than not.

Im a new grad and we place pillows under heals. If PVD exists you would want to elevate to the level of the heart, I think which it seems like that might be what she was telling you.

ALways try to understand the other person, and ask for the explanation. However, if you go in saying this should be like this because I was taught this for this rationale its going to offend.

If your just looking to hear your view is right, your not asking the question for the right reasons?

[loriangel14, RN]

I always put the catheter over the leg. I have seen the results( a large red indentation) of having it under the leg for 2-3 hours.If someone is already at risk for skin breakdown it doesn't take much pressure to create an open area.

[graceomalleyRN, RN]

I don't know, this is why I said it all depends on the patient. I've had patients that the only way to get them to drain was to have the tubing going down. Probably different from fish tanks and siphoning gas because in general, I don't suck on the end of the foley tubing to get it started. There are some foleys you just have to play with to get them to work. I do try to avoid having a leg resting on it. If there's a gap where the leg is raised up, and they have good skin, I might go through there, but in general I prefer to run it down the length of the bed and then have the bag hanging off down at the foot. But like I said, it all depends.

What she said. I can't tell you how many times I've received a patient from ED and in report I was told the patient had a foley but "low urine output." I get the patient, fiddle with the tubing and put it behind and, lo and behold! An extra 200 ml of urine or more. Some patients just have physiology that requires tubing to be between legs for an hourly manual adjustment to prevent backflow.