help Foley question

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I am an RN in an assisted living situation a male pt comlained of blood to his cath. upon assesment noted frank blood temp of 100.2. C/o pain to member. Frank blood to breif. Call to phy spoke with advice nurse. I suggested deflating balloon and reposition. she stated no as long as he does not have a fever of 101.5, flank pain or no urine to offer fluids and wait till am and call home health that takes care of his cath. Pt temp elavated to 101.2 increase confusion a increase in weakness. sent pt to Er. Er nurse calls and is appaled that foley was not just removed. My stance is I followed the advice nurese. Phy nurse. If I removed Cath Pt could hemorage. Lpn at facilaty states she would have just taken it out. Any advice

thank you

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It seems to me as if there could be 1 of 2 possible problems and you would have to figure out which one is the problem before you could go any farther. First either there had been some kind of trauma to the cath i.e. pt pulling on it and causing bleeding ) or secondly that the patient is dehydrated and not putting any urine out but actually bleeding. I would have first determined if the cath was patent by irrigating it . If it flushed o.k. then it would either be trauma or low urine output. It is important to have a cath inplace if there is trauma to prevent clots from forming and blocking off the flow of urine so now we are left with monitoring urine output. If the next two hours there is no urine output the patient is probably dehydrated and needs iv fluids soon plus with the temp could very easily go into urosepsis needing hospitalization. If urine does continue to flow at least 30cc/hr I would monitor for color and presence of blood and perhaps encourage fluids if the patient could handle them . If the patient then spikes a temp I would then call the doctor.

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p.s. if you couldn't irrigate the cath then replace it asap

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There are certain things we can do without an order----irrigating and replacing a clogged cath is one of them. Or two of them. That, however, is in the hospital or home care setting. Not sure what you can do in an assisted care facility, you need to get that clarified. The advice nurse was way off: pain and frank blood demands immediate intervention, especially since he had a low grade temp. I understand she was going by protocols, but the pain and blood should have overridden the temp issue.

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Blood thinners could be causing bleeding. Do you have access to his PT/INR? Is there any other mucous membrane bleeding?

Do you have a bladder scanner available?? Why does he have a catheter to begin with?

I don't feel like you gave us much info to think critically and assess the situation.....

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Specializes in Almost everywhere.

Hi Frog1990!

Was there any reason you couldn't have just talked to home health right away? If they were the ones managing the care of the catheter, I would think they would have wanted to know. I have worked in asst living and as the nurse you can be very limited as to what you can and can't do for the resident because of the rules of asst living. Sounds like he needed further attention as he went to ER. More pieces to the puzzle would have been more helpful in giving you more of an answer.

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Hi thank you all for your replies. Pt was able to pass urine. The reason I called the phy is that I couldn't find anyinformation on the home health that takes care of his Foley. I do relize that today I will have to go in and find out exactly what our protacal is. We have no supplies for foley care except what each home health brings in. After reading all your answeres. I think I did fine just would have sent pt to ER sooner for his own comfort. inthe future I will make sure all infromation on homehealth and what they would like us to do is in the chart. Second look upour facilties exact policy.

Thank you all for your responses. :saint: I am so glad I found this site

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Specializes in surgical, neuro, education.

The other complication could always be enlarged prostate. In that case you might not be able to replace the foley and even if patient had a UTI--they would have to place a coude catheter by a urology nurse or someone with uro exp. If you flushed cath and determined patency and then monitored VS until he spiked enough to warrent ER care then it seems to me you did all you could. The only other step I would have taken is to get a C& S sample to take to ER.

Most older male with enlarged prostate or prostate CA have painless hematuria as a symptom. UTI's can cause some bleeding--but usually not the amount you described. Chances are this gentleman had UTI and prostate problems. He could have pulled on cath because of burning and pain from UTI and this enflamed prostate and caused the bleeding.

(the treatment for the bleeding would be to KEEP foley in and irrigate vigorously. (I have used several liters of NS--but we aspirate after we flush--very uncomfortable--)if this does not work by hand we hang a murphy drip that continuously flushes bladder. In either case need access via foley catheter.

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