Indwelling Catheters

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This is somewhat of a rant, and a discussion. So if I offend, I apologize, and those that get me, I'm glad we can relate. I work on a post-surgical unit where mobility is almost always an issue. And sometimes we get overflow from another unit where mobility is an issue.

Our unit is generally pretty standard about catheters. If you're having a surgery that will make physical therapy unable to see you for approximately a day, you have a foley catheter inserted. This is the standard, minus maybe one physician. And every patient that physician sends up post surgery ends up unable to void. With 300+ in their bladder. Yeah, they get an indwelling catheter too, except it's an extra step for the nurses because we have to call to get an order, etc. P.S. PACU nurses, it's annoying as crap when you send up someone and I scan them the second they get to the floor and they have like 500+ in their bladder.

Anyway, I'm a new nurse, and I'm wondering about your unit's policy. With surgeries that cause prolonged immobilization do your physicians always order catheters? I realize CAUTI is a huge problem, but I have seen physicians deny catheters on a patient with a known long history of urinary problems. I don't mind helping a pt to the bathroom, but 8 times a shift with a post-op and I have 5 patients and my nursing assistant has 14+? I don't want to seem crass, but even if my patient takes just 5 minutes total to get to the bathroom and back that's 40+ minutes a shift. How does your unit handle this if you are on a unit where EVERY patient cannot get up on their own?

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If a pt can ambulate with or without assist the foley should come out. Unfortunately they can't be left in for our convenience.

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If a pt can ambulate with or without assist the foley should come out. Unfortunately they can't be left in for our convenience.

Maybe I miscommunicated. I didn't mean JUST for my convenience. The pt had a long history of issues, and even night of surgery had no catheter. Difficulty ambulating, but managed, I got them up a number of times without complaint, just....I get it. The pt ASKED for a cath the next day and ask for a renal consult and was told no to both. I agree part of it is I just need to work through 'dealing with it' but I can't be the only one feeling like this. I wanna give you ten minutes to get to the bathroom but if you have to go 10 times on my shift and it takes you a long time each time, it can be frustrating.

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Specializes in Cath/EP lab, CCU, Cardiac stepdown.

Is a bedside cammode an option?

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Bedpans?

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Maybe I miscommunicated. I didn't mean JUST for my convenience. The pt had a long history of issues, and even night of surgery had no catheter. Difficulty ambulating, but managed, I got them up a number of times without complaint, just....I get it. The pt ASKED for a cath the next day and ask for a renal consult and was told no to both. I agree part of it is I just need to work through 'dealing with it' but I can't be the only one feeling like this. I wanna give you ten minutes to get to the bathroom but if you have to go 10 times on my shift and it takes you a long time each time, it can be frustrating.

If the pt is having difficulty emptying the bladder and has high residuals a urology consult might be needed.

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Specializes in orthopedic/trauma, Informatics, diabetes.

LOL I work on an ortho unit. ALL of ours have mobility issues and they are really on a trend to limit Foley time. Some sx don't have Foleys (ankles and shoulders) and come from PACU not having voided in 10-11 hours. Knees and hips, they are out of bed POD 1 so Foley out then. Only ones with a hx of retention might get an extra day or two. usually all get a trial and if they don't void, then we may try and in and out and a trial again. If that doesn't work, they get 24 hours and another trial. Very few get long term Foleys. We use a lot of bedpans or BSC. Sometimes we don't have aides so it is pain and potty (and positioning). Time management.

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Specializes in Hospital Education Coordinator.

Our Quality Analysts tell us that the foley has to be removed before midnight on Day 2 of surgery unless MD has ordered otherwise. This is a JC Core Measure. Day of surgery does not count. So if surgery was Monday, the foley needs to be removed by Wednesday, before midnight. If it stays we need assessment q 24 hours with MD order to maintain.

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I think I was just ranting a little bit coming off a frustrating shift where I couldn't keep my head on straight running people back and forth to the bathroom. I feel better, just needed to get it out I think! I know reducing catheter associated infections is important, and I do believe in getting them out early - I just need to figure out a way to clone myself so that I can get multiple people to the bathroom at the same time =p

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My floor is ortho/med-surg. Generally our patients only have Foleys if they came in with a hip fx. Since they usually go home or to rehab on POD 3 or 4, it doesn't make much sense to keep one in after surgery. A big part of therapy is for them to learn to manage their toileting as independently as possible. They do take a long time to go to the bathroom and the women seem to pee a lot! The men use urinals and we use bedpans the day of surgery since the pts have nerve blocks. We use the bedside commode mostly unless the pt is doing really well.

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Starting POD 1, we very strongly discourage the use of bedpans. I make sure the newer techs know this so that they won't use a bedpan for their convenience. Every trip to the bathroom provides a little therapy session and an opportunity to reinforce teaching related to precautions and safety.

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For our hip and knee replacements, catheters usually come out on the morning of day 2. The surgeons are usually are ok with them staying in a day or two longer if the patient is really immobile.

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