Lasix and Foley for female patients..automatic ?

[carachel2]

We had a busy, but not crazy day in the ED on NY. I had two ladies who were in CHF and were given IV lasix in the ER. Both of these ladies were semi-mobile, but needed a bit of assist in getting up to the bedside commode. Needless to say, they kept me running for the few hours they were held in the ED (we had no tech on duty).

I heard a bit of grumbling from one nurse that I should just put in a foley for these patients. I tend to think it is an unnecessary introduction of a potential infection source and can prolong hospital stay for patients who are mobile enough to get up and go to the bathroom with minimal assist. I despise nurses who get the foley order simply for their own convenience on lasix cases like this.

So what are your opinions ? Get a convenience foley or dig in and be prepared to be helping these patients in and out of bed and be busy ?

[SFCardiacRN]

So, if they dont want to put a foley in her, who would they put a foley in due to immobility?

The risk of foley induced infection goes up the longer it is in. You cannot use foleys as long term treatment for incontinence in women. (Men can use condom caths) Unfortunately, there is no short cut to fastidious care in this case. Hope this helps.

[NurseNili]

here in my ed, chf patients are placed on lasix drips, and we have to do very careful intake and outputs, so we can titrate our lasix drip. most of the patients placed on these drips come in very sob and become more sob upon exertion. i will place a foley due to the i and o situation and to save the patient from exerting themselves. if placed with the utmost sterile technique and taped to their leg with some slack, they pose little risk of infection, if only kept in under 48 hours. if my patient is only semi-ambulatory or nonambulatory, forget it. they bought the foley.:angryfire

[SFCardiacRN]

The OP is talking about patients that are ambulatory but may need help, not immobile patients needing I & O. Each RN has to decide what is best for their patient and shouldn't base that on what is easiest. IHHO

[paphgrl]

I'm prone to put the foley in for a few reasons. When it is a very busy day and there is not a good gaurentee that someone will be "johnny on the spot" when the patient has got to go, the foley saves a potential fall from trying to get to the bedside commode. Secondly, if the patient is in a lot of respiratory distress as angie O'plasty notes, getting them up and down to BSC is not always the easiest thing, and not always beneficial for the patient. So, while the foley is beneficial for the Nurse, it is also beneficial for the patient, as they won't fall, or soak themselves trying toget out of bed. I'd feel pretty stupid if a CHF patient sufferred a hip fracture because I couldn;t get to them on time (Say I'm giving Cardiezem in the next room and the aide is off the floor transporting, etc).

The other very simple reason to use a foley with a CHF'er is to get an accurate idea of how mucht he patient actually is putting out. Yes, the stuff can be measured, but often someone (Family member) dumps it without measuring or telling, and then we are left with the patient saying, "Well I went 4 times..." This happens to me even after I repeatedly educate family and patient not to do this....

Thing is, I have seen mostly horrible technique for putting foleys in women.So, I'm dead set now about doing my own foley's....rather than delegating it.

People who don't clean appropriately, nurses who let go of the labia after cleaning and then open it up again to insert the foley, forget sterile technique entirely...

It isn't that hard to put a foley in properly, but I'd bet most of the time they aren't.

I am glad you mention poor foley technique. As a student I routienly witnessed seasoned nurses insert the cath tip in the lady parts before they figured out where the urinary meatus was. After poking around the lady parts, they insert the now non sterile catheter. As a newgrad, I had a preceptor who insisted I replace the cath if I miss on the first attempt. Until working with her, I thought probing for the meatus was the norm!

[Chaya, ASN, RN]

I agree with KatieBell about keeping accurate I + O; with our CHF exacerbation patients this is a must! Ambulatory or not, we don't leave it to the patient to be compliant. We make every effort to get the Foley order for the day or two it takes to resolve with lasix.

Yeah, female Foleys can be scary. I will actually throw on a non-sterile glove, locate the meatus and plan my approach before opening the sterile stuff. (Plus I'm superstitious. If I don't have an extra cath handy, it's guaranteed that I'll contaminate the one I have!):chuckle

Chaya

[beauty nurse]

I accetp with KatieBell

Foley it's important for Pt with CHF to calculate accurate I&O.

even it a sourse of infection ,, put we can minimize it by sterile technique.

[SFCardiacRN]

Accurate I&O can be done by bedpan.

[UM Review RN, ASN, RN]

Accurate I&O can be done by bedpan.

True, but just try and find the patient that will use one! :chuckle

[mom23RN]

Accurate I&O can be done by bedpan.

Not when they lean back and spill it all over the bed.