when male patient pulls his foley out

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what do you guys usually do when a male patient pulls his foley out and he is bleeding where the foley is inserted?

Specializes in Med-Surg.

I don't agree that you need a urology consult for traumatic bleeding from a foley being pulled out. Uncontrolled, bleeding that doesn't stop after a reasonable amount of time, or clots that obstruct and inability to reinsert are reasons for a urology consult. But to consult a urologist for bleeding after a foley comes out isn't the first thing I would do.

Leave it out, see if they bleed on their own. Or put it back in, knowing that the cath itself can provide pressure to perhaps stop the bleeding.

Observe. Restraints and mitts prn. Of course the MD is notified.

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Specializes in L&D, High Risk OB, OR, Med-Surg, PHN.

]Had a TURP pt pull his 30 cc foley out balloon intact MD had me reinsert and ask family to sit at bedside. A lot of bloody fluid pt he did okay.

Lisa:bluecry1:

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Specializes in Neuro/Med-Surg/Oncology.
I don't agree that you need a urology consult for traumatic bleeding from a foley being pulled out. Uncontrolled, bleeding that doesn't stop after a reasonable amount of time, or clots that obstruct and inability to reinsert are reasons for a urology consult. But to consult a urologist for bleeding after a foley comes out isn't the first thing I would do.

Leave it out, see if they bleed on their own. Or put it back in, knowing that the cath itself can provide pressure to perhaps stop the bleeding.

Observe. Restraints and mitts prn. Of course the MD is notified.

I would be concerned re: further damage with reinsertion, especially the patient is elderly. It's a lot easier and the urologists are much happier to irrigate, check for damage and reinsert early than have to evacuate a bunch of clots, start a CBI and send the pt for a cysto. A lot more can be done with less invasion if done early. If the doc on call checks the patient and okays reinsertion, believe me, I'm all for it. It's not like I would be calling the urologist myself for scant pink tinge to pt's urine.

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Specializes in Neuro/Med-Surg/Oncology.
]Had a TURP pt pull his 30 cc foley out balloon intact MD had me reinsert and ask family to sit at bedside. A lot of bloody fluid pt he did okay.

]Lisa:bluecry1:

30cc!?!? :eek:

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All I have to say is ouch

Collin

I agree with you and i would have tears in my eyes.

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]Had a TURP pt pull his 30 cc foley out balloon intact MD had me reinsert and ask family to sit at bedside. A lot of bloody fluid pt he did okay.

Lisa:bluecry1:

yep, i've had pts pull their 30cc balloons out, intact.

and the urethra does indeed swell, after such trauma.

that's why i insert another one immediately, usually 16/18.

this size allows blood/clots to pass.

irrigate the dickens out of it, reposition and tape to leg.

i get md to prescribe anxiolytic, and frequently check on pt comfort.

and a lot more irrigating.

this usually seems to do the trick.

leslie

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Specializes in icu, er, transplant, case management, ps.

Ouch, ouch. I have had a few male patients discontinue their foleys. The uro called taught me a valuable lesson for reinsertion. Get a fresh, unopened tube of K-y, a sterile 30 cc syringe. Put the syringe into the opening. Put atleast 30cc of Ky and push. I had no problem passing the next foley and the patient didn't get an infection.

But a patient would have to be confused to pull out an inflated foley. The thought just sets my teeth to grinding.

Woody:balloons:

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Doesn't happen as much anymore since we try to not use so many caths in LTC, but it is common with the confused elderly that my have a cath in due to retention or severe pressure sores. No, we are not permitted to use Mits. We don't even have any in the place.

A lot of time, there is no real trauma except for a bit of bleeding. The confusion might help dull the pain. Depending on the reason for the cath, we might or might not reinsert.

Sometimes taping it to the leg relieves the pull or irritation.

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i'm asking this question because one of my male patient's foley was accidently pulled out and i reinstered foley immediately and irrigated it and called doc. but other nurse who i work with said i shouldnt have reinsterted foley and should have waited few days to reinsert the foley. but i have gotten a lot of responses here to reinsert the foley immediately. was i wrong, or what i did was okay? its been three days since his foley was pulled out and his foley is still draining blood and his foley is not draining too well of urine. can a patient vomit blood because of this?

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can a patient vomit blood because of this?

huh?

no, you wouldn't expect a patient to vomit blood because he'd pulled out a foley. two separate systems.

what is his platelet count? coags? liver function? is he on steroids, nsaids, anticoagulants?

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]Had a TURP pt pull his 30 cc foley out balloon intact MD had me reinsert and ask family to sit at bedside. A lot of bloody fluid pt he did okay.

Lisa:bluecry1:

Ouchy ouch! Seen it done with a 10cc intact, but never something that big.

I had to reinsert too, as MD said that if I left it out for any length of time the swelling might inhibit putting it back in and then he'd be in real trouble. He did OK too.

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my patient didnt have any urine output because of bleeding, and all of a sudden patient had coffee ground emesis. i'm asking this because i've heard of patient vomitting feces and bm coming out of patient's tracheostomy. :uhoh21:

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