male pts who pull out foleys?

[erin01]

So i have now seen this two times. One was someone else patient and then it happened to me. I had a confused pt who right before the start of my shift pull out his foley. After i got report i went to check on him and he was covered in blood. So I cleaned him up and looked to see how bad it was. Part of the problem was he was pulling at himself only making it worse. So I did my best in cleaning him on went on my way. But every time i check on him he was continuing to dribble blood and now covered himself in it. So i was hopping that it would stop and he would urinate so i would not have to reinsert. Well close to 8hrs later i called the Dr. and explained he not urinated and i was concerned about him pulling it out again, so i got soft wrist restraints. I felt horrible for having to do this but it really was for the best. OF course once i did it all that was coming out was blood!!!!!!!!! I felt so horrible, and i just kept checking him all night to make sure he was ok. Now when i think about what he did...i understand that there has to be trauma since the balloon was still inflated! But its so hard, i just wanted to hear others options on this.

[oneLoneNurse]

Yow, that hurts! But, elderly, confused elderly men do that. They need soft restraints to keep them from doing it. Don't feel bad. It's something that may be necessary depending on the patient.

[Flare, ASN, BSN]

I've seen my share of self-removal of catheters. Most bleed like faucets for a while then taper off, though it always seems that my patients on a blood thinner were more apt to pull it out creating a scene not too far off from a horror film. You always feel bad for them, but remember it's our job to protect them from themselves if they are in danger of injuring themselves. Soft restraints in the confused little old man (or in some casaes the confused young man) pulling at their foley are usually necessary. You'd think they wouldn't do it again, but lo and behold you get the new one in and in 5 minutes they're tugging on it again.

Oddly, i don't think i've ever had a female patient rip her own catheter out.

[phoenixrn]

I had a female patient pull her catheter out.... twice! I remember staring in disbelief at the size of the balloon lying on the bed. And she didn't bleed one drop!

[sunnycalifRN]

One of our restrained, confused patients was able to pull out his foley!! Not with his hands, but with his foot!! He got the drain tube between his big toe and 2nd toe and the rest is history!! This same patient has pulled out TWO PICC lines, also!! (very sad case . . . schizo . . . wants to die . . . asks us to kill him!!)

[OutlawNurse86, BSN, RN]

As a male nurse (and a man in general) this thread gives me sympathy pains.....

Ow.....

[WalkieTalkie, RN]

Hah, I saw teenager able to get at it with his with his toes and pull it out!

[Larrythenurse]

Ouchee. But there are several thing to be done if the person has a potential for this:

1. Ask your MD how necessary the cath really is. Sometimes the person is cathed because of incontinence so try to just d/c it (with all other attendent risks) and put them in Attends instead.

2. If you got to have it, use the smallest lumen possible and underinflate the balloon! That way there is less trauma. (Of course increased ease to pull it out also!)

3. Keep the member as clean as possible! Especially with direct care staff, get right in there and show them how to retract his skin if need be and clean all around the head of the member.

4. This one is my favorites: Hide that thing! Put your guy in a Attends with a couple of pair of underwear and the hose threaded out back. Put his pants on backwards. ('Course check to make sure the line is patent, etc.) Give him an elastic band attached to his pants to yank. If pica is not a risk give him silly putty or other textured material to hold. Put something else in his hand to stimulate him!

5. Make darn sure the thing is loose and not pulling! Consider using KY (with xylocaine is great) on the urethra to cut down chaffing.

6. Make sure hairs are not getting wrapped up and pulled on the tube.

7. Folks, watch out for erections! Men get them naturally during the sleep cycle (and at other times, not always sexual.) If cathed, this can cause great discomfort. Examine behaviorial issues around the incident; could it have been sexually induced?

[Anisettes, BSN, RN]

5. Make darn sure the thing is loose and not pulling! Consider using KY (with xylocaine is great) on the urethra to cut down chaffing.

All of them awesome suggestions and regarding #5, please also use a cath strap (or make one out of tape if your facility doesn't have the adhesive velcro ones). Dangling foleys are one of my pet peeves, I can't stand it when an indwelling cath is placed in somebody and just left it dangling in the wind. If it's going to be left inside someone for more than a few hours - secure it! It hurts whether you're male or female when it's tugged or allowed to move all over the place. I even wrote a letter to Bard years ago asking why they couldn't automatically package one in the foley kit like they do the sterile gloves, specimen cup, etc... to encourage people to use it..

[ONCRN84]

I had one do that on medical. I was a new nurse and was told by an older nurse that I need to replace it ASAP before the swelling closed off the urethra and we wouldn't be able to get one in and he'd be unable to pee. Don't know if it's true or not, but it made sense at the time and we put one right back in.

[Bill E. Rubin]

I have seen confused LOLs pull them out (and make a bloody mess).

The other thing that sometimes helps is the soft mitts instead of wrist restraints. Of course that doesn't help against pulling out with feet (but creative routing of the tube does). The mitts can also help against pulling off tele wires and trachs, etc. Some pts are expert at getting the mitts off however, but they are often a less-restrictive option for many pts.

[mprather]

Another thing you have to be mindful of, is when they pull it out, and there's lots of blood...they risk developing clots in their bladder and will be unable to void. Then, you would have to re-insert, irrigate until it's pink and sometimes have the Urologist to place a TY cath for continuous irrigation. So, sometimes it is necessary to restrain to prevent from further complications.