Need some advise...Please!!

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I had a pt in the ER who refused to have a nurse put in a foley so the resident ordered a urology consult. The doctor had a really hard time persuading the pt to let him put the foley catheter in. The pt was verbally abusive to the urologist, ER physician and I the nurse. Tell us we were stupid, didnt know what we were doing.. so on. 30 minutes and 4 mg iv versed later, the patient had the foley in. The doctor said try not to let him pull this foley out. The pt proceeded to say he had to pee. I and other nurses tried to pursuade this pt that he had the foley in draining his bladder. Pt stated it wasnt draining fast enough and that he had to go pee. Pt stated that he wanted the foley out. Numerous times did I have to tell the pt to relax and lay down but he was very agitated and annoyed. Pt locked himself in the bathroom and came out with the foley in two pieces. He went into his belongings and had a box cutter he used to cut the foley tubing and pulled the foley out. I inspected the foley initially and it looked intact so I threw it away. Went to the orders to notify the resident and the urologist wrote orders for sedation 1:1 sitter or restraint to keep pt from pulling out foley. I think about the situation 24 hours later and I cant say for sure what i saw. What if the foley was not intact when I threw it away? Am I guilty of neglect or negligence?

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What difference does the condition of the catherter make to any of this?

You had an agitated non-compliant patient. You did not restrain him either chemically or physically which is a good thing because you're not supposed to unless he's a clear danger to himself or others, right? So he removed the catheter. The physician then ordered a sedative.

What could you have done differently? Tied him to the side rails? That's a no-no. Grabbed him to stop him? He'da hurt you.

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Unfortunately you can't control what a patient does all the time. Was he competant when he said he wanted the foley out? Just document what happened and that you inspected the foley and it appeared intact. Documentation is your best friend!! LOL!! Good luck and don't dwell on it. You did what you could from what you wrote. :)

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Specializes in Rehab, Med Surg, Home Care.

The condition of the catheter matters because it was necessary to be able to verify that none of it was left in the patient's bladder. (Granted, when a patient pulls their catheter out it is not usually with the help of a box cutter-eek!) When we have a PICC line or any other invasive device come out, we examine it and document if it was intact or not. If not, off to x-ray they go!

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I don't think you're guilty of anything because on initial inspection you thought all the pieces were there.

Question: why was this pt being forced into a foley he obviously didn't want? If a pt tells me he does not want a foley, I back off.

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Question: why was this pt being forced into a foley he obviously didn't want? If a pt tells me he does not want a foley, I back off.

my thoughts exactly as long as the pt understood, which in this case i assume he did, because he was abusive and agressive (which is totally unacceptable) doctors should not prescribe a sedative in order for the procedure to take place and for him to keep it in place, they should have carried out this mans wishes and not done it.If the procedure was carried out when the pt refused it is classed as 'battery' in the UK (i assume in US too)and leads to disciplinary action and can be struck off the register! Did the man complain to anyone about this taking place without his consent?

sorry but dont mean to be nasty here but if a pt says NO he means NO! i think its terrible the procedure was carried out and as nurse you should be acting as the pts advocate and who actually administered the sedative the nurse or doctor? As the nurse i hope you documented everything.

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Specializes in Medical, surgical, inpatient rehab.

The condition of the foley is VERY important as a prior poster said, it is nurses responsibility to make sure she knows if any was left in the patient. Also though I am wondering something else, you mentioned the urologist ordered a 1:1, how did the patient get into the bathroom by himself? Is this part of what you are worried about?

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The condition of the foley is VERY important as a prior poster said, it is nurses responsibility to make sure she knows if any was left in the patient. Also though I am wondering something else, you mentioned the urologist ordered a 1:1, how did the patient get into the bathroom by himself? Is this part of what you are worried about?

I agree. There was a patient on the unit next to mine who managed to pull his foley out. The nurse was unable to find the tip. Needless to say the patient had to undergo an invasive procedure to have the tip of the foley removed from his bladder.

Also had just the opposite happen to me recently. I was floated to another unit one day and was taking care of a rather large, elderly man with multiple health concerns. He had a foley that according to night shift's report, the patient was refusing to have removed, even though the doctor's order stated it be removed at 5AM. The urologist came in that morning and proceeded to ream me out because the foley was still in. I told the urologist that the patient was refusing to have the foley removed and that I could not do it if the patient was refusing, and that HE needed to go talk to the patient instead of yelling at me. When the urologist came out of the room, he decided it was in the patient's best interest to keep the foley another day or so. Go figure...The urologist did apologize though!

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Specializes in Critical Care.

With sound thinking I would have to say that if the pt cut the foley tubing with a box cutter, the saline in the balloon would have drained. Thus allowing him to pull it out. If you say that it wsa intact I would say it was intact. The baloon was probably deflated, probably a 99% chance, when the foley was pulled out. You saw what you saw. If for some reason the foley was not intact and a piece was left inside of his urethra or bladder then it would just be a mistake. That is not negligent. To be neglegent you would have had to have a duty to act, and fail to do so. There is nothing for you to fret about too much.

The one thing that I would worry about is that you are working for a hospital that would allow things like that ot happen in the first place. If a patient says no, gets a consult, and says no again and the physician orders versed and puts the foley in anyway, it is considered assault. Which is something to worry about.

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Specializes in Stepdown progressive care.

I also believe that the balloon would probably deflate after being cut. We just had a patient on my floor that cut her foley and the balloon did deflate.

Why was the patient being forced to have a foley? Was there a medical reason for it?

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Neglect, no. Negligence, no. Battery, yes. Sexual Battery, probably. That's what I would be worried about, this pt coming back with a lawyer. A pt has the right to be in control of their own healthcare. Period. Any competent person has the unmitigated right to refuse care. Whether they are verbally abusive or polite and respectful is irrelevant, they have the right to say NO. Or is there something that I don't understand about patients rights???

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Neglect, no. Negligence, no. Battery, yes. Sexual Battery, probably. That's what I would be worried about, this pt coming back with a lawyer. A pt has the right to be in control of their own healthcare. Period. Any competent person has the unmitigated right to refuse care. Whether they are verbally abusive or polite and respectful is irrelevant, they have the right to say NO. Or is there something that I don't understand about patients rights???

I agree 100% with the sentiments expressed in this post. No means no and to force a patient to accept a procedure that he has not consented to is absolutely wrong. I do however disagree that this could be considered sexual battery. Just because it was a foley does not mean that there was a sexual INTENT, which is a required component when charging someone with a sexual crime. That would be like saying that since I ran you over with my car and the car happend to hit your genitals, I would be guilty of a sex crime. Doesn't work like that.

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