Need some advise...Please!!

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.

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. :)

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!

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.

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.

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?

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!

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.

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?

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???

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.

Lostdruid, with all due respects I disagree. When a police officer makes an arrest it is based upon probable cause. Showing intent has nothing to do with it. Probable cause means that there is a reasonable belief that an offender has completed the elements of a crime as defined by state statute. There are 3 tests for criminal prosecution and conviction. First the police are concerned with probable cause, second, the prosecution is concerned with reasonable expectation of successful prosecution, and third, the courts are concerned with guilt beyond a reasonable doubt. The subject of intent comes in somewhere between the prosecution and courts. As far as being able to charge someone with sexual battery in the circumstances provided at the start of this thread, it would depend upon how the state statute was worded in the state in which it occurred. In Florida, penetration of the urethra is not specifically covered in the sexual battery statute. In other state laws that I have reviewed, it is covered. I know of a case in Florida where a child molester penetrated a male child's urethra with an object and was charged and convicted under the sexual battery statute. I'm no prosecutor, but I think it had something to do with case law. There is a provision in the statute for bona fide medical purposes. But bona fide goes out the window when the patient refuses or withdraws consent. As to the matter of using a sedative to make the patient more compliant, there is a provision in the Fla statute that makes the use of this a higher degree of felony if it renders the victim helpless. The use of a sedative could result in a charge of false imprisonment if the sexual battery charge could not be applied. During my career I have had several advanced classes on the subject of sex crimes investigation. The issue of medical personnel going over the limit has come up. You really have to be careful when it comes to consent. The police are charged with the responsibility to protect the rights of an individual with regards to equal protection of the law. Failure to do so may result in criminal and civil liabilities. It is preferable to make an arrest if it meets the elements of a crime even if you don't agree with it.