labor room nursing interventions

  1. Working on a research project with deadline. Trying to find a reference I can cite that addresses the need to remove a foley urine cath when active pushing begins. L/D is not me area (alway worked Cardiology). Obviously, we all know the balloon must be deflated and cath removed to avoid injury to bladder and/or urethra, but I need a source to quote. Would greatly appreciate any comments
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  3. by   gwenith
    Bumping this thread to the top so it can get more answers
  4. by   SmilingBluEyes
    I don't know of a reference and further, we do not always remove them in pushing stages. I have not seen women have bladder trauma in this practice, altho some of our docs DO want them out in pushing. The trouble is, in the presence of a dense labor epidural, if we remove them, the chances are fairly good they will have to have another catherization to empty their bladder while the epidural is wearing off. I have seen this more than once. So you are stuck with the additional infection risks posed by multiple catheterizations aren't you? If the epidural is not dense, then it's a different story. We can get them up to pee before their bladders become over-distended and risking lack of involution of the uterus.

    But like I said, I can't give you a specific reference that tells us to remove foley catheters in the pushing stage of labor. I imagine the recommendation appears in AWHONN or ACOG journals someplace. Good luck in your search!Di

    Did you try posing this question the perinatal listserve?
  5. by   L&D_RN_OH
    We don't use foleys for vag deliveries, even with an epidural, so I can't help you.

    Deb, do you really end up cathing pts quite often after delivery? I've rarely had a pt unable to get up to void within an hour or two of delivery, even with an epidural. Then we give them 3-6 hours, unless they are distended. Unless, maybe our epidurals aren't as strong. Although my pt the other night, couldn't feel a thing, even for pushing, and she was still able to get up to the BR 2.5 hours PP.
  6. by   SmilingBluEyes
    It depends on the epidural, or rather the anesthesiologist method. USUALLY, Ours are quite dense and they get PCEA, which can make them even more so. So in the absence of a foley, you can see how the bladder will fill up and rapidly, impeding both progress of labor and involution after delivery. If an epidural is NOT dense, no, we don't have to cath after delivery. Usually within 2 hours, we can get the moms up to the bathroom to toilet and clean up.
  7. by   SmilingBluEyes
    3-6 hours? After epidural labor? Nope, way too long--- considering the amount of IV fluid load on board during labor and for the epidural. Nope I would NEVER wait that long.
  8. by   L&D_RN_OH
    Quote from SmilingBluEyes
    USUALLY, Ours are quite dense and they get PCEA, which can make them even more so.
    What is PCEA?

    And no, it is 3-6 hours after last void, whether that was a cath or a trip to the BR. Generally, they void before th epidural is placed, then we cath 2-3 hours after it is placed. Usually the pt is not still in labor much longer than that.
  9. by   Spidey's mom
    I've never had a patient with a foley, epidural or not. How strange that we practice differently.

    My patient usually gets up for a shower after delivery even with an epidural.

    The last one slept until complete and then pushed the baby out in 5 pushes . . . bonded with the baby for about 1/2 hour and then up to shower.

  10. by   imenid37
    PCEA Pt. Controlled Epidural Analgesia. Where I used to work, C/S mom s had them x48 hours post op for pain relief. We don't use them where I am now, except in rare cases. No foley at my place for epidural either. We straight cath prn. I have also had pt. push w/ foley in. For example, a pre-eclamptic on Mag and Pit who has the foley in for strict I/O. I've had some docs say remove it for pushing and replace it after delivery and others just leave it in. I agree w/ StevieLynn, there are lots of different practices. What is Gospel at one institution, may be unheard of at another.
    Last edit by imenid37 on Apr 29, '04
  11. by   L&D_RN_OH
    Quote from imenid37
    PCEA Pt. Controlled Epidural Analgesia. Where I used to work, C/S mom s had them x48 hours post op for pain relief.
    Ohhhhh, we just use PCA for CS pts. But, if they kept it in for 48 hours, didn't that make it difficult to ambulate? Or is that like a walking epidural?

    Our pts with epidurals have continuous infusions until delivery, but not PCEA. And yeah, we only use foleys for CS.
  12. by   SmilingBluEyes
    Yes PCEA is like a PCA for epidurals. Pts press a button for an epidural bolus if they need it. It's very controlled, requires less need for BIGGER boluses by anesthesia personnel, and we get very good reviews from our patients using this. They love it.
  13. by   SmilingBluEyes
    Well, patients on epidural anesthesia don't ambulate where I work. They can't. They can't pee either, hence the use of foley catheters in cases where epidurals are in place more than a couple of hours or so. These epidurals are just too dense. Most CAN move their legs for the most part, but very few can feel to pee. 90% , with proper coaching, do SUPER on pushing. I guess it's all in the difference in the drug cocktails anethesia personnel use in their anesthesia practices as to what capabilities patients have while on an epidural pump.
    Last edit by SmilingBluEyes on Apr 29, '04
  14. by   imenid37
    Our post-op pt's w/ PCEA did walk to the bathroom after Foley came out and in the halls, etc. w/ assistance. It was Analgesia NOT Anesthesia. It was good because it was regional and so there was not so much drowsiness. In other words, good pain relief w/o the sedation. I liked it and it is one of the few things I miss about my old job. I don't always think they needed it for 48 hours, but that what it was ordered for. Often, it fell out because the pt's moved around so well. They usually had a basal rate and then dosed themselves prn w/ Fentanyl. There was no local anesthetic in most cases, so they ambulated well. Lots of itching seemed to be a drawback in a fair number of pt's.