OB Nurses....Question For Ya

Specialties Ob/Gyn

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I no nothin' about OB (work in ICU) and was just curious about something. Is it normal to have frank red blood in a Foley during a lady partsl delivery?

Well our epidural rates are through the roof, and therefore foleys are warranted and used often. I guess it's a difference of frequency and timing. If our epidural rates were lower and they were done later in labor, I would not place a foley either.

Why would you have an epidural if you were NOT in active labor? We try NOT to place epidurals until we have seen good cervical change, but it isn't always the case, of course.

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Sigh, where did I say we do epidurals on NON-active labor patients? Labor can be quite protracted, as you know, especially in inductions and primip cases.

So sue me or shoot me; I can't see straight-cathing people over and over after hours of labor when a foley will do the trick with less chance of infection and trauma of repeated instrumentation of the urethra.

Differences exist in many places; let's just leave it at that--- In a perfect world we would all have it like where you are, no one getting epidurals til later in labor and rarely getting them at all at that! Even better, they would all give birth drug-free and interventions (like caths) would be virtually non-existant.

Sadly, I live a long way from "Perfect". So, yes, It varies, and where we work (which apparently differs from where you are) epidurals are very common (despite childbirth and lamaze classes), tending to run over hours, requiring bladder hygiene, simple as that.

That is the beauty of these threads; we get to learn from others what practices are common and what are not and compare notes. Does not make others "wrong" necessarily, but doing it differently, with the hopefully same good outcomes. Have good day now.

Probably part of it is that we do not do huge numbers of epidurals and they are not done early on in labor very often. I have never cathed a patient more than twice. I understand the rationale for having one but we are not into mechanized labor/birth at my place. None of our practitioners order routine foleys. Personally, I might choose to put in a foley if I have cathed my patient a couple of times and it seems as if we might be heading to the OR, but that's it.

other than that, we try to keep labor as "normal" as possible.

ditto in my place of work. Our Infection Control officer actually states that is preferable from an IC standpoint to straight cath 2-3 times than leave an indwelling cath as that is a direct path for bacteria to migrate into the bladder. We always place Foleys in pts on Mag. I believe our guidelines state that if we need to straight cath more than twice (in labor or pp) than it is recommended to insert a Foley at that time.

In the rare cases where a patient not on Mag has a Foley in labor (such as a prolonged induction) the Foleys are pulled before pushing to avoid damage, although I think Deb's practice of leaving the deflated balloon in place is brilliant.

At any rate, we encourage all of our patients, epiduralized or not, to get up within 2 hours of birth to void and shower. It's rare that one of our patients does not "have her legs back" by then. Very few of our pts have trouble voiding post delivery too; if they can't "go" on the toilet many are able to pee in the shower- works even better than using a peri bottle!

Answer is you can't prevent it falling out fully. Just make sure it's taped well to the leg, let it empty passively by attaching a 10cc syringe to it, (leaving the syringe in place), and hope it does not....fact is, 50% of the time, the foley falls out. So obviously, about 50% of the time it stays in. This makes it worth it to try.

If it stays in, we reinflate it. If not, it comes out, IV fluids are slowed, epidural turned off and voiding is urged within 2-3 hours after birth. It works fine where I work doing it this way. I RARELY have to do PP straight caths unless the labia are extremely edematous..

I am learning so much on this board! I am curious, SmilingBluEyes, if the patient doesn't push it out during pushing, when do you routinely d/c the Foley? For us, we d/c the Foley on everyone at some point during the pushing phase, and everyone, epidural or not, is escorted to the bathroom at 2-2 1/2 hours post partum (unless there are complications). So I am just wondering how long your Foleys are left in. Thanks in advance!

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

the foley's only remain until a patient can ambulate and take PO fluids.

usually this is less than 2-3 hours post-delivery, but if an epidural is particularly dense, it may be 4 or more hours. It depends on patient and the anesthesiologist's epidural. Some are more dense than others.

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

At any rate, we encourage all of our patients, epiduralized or not, to get up within 2 hours of birth to void and shower. It's rare that one of our patients does not "have her legs back" by then. Very few of our pts have trouble voiding post delivery too; if they can't "go" on the toilet many are able to pee in the shower- works even better than using a peri bottle!

same here. early ambulation is ALWAYS encouraged where we work, as is showering when the patient can stand and walk on her own.

Probably part of it is that we do not do huge numbers of epidurals and they are not done early on in labor very often. I have never cathed a patient more than twice. I understand the rationale for having one but we are not into mechanized labor/birth at my place. None of our practitioners order routine foleys. Personally, I might choose to put in a foley if I have cathed my patient a couple of times and it seems as if we might be heading to the OR, but that's it.

other than that, we try to keep labor as "normal" as possible.

We do lots of epidurals and NO foleys. We get them up before epidural placement to void and then if need be, straight cath.

Come to think of it I cannot remember ever placing a foley for a laboring woman.

Deb is right . . . . this is a manifestation of the regional differences, nothing more. As an example, I use phenergan all the time IV and have never had it cause pain or phlebitis.

steph

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

touche steph. I kinda wondered when you would be bringing that up.

the foley's only remain until a patient can ambulate and take PO fluids.

usually this is less than 2-3 hours post-delivery, but if an epidural is particularly dense, it may be 4 or more hours. It depends on patient and the anesthesiologist's epidural. Some are more dense than others.

We often turn our epidurals off during pushing and most patients can get up and walk to the BR in the hour or so after birth. If not, we just wait. If the bladder is distended, we cath, if not, we wait.

As far as taking PO fluids.....we feed them a meal during that hour recovery period. They are usually starving!!

Well our epidural rates are through the roof, and therefore foleys are warranted and used often. I guess it's a difference of frequency and timing. If our epidural rates were lower and they were done later in labor, I would not place a foley either.

When you said "if they were done LATER in labor", it lead me to believe that maybe your epidurals are put in in very early labor. That's why I responded as I did.

Sigh, where did I say we do epidurals on NON-active labor patients? Labor can be quite protracted, as you know, especially in inductions and primip cases.

So sue me or shoot me; I can't see straight-cathing people over and over after hours of labor when a foley will do the trick with less chance of infection and trauma of repeated instrumentation of the urethra.

Differences exist in many places; let's just leave it at that--- In a perfect world we would all have it like where you are, no one getting epidurals til later in labor and rarely getting them at all at that! Even better, they would all give birth drug-free and interventions (like caths) would be virtually non-existant.

Sadly, I live a long way from "Perfect". So, yes, It varies, and where we work (which apparently differs from where you are) epidurals are very common (despite childbirth and lamaze classes), tending to run over hours, requiring bladder hygiene, simple as that.

That is the beauty of these threads; we get to learn from others what practices are common and what are not and compare notes. Does not make others "wrong" necessarily, but doing it differently, with the hopefully same good outcomes. Have good day now.

None of us lives or works in perfect! LOL! Why are you getting defensive? I was just responding to the post.

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I am not getting defensive. (rofl or I am in denial and am)..... :rotfl:

I guess I went there cause you said "foley's in epidurals are never warranted". That is not true in all cases universally. That they are not recommended in various settings, I see right here, but that does not mean they are "not warranted" in others. The literature I have read recommended this over repeated straight cathing due to infection control concerns and increased instrumentation/damage due to numerous caths.

I imagine there is literature stating straight caths are preferable. I just have not gotten my hands on it as of yet and this practice where I work serves us well.

It's like Steph said, for example, in some places, pushing IV Phenergan is ok and practiced-----whereas some of the current literature states this is a dangerous practice and some hospitals have discontinued it based on these studies...... It's apparently regional.

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