OB ultrasound...foley or no?

[Kalipso]

You have a 9 wk pregnant female with c/o new onset bleeding 2 hours ago, bleeding has not even filled one regular pad. This is the first time she has ever been pregnant. You have started a line drawn blood and told pt is going to need to go to ultrasound.

Now first of all, at my last job, the MD would do a pelvic exam to see if the blood was coming from the cervix. My new job apparently they just do an ultrasound, no biggie just different. But to do this ultrasound they order me to put a foley in. I was a bit appaled at this. My last job we just hung a liter of fluids and told them to put on the light when they felt the need to go. I was told that the foley was necessary so the ultrasound tech can fill the bladder and if the pt needs to go to surgery then the Foley was already in. Now in 3 years I've only sent one OB patient to emergency surgery. Frankly I think this practice is quite invasive for what she needed, could easily lead to more complications, and it's true value is so the staff don't have to wait 30 minutes for her bladder to fill...which isn't a patient focused reason. Yes, if she looked bad(pale, low bp, lots of bleeding,fever) I probably wouldn't be so critcal but thatwas not the case and in fact is not the case for most treated abortion or total abortion patients I've seen. I just was wondering if foley insertion for this was more common than I thought or am I right to be a bit shocked by this?

[Anna Flaxis, BSN, RN]

Nope, never placed a foley for an OB US. I would think it strange as well.

[iluvivt, BSN, RN]

I would say that it depends on how quickly you need to get that US done. If the results are needed really urgently then the patient needs the Foley. I say hang the IVF or if the patient can just drink lots of water and be told not to urinate then the bladder can fill up rather quickly (as long as no potential surgery). I too am getting the feeling it is to expedite the whole process. Why risk a UTI if you do not have to do so and put the patient through that...I am with you on this one!

[ChristineN, BSN, RN]

I have only ever placed a foley pre OB U/S one time, and I remember it was a special situation where the pt was on the U/S table but they were having difficulty visualizing.

I would speak with the doctors and see why this is the practice. Maybe U/S expects it, maybe they had a bad experience once involving a pt that didn't have a catheter.

This may be one of those times that you need to remind your pt they have a right to refuse any part of the plan of care.....

[vintagemother, BSN, CNA, LVN, RN]

I had a foley put in to do an ob U/S when I was seeing a specialist while trying to conceive.

They put it in because it was easier to get the right amount of fluid into the bladder to better visualize the uterus.

My regular ob would have just told me, "leave you didn't drink enough water." So I appreciated the foley.

[applesxoranges, BSN, RN]

For us, it's what the patient wants. We have to give them the choice. The foley is preferred as it is quicker but the IV fill is an option. Most prefer an IV fill. Two times there were patients that the ultrasound techs just took anyway which was kind of a head scratcher since usually it is a fill just in case they can't visualize everything. They got the job done somehow.

[BrnEyedGirl, BSN, MSN, RN, APRN]

We always use a foley for

[Sassy5d]

My place requires foleys. They would sit on a pt till the cows came home.

I don't like the practice but what can ya do.

[Kalipso]

My previous employer did IV fill, it only took 30 minutes to get enough fluid in the bladder and now that I have to do this 'insert a foley for ultrasound' thing now I can say with little doubt that the idea that a Foley is quicker is false. I can see putting it in during certian circumstances but frankly if a hospital is trying to do patient focused care then foley insertion should not be a standard of practice....even in the ER.

[vintagemother, BSN, CNA, LVN, RN]

When you say IV fill, do you mean they give the pt IV fluids so their bladder fills? (Sorry for the question, I'm a new nurse)

[Anna Flaxis, BSN, RN]

I'm really surprised at how common this practice is. We will typically infuse fluids intravenoulsy, or if the pt is taking PO well, they can just drink water- and ask them to hold their bladder until after the US. If the US is going to be a while, I've even allowed them to empty their bladder prior to the pelvic exam, and then just hold it from then on. A foley seems kind of invasive to me.

[ADeks]

My ED does the same thing with the foley. It's a radiology thing. Patients can refuse, but I have seen them send patients back saying their bladder isn't full enough.

They also insist they can't do the US until the HCG quant has resulted. Which to me, doesn't make sense because they don't read the US, the radiologist does. By the time they read it, it'll be back.