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?
Yep, I'm kinda surprised at the practices described in this thread. Vag bleeding
For this patient presenting in my ED, the likely course would be labs, pelvic exam to visualize os, and possibly bedside transabdominal and/or translady partsl U/S.
I guess I've always looked at it this way,.if you are c/o abd pain 10/10, are less than 14 weeks preg and have no documentation of an IUP, ruptured ectopic trumps CAUTI.
It seems really unnecessary to me. An ectopic is diagnosed by an HCG quant and lack of visualization of IUP, and usually it's not a conclusive diagnosis, but a high index of suspicion. If the bladder isn't full enough, the sonographer can go translady partslly, which requires an empty bladder. Just seems like a barbaric practice for the convenience of the physician to me.
Specializes in Pediatric ED;previous- adult Ortho/Neuro.
We do this sometimes too, in a pediatric ED. Usually if lower pelvic abd pain, they are NPO and want to r/o torsion, which would be surgical, and a smaller deal window for getting the to OR. Not sure if torsion is more common in pre-teen/teen girls as opposed to adults? It's a pain though, I really don't like putting them through it. Though I get it more for an acute surgical issue where they want to get to OR within 6 hrs to avoid losing the ovary, and don't want to wait an hour or more for the bladder to fill by doing IVF.
It seems really unnecessary to me. An ectopic is diagnosed by an HCG quant and lack of visualization of IUP, and usually it's not a conclusive diagnosis, but a high index of suspicion. If the bladder isn't full enough, the sonographer can go translady partslly, which requires an empty bladder. Just seems like a barbaric practice for the convenience of the physician to me.
Specializes in Emergency, Critical Care (CEN, CCRN).
We've been waging this battle in my shop for the last 4.5 years that I've been in practice, and likely for a lot longer before that. Our physicians have repeatedly stated that they no longer agree with routine Foleys for pelvic ultrasound, we certainly don't like placing them because we incur trouble for violating the CAUTI protocol, and our radiologists have stated they don't care one way or the other as long as the image quality is decent. However, all our hands are tied by a certain non-trivial number of sonographers who will not perform any pelvic or abdominal ultrasound for any reason without a Foley. I've even had my ECP write a physician-to-nurse order "Do NOT place Foley for ultrasound, please send patient for exam when bladder full" and had the sonographer refuse to do the exam. (They also adhere to the rather quaint practice ADeks mentioned of refusing to do exams without a quantitative HCG result in hand, but that's another story.)
This issue has gone to the respective chiefs and directors of all parties involved (physicians, nurses and radiology technologists) at least three times that I know of, has come out with the same resolution every time (no Foley for pelvic U/S unless truly emergent), and yet we still have problems. At this point, I'm not sure if it's a lack-of-education issue or just plain stubbornness. For those of you who have working no-Foley practices, how did you get all your stakeholders on-board?
This used to be the practice where I work before I started there. They stopped doing it and switched to IV since foley comes with risk for UTI, and you're just creating a whole new problem for your pt.
Some pts still ask for it, it's their right.
BTW, in my experience, if you can't get a super great IV, bladder will take 2 hrs to fill and even longer for some ppl, also think some ppl are slightly dehydrated as baseline. And they're taking up a bed all this time...
Altra, BSN, RN
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