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Pushing with a foley in place

I was wondering how other nurses manage the second stage of labor when the patient has an epidural and/or a foley catheter in place. Do you remove the catheter for pushing, deflate the balloon, or leave it alone? I was helping a new grad last night with a complicated patient who had been pushing for nearly 2 hours. Her foley had clotted blood in it and we ended up removing it and replacing it. As a pretty seasoned nurse I have my own way of managing this, but was interested in some input from others. Thanks!

SmilingBluEyes

Has 20 years experience.

We deflate the balloon and if the foley stays in place, leave it there. If it comes out, obviously, we keep really good track of the bladder distention after delivery. I find the foley stays in more often than not if taped properly to the leg!

We remove the foley before pushing. After delivery we keep a close watch for bladder distention and encourage the pt to void as soon as possible. If the patient is unable to void, or unable to walk to the bathroom we usually straight cath them.

I feel like I live in an alternate universe . . . . we don't place foleys at all. Not for epidurals, not for regular deliveries. At times the doc or I will do a straight cath if during delivery we see that the bladder is full . . .but a foley? Never. Weird.

I had an epidural for my last child - my first epidural out of 4 babies. No foley. Well, not until I headed back for an emergency cesarean.

steph

SmilingBluEyes

Has 20 years experience.

Rofl, well, It's not weird to me, Steph, to place a foley in some labor situations

For example, it works great for long labors who have epidurals and to me makes a lot more sense than straight-cathing people repeatedly. But then, I think we debated this before, didn't we? :rotfl: Practices vary, but I would not say others' practices are "weird" just because they differ.....they just do that...differ.

We don't place foleys for laboring with an epidural either. It's rare that any of my patients have had an epidural long enough that they need to be straight cathed more than once or twice. Generally, it's just once, and sometimes, not at all, if their labor goes fast enough.

The only Moms to get foleys, are those going for a csection.

Very interesting how practices differ. I would think the risk of infection would decrease by putting a foley in to begin with rather than possibly having to straight cath someone 2 or 3 times. Then again .. the risk of infection would be less to not cath someone at all rather than inserting a foley. I love talking myself in circles.

Very interesting how practices differ. I would think the risk of infection would decrease by putting a foley in to begin with rather than possibly having to straight cath someone 2 or 3 times. Then again .. the risk of infection would be less to not cath someone at all rather than inserting a foley. I love talking myself in circles.

This sounds like a job for Evidence-based Practice Woman! :coollook: I wonder if there are any studies.

Fiona59

Has 18 years experience.

Had a 27 hour labour with epidural and foley (both were started after 16 hours of labour). I remember the foley came out when the baby was about six hours old and the epidural had been discontinued...

KaroSnowQueen, RN

Specializes in Telemetry, Case Management. Has 30 years experience.

My DD just delivered Saturday and they put in a foley as soon as she got the epidural, took it out to push and put it back in afterwards (but she stayed in L&D for almost 10 hrs afterward d/t complications). But they said they put in foleys again until the epi wore off.

My DD just delivered Saturday and they put in a foley as soon as she got the epidural, took it out to push and put it back in afterwards (but she stayed in L&D for almost 10 hrs afterward d/t complications). But they said they put in foleys again until the epi wore off.

See, now that does sound strange. I can understand using the foley during labor with the epidural. But the epidural is turned off at delivery if not a little before. The numbness should wear off within about an hour, which gives the patient plenty of time to get up to the BR without the need for a catheter.

SmilingBluEyes

Has 20 years experience.

Well, that is part of the problem; if you turn off the epidural to push, what's to say they don't push for 2-3 hours (or more) , experiencing horrible pain at this point----and in the event they can't push or baby gets stuck or is acynclitic or OP---- and mom needs a csection. Well, now you have turned off her epidural and the anesthesia crew has to play "catch up" with pain control, which may or may not be possible when an epidural has totally worn off. So, you have created another set of problems, potentially, in turning off the drip completely.

When a mom is super-numb, I request the MDA cut the rate in 1/2. this usually does the trick, w/o risking the pain medication benefit being totally lost. It also is useful for post-delivery repair of lacs.

I truly think turning off the epidural to push is ill-advised. We never do that where I work for the reasons above.

Our post-partum infection rates are well below the national standard, according to the latest report from our Infection Control Nurse, so I don't think we are creating infection control problems, using indwelling catheters in the case of extended epidural use/labors.

SmilingBluEyes

Has 20 years experience.

I forgot to add: once baby is out, we turn off the epidural drip. The epidural usually wears off WELL in time for mom to get up and void without the need for straight-cathing at all. If the foley is still in place, we leave it there until mom can get up to the bathroom to do pericare.

It works very well where I am, but I realize practices do vary. I am just saying how we do it and why I don't think it's all that weird.

I forgot to add: once baby is out, we turn off the epidural drip. The epidural usually wears off WELL in time for mom to get up and void without the need for straight-cathing at all. If the foley is still in place, we leave it there until mom can get up to the bathroom to do pericare.

It works very well where I am, but I realize practices do vary. I am just saying how we do it and why I don't think it's all that weird.

We don't turn off the epidural until baby is delivered either, but I have heard of it being done.

I don't think using a foley is a weird idea, I think taking it out before delivery then putting it back in after a successful vaginal delivery is a strange practice. I guess my point is, if the foley is in place due to Mom being "numb" and unable to get up to void, then why does she need a foley after delivery when the epidural is off and she will be able to get up to the BR (at some point)?

We never do foleys either.

k_cole21

Specializes in L&D/MB/LDRP. Has 5 years experience.

At the hospital I'm currently @ we always do foley's. I find it to be most helpful for the sake of repeatedly introducing the st. cath & for saving time for the nurses. However, we do take the foley's out to push b/c it can cause trauma to the urethra if that bulb comes out fully inflated. I've seen that happen a few times. I have run in to some docs that refuse foleys and insist on st caths @ other hospitals.

I can't even remember the last time I had to straight cath a woman in labor with an epidural. So the concern about cathing a woman 2-3 times doesn't apply where I work.

I get the woman up to void before the epidural is placed and usually she delivers within a few hours - we do let the epidural wear off a bit before pushing - we don't have continuous epidurals. The CRNA places the epidural, gives the meds and leaves, checking back in about 20 minutes later when the mom is usually numb. We can call him back in to redose or have the doc redose if necessary but usually it only takes one dosing to get the women complete and to the pushing stage. The epidurual wears off in about 3-4 hours, sometimes less, and she has relaxed enough to get some rest and allow the cervix to dilate. After delivery she is usually up and in the shower and then we move babe and mom to post-partum room. I've never had a problem with a mom not able to void.

I'm not saying one way is better than another - just remarking on the differences.

steph

Wow. Just last night I had to straight cath my patient because she was too numb to walk to the BR about 3 hours after delivery. She did have an epidural redose right before delivery however. Alot of times even when the mom's can walk they still can't void. I'd say I have to straight cath about 1/10 patients after delivery. I wonder if it has anything to do with the specific epidural med we use, or the dosage.

sbic56, BSN, RN

Specializes in Obstetrics, M/S, Psych. Has 24 years experience.

I can't even remember the last time I had to straight cath a woman in labor with an epidural. So the concern about cathing a woman 2-3 times doesn't apply where I work.

I get the woman up to void before the epidural is placed and usually she delivers within a few hours - we do let the epidural wear off a bit before pushing - we don't have continuous epidurals. The CRNA places the epidural, gives the meds and leaves, checking back in about 20 minutes later when the mom is usually numb. We can call him back in to redose or have the doc redose if necessary but usually it only takes one dosing to get the women complete and to the pushing stage. The epidurual wears off in about 3-4 hours, sometimes less, and she has relaxed enough to get some rest and allow the cervix to dilate. After delivery she is usually up and in the shower and then we move babe and mom to post-partum room. I've never had a problem with a mom not able to void.

I'm not saying one way is better than another - just remarking on the differences.

steph

I like the single dose method for epidural, if it makes sense to use it, as well. We never place foleys either and rarely do we need to straight cath even with running epidurals. I think smaller rural hospitals like ours are more apt to be less interventive and tend to do only what is really necessary. I can see the blanket policy of everyone getting the same care which includes more intervention in the larger places, as they can't be as personal about the care with the numbrs of deliveries done.

SmilingBluEyes

Has 20 years experience.

I like the single dose method for epidural, if it makes sense to use it, as well. We never place foleys either and rarely do we need to straight cath even with running epidurals. I think smaller rural hospitals like ours are more apt to be less interventive and tend to do only what is really necessary. I can see the blanket policy of everyone getting the same care which includes more intervention in the larger places, as they can't be as I personal about the care with the numbrs of deliveries done.

I am sorry but I have to address this post.

I , too, work in a "smallis" community hospital (we do only about 700-750 del/year), where many get their epidurals early in labor (at their request, naturally), and will have very overdistended bladders if left alone for hours of labor. They cannot get up to void, cannot feel to use a bedpan, either.

We do provide personalized and competent care, on a case by case basis, like most places. But if you think about,it you realize: IF a person is going to request an epidural at 2-3 cm and will labor for 7-8 or more hours, what else might you expect we should do? She has had a fluid load (IV) of at least 1-2 liters prior to and during epidural anesthesia/labor. At some point, her bladder will distend over those hours. I have emptied more than a liter of urine in many indwelling catheters in the course of labor and right after delivery. It may be due to varying medication mixtures and techniques employed by individual CRNA's/MDA's, surely as to how soon a woman "gets her legs back" and can void on her own. It's typical, unfortunately for it to be while for ours---sometimes more than 2 hours after the drip is turned off.

Like I said before, because practices vary; this does not mean a place lacks in personalized care or is doing interventions just because of "blanket policies". We have no blanket policy regarding use of indwelling catheters in labor. I believe the orders read, "monitor for bladder distension and cath prn", not "place an indwelling catheter in all patients receiving epidural anesthesia".

Of note: People receiving shorter-term anesthesia (specifically, intrathecal---perhaps the single-dose method you are referring to) don't get cath'd at all. We realize in the short term, it is usually unnecessary.

The OP was looking for suggestions regarding what to do with a foley catheter during pushing phase, and this is what we do where I work. I was trying to address her original question.

Yes, some practioners don't use them. It is individual, that is all. Hope this post is not offensive, I just wanted to clear up a misconception I saw here. If I am mistaken, I apologize now.

thanks. :)

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