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Removing Foley’s on intubated patients

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by righteousjenn righteousjenn (Member) Member Nurse

righteousjenn specializes in CVICU.

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So I work in CVICU.. within the last year our ID team has really been pushing for removal of Foley catheters on intubated patients. I am struggling to see the rationale behind this because most of the patients we do get who they are pushing this on are really sick. I have removed them on supervisor request only to have to reinsert my next shift due to urinary retention post removal (my guess is because they are sedated and it really does take active participation to void the first time).

How does your hospital manage these patients? Are other facilities doing this as well? And where is the evidence showing that this is ultimately better for them at this stage of their ICU stay? I’ve tried looking it up but have found nothing. 

I do realize the risk of infection, as with any invasive device, however, or CAUTI numbers have been 0 thus far in our unit (prior to them recently pushing this on us) 

my unit is small... our ICU is about 3x the size and most of my removals/reinsertions happen when I float to their unit. 

 

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125 Posts; 1,763 Profile Views

I'm not sure why one has to do with the other.    Intubation isn't related to urinary issues.    While the need for an indwelling cathter indeed should be revisited from time to time, I'm not sure why intubation is even a trigger let alone an indication for removal.

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missk729 has 1 years experience as a BSN, RN and specializes in Medicine ICU.

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Hello, nurse from Texas here! I am a Medicine ICU RN, and on my unit we generally try to assess the need for foleys in all of our patients. Most of the reasoning is to decrease risk of CAUTI's in our patients.  I've had one male patient who did have a condom catheter once his renal status improved. Other than that time, most intubated patients I have cared for had Foleys in place.

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Wolfbiologist specializes in None yet.

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As a male with the  experience of a mere 10 day foley, these things are horrid. The bladder spasms almost ended me. Pain from a spasm caused me to faint, fall, and smack my head on a concrete floor. That sucked.

Then when a nurse finally removed the wretched thing, I was unable to speak... let alone breathe... due to the pain of removal.

Kill me before you try to insert one of those damn things again. Otherwise, I will fight you to the the death if you try to shove one of those things in me.

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amoLucia specializes in LTC.

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Why intubated pts? I ask just like you.

Are they intubated AND unresponsive??? I guess they'd not complain about being turned & managed for incont care. So, on the other hand, being intubated BUT responsive pts could resist turning and be more restless.

Wouldn't I&O be expected of ICU level of care pts? We all know that output accuracy is almost impossible without a fc.

Incont increases the risk of skin issues, so wouldn't this be counterintuitive???

Oh, hush my mouth!!! Why should the higher-upperers make sense? 🤯

Maybe your physician staff could be an ally?

 

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viprn21 is a BSN, RN and specializes in CCRN.

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Foleys and CVCs are like ETTs...assess for readiness to remove at least daily. We had a similar push the past few years at my facility and I was frustrated at first, but over time I've come to see it's better for the patients. We have what are called PureWicks, they're basically a giant tampon attached to suction that sits between the patient's labia and catches the urine. It doesn't work on every single patient, but it's awesome when it does work. And males can use condom catheters.

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CCU BSN RN has 7 years experience and specializes in CICU, Telemetry.

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As far as I'm concerned it's a great idea in MICU, not as often in CVICU. First 12-18 hours postop- decreased UOP is often a sign that my CI/CO are falling, especially now that we're using less swans (or rather, it's the sign that motivates our providers to take action). Imagine if I had to wait 6-8h to find out instead of getting that data in real time... Then the foley really would be in all week. 

If my IABP migrates south and occludes the renal arteries...do you want your nurse to find out in an hour or two, then get an interventional doctor to adjust it in another hour or two, or shall I wait until my patient doesn't void for 6-8h, then another hour or two to get the device repositioned, and then I guess we'll keep them in ICU a few more days to 'watch' their AKI, but without accurate UOP...

 

PureWicks are great when they work. If your patient is wiggling/moving about the cabin or doesn't have enough girth/bonus skin on their labia...you can be SOL. I had one last week who couldn't bring herself to use the purewick. psychologically. too afraid she'd wet the bed. Was in tears in pain rolling onto a bedpan, still couldn't pee, had to lie flat for 6h (probably longer after I left, since her groin started bleeding while rolling about to get on the bedpan). I wound up straight cathing her 5 minutes before shift change because she was howling in pain, her doctor hadn't paged me back for 3 hours, and I'd spent the better part of 3 hours trying everything I could think of to extricate urine from her bladder. 

 

Men with urinals when they have any device where they aren't supposed to move/sit up/etc.....I've had more than a handful of patients with IABPs that go from CDI to oozy as all get out because my patient was using a urinal. I've literally given blood transfusions because my patient doesn't have a foley. 

 

Cardiorenal? CHF? Intubated patient on max vent settings with sub-optimal oxygenation? Yeah, let's throw some lying flat and rolling onto a bedpan into the mix. I'm sure they'll recover real quick after, too. That SpO2 of 53 is totes not real. They've always looked kinda blue. They just come from the Avatar planet. 

 

There are exemptions to every rule, I'll be the first to admit. Most nurses DO try to get CVC/ETT/Foley/Restraints out/off as soon as it's safe and appropriate. Most patients in our CVICU are here for 2-4 days before we transfer them out. Very few have marathon, months-long ICU stays. Our management recently started pushing docs on rounds to DC femoral central lines w/in 48h of admission. Their solution? Pull the line, but don't replace with a more appropriate site. 

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viprn21 is a BSN, RN and specializes in CCRN.

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On 10/26/2019 at 2:51 PM, CCU BSN RN said:

As far as I'm concerned it's a great idea in MICU, not as often in CVICU. First 12-18 hours postop- decreased UOP is often a sign that my CI/CO are falling, especially now that we're using less swans (or rather, it's the sign that motivates our providers to take action). Imagine if I had to wait 6-8h to find out instead of getting that data in real time... Then the foley really would be in all week. 

 If my IABP migrates south and occludes the renal arteries...do you want your nurse to find out in an hour or two, then get an interventional doctor to adjust it in another hour or two, or shall I wait until my patient doesn't void for 6-8h, then another hour or two to get the device repositioned, and then I guess we'll keep them in ICU a few more days to 'watch' their AKI, but without accurate UOP...

  

PureWicks are great when they work. If your patient is wiggling/moving about the cabin or doesn't have enough girth/bonus skin on their labia...you can be SOL. I had one last week who couldn't bring herself to use the purewick. psychologically. too afraid she'd wet the bed. Was in tears in pain rolling onto a bedpan, still couldn't pee, had to lie flat for 6h (probably longer after I left, since her groin started bleeding while rolling about to get on the bedpan). I wound up straight cathing her 5 minutes before shift change because she was howling in pain, her doctor hadn't paged me back for 3 hours, and I'd spent the better part of 3 hours trying everything I could think of to extricate urine from her bladder. 

 

Men with urinals when they have any device where they aren't supposed to move/sit up/etc.....I've had more than a handful of patients with IABPs that go from CDI to oozy as all get out because my patient was using a urinal. I've literally given blood transfusions because my patient doesn't have a foley. 

 

Cardiorenal? CHF? Intubated patient on max vent settings with sub-optimal oxygenation? Yeah, let's throw some lying flat and rolling onto a bedpan into the mix. I'm sure they'll recover real quick after, too. That SpO2 of 53 is totes not real. They've always looked kinda blue. They just come from the Avatar planet. 

 

There are exemptions to every rule, I'll be the first to admit. Most nurses DO try to get CVC/ETT/Foley/Restraints out/off as soon as it's safe and appropriate. Most patients in our CVICU are here for 2-4 days before we transfer them out. Very few have marathon, months-long ICU stays. Our management recently started pushing docs on rounds to DC femoral central lines w/in 48h of admission. Their solution? Pull the line, but don't replace with a more appropriate site. 

Good points. Accurate I&O count is an indication for foleys, and post op hearts and critically unstable patients for sure need a foley. But being on a vent alone is not an indication for a foley. 

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