Scope of practice

[CityKat]

Hi there..

I have a few questions in regards to foleys. First, is it true that it will no longer be in the scope of practice for RN's to insert a male foley due to the high risk of rupturing the prostate?

Second, who is allowed to insert a foley and is this regulated by state?

Thank you:)

[wonderbee, BSN, RN]

You do get some misinformation in NS. I think some of the lecture instructors are rusty. One of m instructors told us to clamp off a foley if we get a liter or more of urine in a one hour period because the pt. will go into shock. When I came onto my current unit, everyone had a good laugh at that one. Clamping off a foley's not going to do anything but rupture the bladder.

[traumaRUs, MSN, APRN]

RNKittyKat - I can attest to this thinking - it used to be that yes, you did clamp the foley after a liter was released with the thinking that releasing all the urine would result in shock (honest).

However, nowadays that is known to be erroneous and we just insert a foley and let things drain.

Medicine and nursing have changed tremendously even since I became a nurse in 1992 and its every-evolving. This just points to the fact that you must always continue your education - read professional journals, take additional courses, attend conferences. You must always strive to stay current.

[CityKat, BSN, RN]

So is the fear due to the postioning of the bladder in the male anatomy? I know you need to insert it quite a few more inches on a male that you would on a female but I am still not getting the "why" and "how" for making this a risky procedure....

It's a good question. I have not received an answer either. Like someone said, there is a lot of misinformation that goes on in nursing with some professors obviously not keeping up with the ever changing world of medicine. However, my clinical instructor said that it's our hospitals protocol that the doctors are the ones who insert the male foleys. As to why..it has to do with the bladder which I originally thought was the prostate and that's the answer I got. I am sure at some point in my career I will learn from someone, as we are always learning in nursing.

[cardiacRN2006, ADN, RN]

It's the prostate. I guess they think we aren't competent enough to know not to inflate the balloon until after we pass the prostate.

I wonder how often this has happened? I mean, it's obvious when we get to the prostate, and obvious once we pass it.

[smk1, LPN]

Maybe they think we will puncture the bladder? but seriously, once it is in the urine starts flowing and you know to stop advancing the catheter. (and wouldn't we hav this same issue with females?) THe only other thing I could think of is that maybe people are blowing up the balloon (in foley caths)too early in the males because the urethra is much longer than in females, and not getting all the way into the bladder and causing trauma to the urethra. Honestly though, how is an MD going to be any better at this? Interesting discussion. I wonder if there is any research on this subject to support the idea that MDs have a better outcome, or if it is just a liability thing?