why ? why? see no value

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Have a patient with a supra pubic catheter that the doctor wants flushed every shift in the nursing home. I always thought a catheter was a closed system and needed kept closed to prevent bacteria from the air entering it. Pt also spends a lot of time in the W/C so hard to follow the order. All the others with this type of catheter are flush only PRN. Pt has been known to use extremely foul language when told to get in bed for procedure. Catheter has been known to be unflushable in just 2-3 days after it was changed. It is used due to neurogenic bladder. All supervisors know of our problems with the pt and unable to do flush every shift. Pts cannot be forced to go to bed. Any ideas?

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Why does the patient have to be in bed to irrigate the SP cath? I'm guessing the reason it is being flushed is because it gets occluded otherwise. How is it "unflushable" in 2-3 days? Is it occluded and needing changed again in that time? All the more reason to stick to the order. Do it while he's up.

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Specializes in Cardio-Pulmonary; Med-Surg; Private Duty.

Agree -- flush the catheter when passing meds on each shift, since you have to track the patient down for med-pass anyway. Wheelchair shouldn't be an issue.

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You stated the reason for the frequent flushing in your post, I'm confused about your title stating no value.

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Specializes in Emergency, Telemetry, Transplant.
Catheter has been known to be unflushable in just 2-3 days after it was changed.

And there you have your answer...

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Specializes in Pediatrics, Emergency, Trauma.
You stated the reason for the frequent flushing in your post, I'm confused about your title stating no value.

So am I.

I have worked in facilities where it is absolutely necessary to flush the it's suprapubic tube each shift, or 12 hours, and they didn't need to be in the bed.

You can either get the patient before getting up, or work with the pt to make sure the tube is flushed; they may "curse", but are you actually listening to this pt?? Do you "value" his wishes to flush it in a way where he can be comfort ale and stay up?

If the patient is refusing, then go up the chain of command.

You will see the value when the pt is sent out and if this patient is, uh, "ornery" and decides to call the Health Department, then you will have some...explaining to do...

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Specializes in Neuro, Telemetry.

I agree that you stated the value in your OP. I have a resident in my care that requires BID suprapubic cath flushing as well. If we do not flush, she gets calcium/WBC/dead tissue "balls" at the end of the cath and it becomes occluded and non removable. She once developed a baseball size "ball" even with the flushing. She had to be sent out to have her catheter changed.

This is can be done in a wheelchair too. I actually find it easier in a wheelchair because then the return glow starts immediately and the bladder empties. When in bed, I had to sit out resident with HOB pretty higher or barely any of the NS wil flow back out, or it will flow very slowly. The flush causes this resident pain and the full bladder causes spasms. Getting it empty quickly is important.

Look ok at the whole picture like mine above. I'm sure you will see a very good reason for the flush orders that outweigh the inconvenience of dealing with a grumpy resident.

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Specializes in HH, Peds, Rehab, Clinical.

I'd be ticked too if you "made me get in bed" to do this. Either do it in the w/c or time it so it's done before s/he gets up or after they are in bed for the night. You are the one making this difficult!

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Another hit and run OP?

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Some people with neurogenic bladders have so much debris and sediment that their catheters need flushing. It is not the same situation as someone who has a catheter for two days or less because they had a surgical procedure.

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Specializes in geriatrics.

You either flush the catheter as ordered or send the resident to the emergency department due to complications from a blocked suprapubic catheter.

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Specializes in HH, Peds, Rehab, Clinical.

With excellent documentation as to why it happened! "Staff negligent in following prescribed order because they insist on completing flush on their terms"

You either flush the catheter as ordered or send the resident to the emergency department due to complications from a blocked suprapubic catheter.
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