The Foley Story

[Nurseik]

It was the end of the week and almost about ten minutes to the end of the day; when the door closes; my office (outpatient clinic) got a call inquiring about the possible removal of a Foley catheter.

The caller must have relayed her message with urgency that the front desk person said she will allowed in despite the fact that the doors will be closed by the time she arrives. "All she needs is to see the nurse, at least take a look at the catheter for her". :rolleyes:The case did not sound serious enough to be sent to an ER and of course no Primary care Office was open at that hour.

It sounded fine to me, I was still busy cleaning up, and hopefully she gets here before I'm all set to go home. I had a busy day and was ready to jet out of the doors.

The caller arrived about 15mins after she called; middle age and very pleasant lady. She was really anxious; She had an abdominal surgery done; was discharged home and then discovered she was unable to urinate spontaneously; she said it was probably related to some of the medications she got while in surgery (my question was why would they d/c a patient that has not voided or cannot void spontaneously.) According to her story, she had gone back and they placed a Foley a day before she came to our office.

Her CC: No urine in the collection bag since insertion (now over 24 hrs) but she has been leaking urine from her bladder with the Foley still intact in her. She was requesting to have the Foley removed.

My first thought was that the balloon was not well secured but the collection bag was really dry, no evidence of any urine being in the bag. I decided to take a look at the leg bag. Alas! The entry where the urine was supposed to pass through was turned off. Of course, how can the urine get into the bag if it's clamped off!

It was simple, BUT it could have cost her a lot. Let's think about it..., the bladder gets full, and then it backs up into the kidney leading to an infection (pyelonephritis, UTI etc). Patient is fresh post op, this will surely lead to a cascade of events.

BIG LESSON: Your task might appear simple but please take time to reassess and make sure you are doing the right thing. One tiny omission might cost someone else their life. This is a lesson for us (as Clinicians) to learn.

MY GAIN: Self satisfaction that I could solve the problem (it was an easy one). Also seeing the joy and relieve it brought to her. And the endless thank you hugs and kisses. :)

[suanna]

AAUGGGHHHH!!! Trivia question: How do you know you are in the bladder when placing a foley and can inflate the baloon? You get a good urine flow into the bag and then advance the foley a few more cm to be sure you are not in the urethra. It's a wonder the patient didn't have a rubber IUD. With the clamp closed, the person placing the foley couldn't have been sure the foley was in place. That faux pos aside- didn't they do ANY Foley management teaching?? Thanks for helping this lady out- I hope the nursing director of the unit that placed the foley gets an earfull from the patient and/or the family. That is just BAD BAD care. In todays health care market, keeping someone in the hospital for a little thing like being unable to pee isn't reimbursed by the HMOs. Never mind the fact that the patient was most likely S/P sedation, elderly, and had no medical background, I'm sure an indwelling foley cath wouldn't be a problem:rolleyes:, but if the center that placed it had done even part of thier job, the patient would have had a better chance of having an event free recovery. Is it possible the patient closed the clamp herself? I just can't believe a nurse would send a patient home like that.

[Trekfan]

FRIST that poor woman not being able to pee is painfull . what kind of leg bag has a clamp at the point where the folly and bag meet ? I have every bag there ever was and I have never seen this ? Did they put on a clamp on the catheter itself and forget to take it off?

Also its grate that you where able to help her :) without sending her to the ER around here NO urgent care and most doc. offices will not touch a foley with a 10 foot pole .If you are having any kind of problem with it IE pain, flushing , clogged , ect they will tell you to go the er

and there was one ER here that sent me to another ER "why you ask" because they did you know what to do with my s/p catheter

the problem was that they ''LEFT THE CLAMP ON " and with the clamp on no water will come out of the bloon

[Nurseik]

Inflating the balloon in the urethra will cause pain.

what I called a clamp is actually a (on/off) knob. It is found on the collection bag. when u turn it up ...it's open and when down it's close.

I'm assuming the nurse just forgot to turn it open after she connected the cather to the bag. And the patient was not educated on how to care for the Foley.

[CecileSF]

this story really makes me think of the small things I can overlook. Sometimes I go through procedures and try to get all the important things. This just shows how double checking is a must. That poor lady, having a full bladder is very painful and can become dangerous. Good thing it was caught soon.