What do you think about foleys and infection?

caliotter3 · Jul 5, 2008

This doctor needs for someone to explain to him what is going on. He is probably stubborn though. If he had to deal with the consequences, he might see things in a different light.

Jules A, MSN · Jul 5, 2008

It can be a tough call. Personally I tend to think the foleys are preferable in the situation you describe. There was a good article on this in Advance for Nurses recently that you might look up.

leslie :-D · Jul 5, 2008

if there are sacral/coccygeal decubs, then i'm all for foleys.

otherwise, the urine is going to macerate and further decay these openings.

even the best dressed decubs, come apart after getting wet.

and then, many aides won't even tell you if the dsg came off.

but, i am a huge proponent of meticulous foley care.

scrub that peri area clean, or else (female) pt will likely get e coli uti.

leslie

KyPinkRN · Jul 5, 2008

There is this doctor at my hospital that is anti-foley. A person will only have it two to three days. That would be okay if it were a person who could actually get out of bed to the BR or ask to go to the bathroom. But, he will even dc it on a person who has multiple decubs, needs to be turned every two hours and is incontinent of stool. I am all for preventing infection and getting a foley out of someone as soon as possible but, come on! When they are on fluids, confused and aphasic related to a recent stroke they have had. It is not like we have the staff available to be changing these people every 15 to 30 minutes ( most of them also being over or close to 200lbs). - and i don't like the idea of people sitting in a urine soaked diaper so it will get done because it has to-. More times than not, we have had to put the foley back in. So what do you think?

I would think that sitting in urine for any amount of time would raise the same concern about infection. It's true that a foley can be a direct path for bacteria to travel up the urethra, but so can being constantly moist in that area. :twocents:

rita359 · Jul 5, 2008

I am not sure what the policy is in nursing homes in Indiana but I believe about the only justification for a foley is urinary retention. All others the foley comes out. I would think a coccyx decub or reddened perineum might pass but I don't know. Most of it has to do with best practice and it has been decided that foleys are not best practice.

RN1982 · Jul 5, 2008

Yeah, foleys can cause infection. So can any other catheter a patient has in their body be it a PA cath, dialysis catheter, IV etc. I'm all for foleys on patients with stage 1 decubs to unstageable bedsores. Why would it be better for a patient to completely soak their bed and risk infecting their bedsores just so they don't get a urinary tract infection which is very treatable? We as nurses just need to make sure that we are cleaning around the foley cath properly. I often find that some of my patients have not had peri care and often has some nasty stuff sitting around the foley site.

4theBetterGetter, RN · Jul 6, 2008

An old time doctor once said....1 day with a foley=10% chance of infection...2 days = 20% chance and so on. Foley caths are a portal for infection especially without proper cath care.....so are all the other lines we insert into folks that's why we have to care for them correctly.

MAISY, RN-ER, BSN, RN · Jul 6, 2008

What easier to deal with: bladder retraining and possible uti or pressure ulcers? Pericare and staffing makes all the difference.

Maisy

moonshadeau, ADN, BSN, MSN, RN, APN, NP, CNS · Jul 6, 2008

Coming up here pretty soon, it isn't going to matter what you want to deal with: Medicare is not going to pay for either hospital aquired pressure ulcers or catheter associated urinary tract infections.

nursemanit · Jul 6, 2008

A few minutes spent researching answers this question. Here are 3 of the most recent published peer reviewed articles on the topic as a start.

Godfrey, H. (2008). Older people, continence care and catheters: dilemmas and resolutions. British Journal of Nursing (BJN). 17: S4-S11.

Inelmen, E. M., G. Sergi, et al. (2007). When are indwelling urinary catheters appropriate in elderly patients?. (cover story). Geriatrics, Advanstar Communications Inc. 62: 18-22.

Nazarko, L. (2007). Avoiding the pitfalls and perils of catheter care. British Journal of Nursing (BJN), MA Healthcare Limited. 16: 468-472.

What people "think" about a nursing topic is not relevant. Nursing has a large body of research on this topic and it has been proven and accepted as best practice for years that indwelling catheters are a last resort.

leslie :-D · Jul 6, 2008

What people "think" about a nursing topic is not relevant. Nursing has a large body of research on this topic and it has been proven and accepted as best practice for years that indwelling catheters are a last resort.

while there are some nurses who would gladly prefer a foley for its convenience, most of us do recognize that foleys are indeed, a last resort.

but more often than not, there are other (realistic) considerations.

and it is our judgment for that particular pt, that s/b considered rather than deferring to 'best practice'.

it is seldom that black and white.

leslie