The Lifesaving Foley

Recently I’ve noticed a peculiar phenomenon with my nursing colleagues, and I wonder if anyone else has this.

  • I’ll be in the middle of a code, look around and see a nurse studiously inserting a catheter into the patient.
  • We’ll be getting ready to intubate an agitated patient; I look and see the nurse is busy intubating Mr. Johnson.

I have no idea why.

Really, I think they’re stressed out, and want to “Do Something”. They see a task they’re comfortable doing, and so they do it. Indication or not, right time or not, utility or not.

I’ve taken to calling it The Lifesaving Foley, for obvious reasons, though I don’t think it’s saved a life yet.


Comments

  1. Eh?

    Hm. I’d say that pretty much all of the patients we code are sick enough to require Foleys in the first place. I’ve hunted for veins in unlikely places during a code, but never yet looked for a urethral meatus.

    Hm.

  2. I guess there’s an up side… the patient would be grateful to be sedated and muscle-relaxed, completely unaware that the IDC (which they would likely need at some point anyway) is being placed. Can’t say it’s something I’d be keen to be awake for!

  3. Hey, if shoving a tube up the wazoo doesn’t restart the heart, then nothing will!

  4. Nurse Kelley says:

    Several comments…I bet who you really saw putting in a Foley was a Patient Care Technician and not a “nurse”. And I would also be willing to bet money that they were inserting a catheter into a patient who, coincidentally enough, had recently emptied their bladder onto the sheet. Every experienced ER caregiver knows that to change a wet sheet before placing a Foley is a foolish exercise in futility. Thirdly, once you’ve ever inserted a catheter into a patient who is trying to kick you in the head, you will never again squander the opportunity to place it while your patient is unconscious. Finally, my biggest money would be on the wisdom of the primary nurse who delegated this wearisome task to one of the many people in the room that came running to “help” when her fifth patient suddenly showed themselves to be VERY sick. Now, if we could only get the five scribes to do something useful…

  5. Astonsihingly enough, I can tell the difference between a nurse and a tech, and it’s been nurses that do this. I’m not saying techs wouldn’t, but that’s not who has been doing it, it’s been the nurses.

    Placing a foley after someone has just emptied their bladder is neither a good indication, nor particularly smart (how will you tell good placement prior to inflating the balloon)?

    Ususally there’s only 3 scribes, and they aren’t allowed to do anything useful. We like it that way.

  6. Now – not trying to be obnoxious, but could the aforementioned nurse inserting the catheter have been utilized in another way? Just curious since I know sometimes people do things because it will be needed eventually (not saying it will be needed if not clinically indicated, however) and if they don’t have another role in the code, then they’re just trying to get this done. I dunno….you’d have to elaborate. Did you need them to be drawing up epi and instead they were fully attuned to their catheter-inserting pursuits? This would be problematic, obviously!

    I would never insert a catheter without being told to do so, but then again, I work with babies and it’s just not that simple.. Of course, since we’re in an adult hospital that uses pre-filled epi and bicarb syringes, one can always make themselves useful by noting the dose on the weight-based code sheet and trying to draw up syringes for use. That actually was my job in a code once when it was another nurse’s patient. That and noting the time – I get frustrated by the fact that time is not often paid attention to, and when I say something like, “The baby has had an O2 sat of 45 for 5 minutes now,” the fellow says, “Oh that’s not his real sat…He has a heart rate and that’s the important part anyways.” I’m sure his brain would like to think otherwise…and yes, the O2 sat was real.

    I guess in an emergency situation, even some types of health care workers sort of lose it and focus on whatever the heck gets them through. Not saying that these types of people should be working in places like emergency departments and critical care, but hey….we seem to have all types, don’t we?

  7. Goatwhacker says:

    Thinking back to my ER rotations in residency, all codes had a Foley placed routinely. Of course there were a bunch of residents, interns, medical students, nurses and nursing students standing around so maybe it just gave everybody something to do. Possibly these Foley-placing nurses trained at a facility where it was just part of the protocol?

    We never get three scribes but it is customary to have the monitor leads stretching over to the crash cart so as to trap personnel who might otherwise try to leave.

  8. I guess it’s a matter of timing. In a “medical” code, it may not be of immediate import, but within a short time, urine output monitoring will be a significant part of the followup. For trauma it’s perhaps important right away: looking for blood, etc. As an intern in the trauma room, I could always be useful putting in an ankle cutdown: needed, knew how, out of the way of the folks who actuallly knew what they were doing. So yeah: feeling useful is a factor. But that only applies when the intervention is needed and not interfering….

  9. I am an ER RN. Code blues do not get a foley, unless they live. You can throw the foley in post-intubation–the drugs stay on board for awhile. A is for airway, and always should be first priority. Trauma cases are different, for we have everyone in the room–so there is a set of hands for all major tasks. We have standing orders in our ER, so our doctors expect us to get things done, without being asked or told. I sure GruntDoc knows his staff, so if he says it is a nurse, it is a nurse that is putting in the foley.

  10. Participated in my first code in a long time last week.
    Knew I was missing something!
    Shoulda been popping in a foley instead of making sure the ambubag was hooked up to the O2 outlet!

  11. I guess the thing that bothers me the most is the insinuation that RN’s don’t know any better than to place a foley before making sure that ABC’s are covered. This is highly insulting and blatantly untrue. We do, however know how to multi, multi, multi task and ,if there are extra hands in the room, we are going to use them before they leave for the next major event. If a foley is indicated for the patients well being in the next 20 minutes, then you can bet I’ll be asking a tech or another nurse to help me with that task as soon as resussitaion is complete. Or, in some instances,concomitantly, as the resussitation is going on. That’s how we can take care of so many patients at once!! I have never seen an ER RN get his or her ABC’s backward- mostly, they go about their business of critical thinking, care giving, and saving lives( and covering for our doctor colleagues in several instances). Actually, a foley may be indicated for the ER nurse personally since we rarely get a chance to take care of our own needs in our environment and toileting is often not an option for us. Your disrespectful,gross exaggeration just adds insult to injury. You may be working the next code by yourself…..

  12. Boy, this really did get some feedback! LOL!

    Usually, what happens is that everyone is in the room and so one nurse goes for what we know will be needed, which is a catheter.

    Got the doc and the RT at the head of the bed so the airway is under control.

    Got a nurse doin’ meds. One looking for another (or first) vein and drawing blood.

    The tech probably has the EKG getting hooked up.

    And then there is “Nurse Foley”. I have been her on occasion when I am just an extra pair of hands and Lasix 80 mg has just been given IV and if we don’t hurry, we’ll be changing the linen on an intubated, paralyzed, sedated patient.

    This usually occurs post intubation as rapid sequence intubation isn’t usually a good time for the parting of the thighs.

    So yes, a nurse will grab a foley. Just to help. Because that’s why we all have a meatus to begin with. : D

  13. Wow, Al. Does Texas require that nurses have their senses of humor surgically removed prior to licensure? ;-)

    Seriously, folks. We’ve all been there and seen that. Docs do it, too; years ago an oncologist who had just finished ACLS and wanted to help out in a code. He grabbed an NG tube and started lubricating it so that he could “get the stomach empty before they try to intubate.”

    Mercy.

    We all learn when we share our stories with each other. That isn’t disrespect, folks – that collegialism, where you can share things worrying about getting slammed for doing it.

  14. doctordel says:

    Hell hath no fury…

    Since his intent clearly was to elicit these exact types of responses, we can all rest assured that the purpose of this post has been fulfilled. The jocular “Lifesaving Foley” is a term that a nurse-yes, a NURSE-turned me on to when I was a resident and I have heard it repeated by nurses and other allied staff since.

    Relax, y’all. No one is suggesting you don’t know your stuff. I am sure the authors of the heated posts noticed that GD cast no dispersions upon those nurses involved in the actual execution of the code.

    We love you. We respect you. See following post by GD for more of how we feel. Sheesh…

  15. Alwin,

    I know it’s probably a lot more complicated in an adult, but for neonates, decompressing the stomach really might just save a life! I don’t know that I would always have time to insert an NG/OG tube prior to intubation, but if one is in place (and most likely, if the baby is getting intubated, he or she already has an NG or OG), then the belly must be decompressed before intubation. Otherwise the infant will likely spit up and then may aspirate.

    Now, as I said, this is a lot less complicated (or so it seems) in an infant. I can get one of those tubes in place in about 10 seconds or less. Not trying to start an argument, but there is a rationale for emptying the stomach contents, at least in neonates!

    Take care,
    Carrie :)