Foleys, Foleys, Foleys!
True or False - Sterile Technique is used to insert a Foley Catheter
True!
True or False - A urine specimen can be collected from the foley bag
False - a urine specimen cannot be collected from the bag
How can the nurse determine if the foley can be removed?
Who charts the insertion of the foley?
RN only. PCT may chart application of Primofit and Purewick, but not the insertion of a foley
When walking into your patient's room who has had a foley for 2 days. The patient is up in the chair, but the foley is on the floor.
Where do you document your foley insertion?
Add LDA in the I/O's flowsheet
A PCT can collect a urine specimen from the foley collection port
False - Only a nurse can collect a urine specimen from the foley collection port
How often does Peri & Foley Care need to be completed and documented in Epic?
At least once a shift, before noon on days and before midnight on nightshift
**We had a CAUTI :(
True or False - I should bring 2 Foley Catheter kits with me into the room when planning to insert a foley
True! Always have an extra nearby in the event you break sterile technique
You have a U/A ordered for your patient complaining of pain and frequency on urination. The patient asked if the wipes in the kit with the cups and tubes are needed. You say...
Yes! They are to be used prior to the patient beginning to void. The patient is then suppose to start voiding into the toilet, then stop and begin voiding into the cup to collect at least 30mL of urine.
BONUS! Is there a needle located in the lid of the specimen cup?
How often must you empty the foley and where do you chart?
Every 4 hours and PRN (when bag is about half - 3/4 full) *Do not let over distended or overfill
-Chart in I/O's in Epic
True or False - the nurse can order a U/A & Culture per protocol if the urine looks bad
FALSE - The nurse needs a clinical justification to order a U/A with culture reflex which needs to be chosen when the U/A is being ordered.
*Dysuria, Flank Pain, Suprapubic pain, Increased urinary frequency & urgency, hematuria, sepsis from suspected urinary source, undergoing urologic procedure, pregnant. If none apply, call the provider to determine the clinical justification
How many wipes do you have to use in the green ReadyCleanse wipe package?
ALL 5 WIPES
BONUS! - How can I find how to use each wipe?
You DO need to use the sterile drapes. The drapes help extend the sterile field around the insertion site
I need a U/A for my patient...but they are incontinent and requiring a Purewick. I am just going to change all the tubing and Purewick to collect a specimen from there.
True or False - I don't need the green clip on the foley tubing. It is just used to keep the foley from pulling.
FALSE! The green clip is used to keep the foley in a straight flowing position preventing dependent loops by clipping it to the bed sheets
What are some inappropriate reasons to order a U/A w/ reflex?
-Dark, Cloudy, or Foul Smelling Urine
-Sediment in catheter bag
-AMS, confusion, delirium
-After a patient fall
-Per family/patient request
-After tx of UTI to document cure
-Routine exchange of catheter *if there is an order, collect AFTER exchanging to foley
How do I document on my CBI?
-Document urine output in I/O's. Each time you change the bag, add up all the urine volumes documented since last bag change. Then you put the bag infusion amount in the "CBI Irrigation Intake" and the urine output in the "CBI Foley Output", then the Net output is calculated for you.
**The Urine output added in the CBI Intake and Output does NOT cross over into I/O's. It is good practice to create a note from the flowsheet when completing this documentation
Can a PCT be considered a second provider in inserting a foley?
No. The second Provider must be a RN. A PCT may assist, but can not be the only other provider assist.
I have had to straight cath my patient twice already. On the third time, I am just going to insert a foley.
NOOOOO! Old practice. You must utilize the Intermittent Straight Cath Protocol in PolicyStat and follow the algorithm
True or False - Peri care means to use the ReadyCleanse wipes
False - Peri care means using soap and water to clean the peri area, Foley care means using the ReadyCleanse Wipes
What can be used to collect a U/A?
-patient clean catch by self
-From Foley Catheter port
-Straight cath
How do I know how to manage my CBI?
View the CBI Policy in PolicyStat
How many times is the insertion site cleaned prior to inserting a foley?
at least 3 times
1) peri care with soap and water before beginning
2) use of castile soap wipes that are attached to the insertion kit prior to beginning foley insertion
3) iodine swabbing right before insertion
BONUS! How do I know what steps to do when inserting a foley?
My patient came in with a foley. I can exchange the foley per protocol and do not need a physician order
You must discuss the exchange with the provider and obtain an order. Why does the patient have a foley? Do they still need it? Should urology be consulted? etc.