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Do No Harm - the FoleyFrom: Arthur W. Curtis, Jr. (artcurtis@juno.com)Mon Sep 23 19:06:29 1996
<If you do not believe it does any good, and you recognize it as a hardship to <your patients, then may I ask, ever so gently, why you continue to do it? This appeared in relation to restrictions of placenta previa found on an early ultrasound, but is very apropos to the following: For more than 20 years I have removed the Foley catheter in the operating room immediately after a CSection. Very rarely is the patient unable to void, and very rarely is a catheter ever needed post op. If the foley is removed immediately post op, then the UTI rates have to be lower, (I have not added my rates to confirm this), and the patient's early ambulation has to be increased. It seems to me that the use of a foley for the first day or first 24hrs (whatever) post op would be justified if the patient is not able to void post op. But she is able to void post op. So then in the words of the above author "then may I ask, ever so gently, why you continue to do it"? The nurses still don't like my removing the foley so soon. It is more work for them and they think the patients are more uncomfortable because of the increased ambulation (often just a bed pan). However the patients love the idea pre op (obviously), but almost all are happy afterwards to have had the foley removed. I have been preaching for all these years but everyone else in our hospital leaves the foley in place until the following morning or for 24hrs. It does make a difference, I think. Obviously early removal of the foley applies only for healthy patients who are stable pre op and remain so post op. Any other situation requiring monitoring urine output (blood loss, toxemia, bladder injury, whatever) requires prolonged bladder drainage. Consider it. ---------------- Arthur Curtis ---------------- general ObG -- ---------------- ArtCurtis@juno.com
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