Breakaway Foley?

[rev ronin]

So a family friend died last week.  Late 80's or early 90's, it was likely his time to go, as we all had seen him decline over the past 6 years, both cognitively and physically. But what appears to have actually done him in is the complications from forcibly removing his foley catheter a day or two prior to his death, which apparently remained inflated throughout the maneuver, such that he had horribly damaged his prostate and urethra.

That can't be that unusual an event, given how many confused or demented elderly men there are.

I've never been a hospitalist, or worked inpatient care anywhere for that matter, and have no medical involvement in this case, so this may be an obvious question, but...

Shouldn't a foley fail before it does tissue damage in response to traction on the distal end?

[jk5142]

Seems to happen every once in a while in the icu...I've never examined the foley after a traumatic foley (self) removal to be able to say whether the balloon system remained intact.

FWIW..

Usually with the few traumatic foley (self) removals I've encountered with patients, there is hematuria without significant evidence of blood loss. We call urology and they will typically re-place the foley and order regular irrigation of the catheter for some period of time. There may be some minor hematuria following but have never had significant drops in Hgb. I wouldn't expect the cause of death to be directly attributed to blood loss, and besides urosepsis (which I would not think of as a complication of the event), I can't think of a reason for someone to die from a complication related to the event. If there was disease progression of whatever else was ailing him/her , leading to encephalopathy>foley self removal and ultimately their demise, that would make more sense. But interested in hearing if others have had different experiences with this..

[rev ronin]

What I heard from the family was that the prostate damage was going to require surgical repair.  He was already inpatient for a fall, had CHF/CKD and was teetering on the balance, based on what family related, and they didn't say this is what pushed him over the edge--it was my educated inference.  He had known sundowning and likely should have been restrained before this happened, which is heartbreaking but the lesser of two evils in cases like this.  If this hadn't gotten him, something else would have in the next year or so--another guess based on my informal observations.

[charlottew]

Restraining sundowning patients sometimes/often makes them even more agitated. Which then leads you to give more sedating meds (Haldol, Zyprexa), which then can lead to aspiration risk. Don't give benzos! They're respiratory depressants and then you are on the road to respiratory failure/intubation.

For dementia sundowning in the hospital, it helps if family is at the bedside (overnight!), but as you can imagine that is a considerable strain on families. If a Foley is aggravating a demented patient, we usually try either a condom cath (of course, they pull that off, too), or else just let them be incontinent. This is in the ICU where there is good nursing coverage.

In my experience with agitated males pulling out their Foleys (balloon usually stays intact), as the above poster stated if there's bleeding, call urology. Most urologic problems are not immediately life-threatening. It could have been he had sustained bleeding requiring surgery, and his CHF put him at high surgical risk (eg. cannot tolerate anaesthesia/stress).

CHF/CKD/advanced dementia - now those ARE life-threatening. (respiratory failure, metabolic acidosis, and dysphagia/aspiration PNA, respectively)

Rev, I am sorry about the loss of your friend.

[CAAdmission]

I saw an opioid overdose yank out a foley after he got narcan. Balloon intact. I'd say he won't have to worry about BPH for a while.

[rev ronin]

1 hour ago, charlottew said:

Rev, I am sorry about the loss of your friend.

Thanks!  Like I said, he was in decline and it was close to his time no matter what was happening, but it's still something in me that the clinician and perpetual student had to ask.  I do appreciate the reassurance that the typical severity of traumatic self-decatheterization is typically not so high.

[Randito]

I see this happen several times per year in post-op patients that are some combination of encephalopathic and delirious. Balloon has been intact every time. The last time I spoke with urology about this situation, they said they will place another Foley and inflate a bit larger in order to tamponade. 

[sas5814]

I did NH work for 12 years or so and this wasn't a terribly uncommon event. In any of the cases I saw there was tissue damage and bleeding and the bulb remained inflated every time. Made my toes curl in my shoes every time too.

[delco714]

Jeez this thread missed the mark

No the balloon almost never fails

No it doesn't TURP them, the opposite occurs causing significant urethral edema.

Hematuria from the trauma 9/10x easily treated by a mid bore Foley replacement.

My weapon of choice? 18F coude

Not sure how the removal caused such chaos, I've yet to see that happen, personally.

Hope that helps