Foley balloon issues

[WI_home_RN]

I'm a private duty RN taking care of a patient with an indwelling Foley. He uses an 18 French with a 5 cc balloon filled with 10 cc. He leaks constantly. Sometimes we check the balloon and only pull out 7 cc when we KNOW 10 cc went into the balloon initially. Where the heck are these 3 cc going?

[Music in My Heart]

Starting with a new foley, the baloon and the path to it are completely empty/dry. I'd be interested in filling a new ballon, then immediately withdraw the fluid. Betting you wouldn't get the full 10cc out.

Mmmm, I think I'd take that bet. Let's not forget, it's a closed system.

[morte, LPN, LVN]

I don't think the liquid is vaporizing at any significant rate at 37C and 101kPa so "evaporation" is probably not the right term. More likely than leaking through the valve, though, would be small amounts of water diffusing through the very thin latex (?) membrane.

I'm curious: OP, over how long a time period are you noting the 3-cc drop in volume?

?osmosis?

[dthfytr, ADN, LPN, RN, EMT-B, EMT-I]

My last idea, then I give up. SOMEONE TAKE THE 3CC SYRINGE AWAY FROM THAT ***** PATIENT!

[leslie :-D]

Starting with a new foley, the baloon and the path to it are completely empty/dry. I'd be interested in filling a new ballon, then immediately withdraw the fluid. Betting you wouldn't get the full 10cc out.

before i insert a foley, i always attach the (filled) syringe and inflate/deflate the balloon.

and i always get the full return.

is that what you're referring to?

leslie

[leslie :-D]

re: silicone catheters

"Catheters made of silicone have a larger lumen than those made of latex. In addition, latex is a comparatively inert material that provokes minimal changes to the urethral mucosa. The larger diameter of silicone catheters may delay encrustation and catheter blockage by reducing the deposition of protein and mucous on the catheter. While silicone causes less tissue irritation and potential damage, the catheter balloon has a tendency to lose fluid content due to evaporation, thus increasing the risk that the catheter may dislodge prematurely. In one study, 100% silicon catheters lost as much as 50% of their volume within 3 weeks."

The Indwelling Urinary Catheter: Principles for Best Practice

so...even if the catheter wasn't silicone, evaporation is seemingly the cause of the fluid loss.

leslie

[shiccy]

I have had this happen very frequently myself as well... Who wouldn't put 10ml in a foley when that's the amount that comes in the prefilled syringe? I've noted 5-9ml consistently when d/cing them. This is usually not an issue with leaking though.

Things to try:

1. Dale foley strap- If it's a movement problem, strapping it to the leg may help

2. Inquire about a B&O suppository for bladder spasms from the MD. This is probably more likely the reason the leaking is an issue for your patient. Be aware, though, that it contains atropine, so if they have allergies make sure that's not one of them!

[jerenemarie]

I've used B & O supp. also with success for bladder spasms which cause leakage. I also found at a urology conference that large foley's (greater than 16 Fr.) can contribute to spasms & leakage so I never use any foley larger than a 16 Fr. (unless the doctor specifically orders it differently).

[DennisRN]

hhmmm, evaporation! That makes sense to me. We don't check it daily but perhaps we should look into that and get an order. Thanks much!!

3 ml of fluid evaporating in a closed system? I can't agree with that as I haven't seen it happen before.

Have you tried different manufacturers and looked at exporation dates?

[cherrybreeze, ADN, RN]

before i insert a foley, i always attach the (filled) syringe and inflate/deflate the balloon.

and i always get the full return.

is that what you're referring to?

leslie

Years ago we were taught to test the balloons, that's now become a no-no (and I can't quite remember why, but I know the guideline changed).

[RNCEN]

Years ago we were taught to test the balloons, that's now become a no-no (and I can't quite remember why, but I know the guideline changed).

We just did our foley lab today. The reason for manufacturers saying NOT to inflate prior to insertion is that the balloon does not fully return to it's original shape (it remains slightly larger than it was), and can cause trauma to the urethra.