Foley Catheter Lubrication

[Twinmom06]

Can someone please assist me? I'm a new grad and in my orientation class are 2 of my friends that graduated with me. The foley insertion we were taught in school and clinical (as well as how I inserted as a STNA in a magnet facility) had us dip the end of the foley in sterile lubricant that we squeezed into the sterile catheter tray.

Yesterday 2 of my friends were assigned to the floor we will eventually be working on with a completely horrible instructor that really got in their face and and one of the things she was lecturing on was that the nursing literature now states that we should be instilling the sterile lubricant into the meatus? I've done numerous searches via PubMed, Google (using sites such as mayo clinic and NJM - NOT Wiki) and have found nothing of the sort except for 1 article from 2005 that indicated instilling lidocaine gel when introducing a Coude catheter into men with BPH that were a difficult insertion. I wouldn't consider 2005 to be "the latest literature" - not sure if she was just being a witch or if there is something I'm not finding. Have any of you heard of this, or can you tell me where else I can look?

both of these normally unflappable classmates of mine are ready to bail because of this instructor.

[VivaLasViejas, ASN, RN]

I don't know why the lidocaine gel can't be used on a female---this procedure hurts us too!! But I've never seen it done, or used it on a female myself....does anyone know why this isn't standard practice?

[MunoRN, RN]

I don't know why the lidocaine gel can't be used on a female---this procedure hurts us too!! But I've never seen it done, or used it on a female myself....does anyone know why this isn't standard practice?

I use it on females I agree it should be standard on everyone, I push the issue mainly on male patients in the hopes that I can get a foothold by focusing on a smaller group of patients. I have no idea why there is resistance to the idea or why it isn't considered a standards of care, I'd personally argue that it's negligence not to use it. The whole original premise of Nursing was based on alleviating suffering, if we've gotten to the point where we can't be bothered to use a urojet then maybe we've lost our way.

[dishes, BSN, RN]

twinmom,

the practice of instilling lidocaine into the meatus prior to inserting a catheter in males has been in place for over twenty years. Since there is already concensus among the experts, there is no need to repeat the research over and over. When I research a best practice guideline I look at the professional guidelines for the nursing specialty, in this case SUNA and EAUN have guidelines that recommend instilling lidocaine prior to catheterization. The research was original done on males and since they have longer urethras the original syringes were designed with enough lubricant for the male urethra. Now there are syringes for males and females, and the practice is moving towards using them with females too.

The Society of Urologic Nurses and Associates http://www.suna.org/sites/default/files/download/maleCatheterization.pdf

and the European Association of Urology Nurses

http://www.uroweb.org/fileadmin/EAUN/guidelines/EAUN_Paris_Guideline_2012_LR_online_file.pdf

[xoemmylouox, ASN, RN]

Urojets are great for patients and are so easy to use. Sadly we next to never have any to use. It should be used on everyone, but I agree males do tend to suffer quite a bit, especially those with prostate issues..

[Twinmom06, ASN, APN]

thanks for the information guys - the clinical we've done and the hospital I've worked in as an aide have never done that - and if that is the standard thats fine - the reason I brought up the research aspect was because this instructor was chastising my classmates that they should have been "up on the literature" - since no one taught us any differently (and none of the hospitals have lidocaine gel anyway) I was looking for specific literature explaining that.

also it wasn't a man she was catheterizing - it was a woman. I guess my greater point was there is a way of teaching new grads without embarrassing them in front of regular staff, making them go home at lunch and cry and wonder if they're in the right profession considering we just graduated 2 months ago and for them its their first job in a hospital. I was looking to see if there were specific studies that I could find and if not could suggest to our education coordinator that perhaps a refresher for either us or the instructor was necessary.

[VANurse2010]

I've had a Foley in before. It wasn't comfortable but it was far from being painful. Making lidocaine mandatory or calling it's non-use "negligence" is a bridge (way) too far.

[brownbook]

I've been a nurse many years and never heard of or thought of inserting lidocaine into the urethra for a "routine" foley insertion. This is what I love about nursing, you never know it all, there is always something new, or in this case maybe something old?

We did insert it into the urethra (males and females) when I used to prepare patients for cystoscopies.

It is interesting but like VANurse said it isn't negligence! Of course the biggest issue is maintaining sterility. That is WAY above the potential for some discomfort. Evidence based practice is to limit the use of or need for foleys, so hopefully it is a rare intervention.

[nurseladybug12]

I learned to lubricate the catheter tip in the tray for both males and females. When I was in school, our clinical instructors were not the same teachers as the one teaching us these skills in lab and sometimes their ways of doing things did not mesh and caused issues. I have also had an instructor be completely unprofessional and chastise and embarrass myself and other students in front of patients. I think that instructors that do this are bullies and purposely try to upset students in order to weed them out for their own personal reasons-because they enjoy tormenting people?, at least that's what I thought when I saw it happening.

[Esme12, ASN, BSN, RN]

BIT, not nit!

If I see nits down there, we got more problems! ;-)

I needed that today!!

Your pharmacy probably has lidocaine gel or viscous lido....you probably/may need an order.....it works as any other numbing agent. For males...I will inject the lido...then go collect the foley insertion supplies....and it's ready.

Females I place the foley in the sterile tray and goob up the catheter there. I don't think that manipulating the meatus of a female is necessary considering it can be dificult to find.

[brypoli]

I think instilling lubricant directly into the meatus is indicated for BPH pt because of difficult insertion. In addition to that when putting gel into the foley catheter make sure to prevent applying on the holes because the urine will not go through it during ibsertion...

[HM-8404, BSN, RN]

Often the "bully" at work is the weakling at home. They are dominated by their spouse or other family members. They see it as their chance to "get even" or they see it as a normal way of dealing with others because that is how they are normally dealt with.

To lube the Foley I pull the plunger out of the back of the lube syringe and place the Foley in. There is so much lube around the Foley tube that is slides in with no problems, males and females.

I learned to lubricate the catheter tip in the tray for both males and females. When I was in school, our clinical instructors were not the same teachers as the one teaching us these skills in lab and sometimes their ways of doing things did not mesh and caused issues. I have also had an instructor be completely unprofessional and chastise and embarrass myself and other students in front of patients. I think that instructors that do this are bullies and purposely try to upset students in order to weed them out for their own personal reasons-because they enjoy tormenting people?, at least that's what I thought when I saw it happening.

[wooh, BSN, RN]

Be careful with lidocaine for the women. I've had catheters, and I've had lidocaine down there. The lidocaine burned way more than the catheter was uncomfortable.