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.

[green34]

I have heard of the lidocaine jelly for males. For routine insertion it is the sterile lube at all facilities I've been at.

[dishes, BSN, RN]

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.

If a clinical instructor went on a rant about being aware of the best practice of a particular procedure, I would answer, "I am happy to be up to date, is the literature for this procedure referenced in the hospital's policy and procedures?"

In my experience, most clinical instructors have a hard time keeping the policies and procedures up to date, so when you ask about them, they either readily agree the information is available or they become very quiet. Either way, your response shows you know where to locate procedure information.

[MunoRN, RN]

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.

So lidocaine jelly shouldn't be used because for some it is only "uncomfortable" rather than painful. Why should those that find it painful (arguably a significant portion of the population) be denied an attempt to limit their pain because some find it less painful than others. I think we're maybe arguing based more on a resistance to change than any sort of logic or to provide better care for our patients.

[BrandonLPN, LPN]

I would use the lidocaine jelly if it were available. It just isn't. Everytime I insert a foley or perform a straight cath am I supposed to page the doctor, get an order, call the pharmacy, fax the order and have a prefilled syringe dropshipped to my facility? And then wait to be written up by management?

It really is going to far to say it's "negligent" to not use lidocaine jelly.

I'm all for pre filled syringes of lidocaine becoming a part of a cath kit and an automatic part of the whole catheterization process. Why not?

With all that said, I do think the portraying male catheterization as "traumatizing" is being a little melodramatic. Of course it's painful. Lots of things are painful. Getting an IM injection is painful. Yes, using a proven safe method to minimize pain when inserting a catheter is a no brainer. Of course we should incorporate it into standard practice if feasible. But to say it's negligent or cruel to just use lubricant is over the top. Part of being a grown adult is tolerating some pain or discomfort. Having a completely discomfort free patient experience is an entirely unrealistic expectation.

[xoemmylouox, ASN, RN]

With all that said, I do think the portraying male catheterization as "traumatizing" is being a little melodramatic. Of course it's painful. Lots of things are painful. Getting an IM injection is painful..

Well I'm female and I've met plenty of older men that I felt sorry for when it came to caths. I have always been pretty good about getting around those large prostates, but not everyone is or cares to be. For those men it can be very traumatic and painful. While I agree with you on plenty of things, I cannot agree that getting a cath is the same as getting an IM inj.

[carsm3]

One of the nurses on our unit inserts the lubricant directly into the meatus then inserts the catheter. We have had males who have had a previous foley say that lubricant directly was more comfortable then lube just rubbed on the catheter. I usually just dip it in the lube really well. But if you think about it, as your inserting the catheter most of the lube is being left on the outside tip. Either way I'm sure is fine. I personally, would follow what your instructor is showing you. Many of our urologists insert the lube directly into the meatus. As long as your using sterile technique then it's really just a preference type thing.

[MunoRN, RN]

With all that said, I do think the portraying male catheterization as "traumatizing" is being a little melodramatic. Of course it's painful. Lots of things are painful. Getting an IM injection is painful.

I've had IM injections before and I've a Foley catheter before, there is no comparing the two. I've also had to reduce my own dislocated shoulder before, still not as bad as a Foley.

I had a patient once who we needed to cardiovert without any analgesia or sedation, even though he was fully A&O during the shocks. Afterwards the MD explained why analgesia and sedation couldn't be used and apologized, the patient replied that the 200 joule shocks were nothing compared to when they put the Foley in.

[turnforthenurse, MSN, NP]

Never heard of it being applied directly to the meatus. I just squeeze the lubricant into the tray and run the tip of the catheter into it...

[chrisrn24]

Never heard of it being applied directly to the meatus. I just squeeze the lubricant into the tray and run the tip of the catheter into it...

Same here and I'm a newish grad.

[dishes, BSN, RN]

Brandon I was thinking about your suggestion that manufacturers should add prefilled lidocaine syringes to catheterization kits so that instillation automatically becomes a part of a catheterization procedure. The problem with this idea is that lidocaine is a drug so the nurse would still require a separate order to instill it. Instead of adding lidocaine syringes to catheterization kits it might be better for manufacturers to add prefilled sterile plain lubricant syringes. There is some research that shows "no statistically significant difference in pain scores between lidocaine and plain lubricating gel instillations"

Should lidocaine gel or lubricating gel be used for catheter insertion? | Practice | Nursing Times

[kayern]

the instructor isn't exactly 100% correct. I'm hoping the instructor was professional enough to "get in their face" away from the patient care area!

You don't say if the patient was a male or female. I have lubed the catheter and either little lub or lidocaine on the meatus of a male. Since you did a literature review ask a urologist for some input.

[kool-aide, RN]

I was just taught last semester in nursing school to squirt lube in tray and dip the cath tip into it.