Getting the foley past the prostate

[queenjean]

Holy cow, I could not get a foley in last night. I used a regular 16 fr, I used a coude, I used urojet, I tried to gently roll the foley between my fingers while advancing, I advanced it to the prostate and then had the fellow take a couple of deep breaths and try to relax before advancing....I don't know what else I could have done? Yet this fellow told me he had never been told his prostate was enlarged and had never had a problem having a foley placed (granted, though he was alert and oriented, he was grumpy - no kidding, with good reason--and was a poor historian).

What gives? Any suggestions? I mean, I realize that sometimes you just cannot get a foley in a fellow; but this seems to happen to me a lot. A female, no problem. A fellow--half the time I end up having to get someone else to do it, or just not being able to get it in!

Any suggestions would be greatly appreciated (by myself and my pts of the male, enlarged prostate persuasion)!

[RNgirlie]

bump. i get problems getting it into males too!

[Elvish, BSN, DNP, RN, NP]

At what angle are you holding the member? Sometimes that makes a big difference.

[CHATSDALE]

maybe using a smaller foley, clutch member at base and hold upright , liberal use of lubricant on entire foley

i have had difficulty with with women w/rigidity that prevented acess more so than with men

i did have an orderly who came over and said that the urine was bloody but it was not bloody urine it was just blood, i reinserted with smaller foley and obtained urine

[leslie :-D]

At what angle are you holding the member? Sometimes that makes a big difference.

initially, up and straight...perpendicular to stomach.

i have troubles too.

and when i get a doc, they ram it in.

it's bloody and traumatic.

i'm coming to dread cathing males.

leslie

[Dorito, ASN, RN]

I saw a Urologist inject some KY right into the urethra once and then used a bigger foley. I had tried smaller ones but he said they're too pliable and that you should use a bigger size. Also, sometimes I've had the guy cough and then advanced it. Also, the angle you hold it can make a difference....I think holding it upright helps avoid problems. I always was better at the males than the females. :imbar

[miko014]

I seem to be the one who is able to get the guys - I'm the one who has problems finding it in some women! I have found that if you just hold constant pressure agains the prostate and wait, the pt will usually relax enough to allow the catheter to pass. Encourage them to take deep breaths, or cough if that doesn't work. Try adjusting the angle of the member, like others said. If it's particularly difficult, a coude can help, but I just hold the pressure and wait, and I have always been able to get it in. Hope that helps!

[PsychNurseWannaBe, BSN, RN]

Have them cough when you reach a little resistance. Normally helps because it moves the prostate.

[Agnus]

when you come up against the prostate and can not advance it is often because when you bump against it the prostate will spasm. Gently hold the cathater against the prostate without pressure. It will relax.

Have the patient exhale. Coughing can also help. Use plenty of lube.

The thing with taking deep breaths to get someone to relax is actually counter productive. It is not taking the deep breath that causes them to release muscle control it. It is the long concentrated exhale at the end. So do not tell them to take a deep breath. This actually helps them contract more. Instead tell them to breath out and demonstrate.

Otherewise they concentrate on taking deep breaths when the focus should be on blowing out. Coughing works because they are blowing out forcefully. But a cough is short and brief so you have to be quick.

[queenjean]

Thanks for the advice. I was holding that member at ALL angles, man. I did not try the cough, though. I'll definitely try that next time.

I did try to wait after hitting the prostate, but maybe I didn't wait long enough or had too much pressure or who knows. I'm interested to see if the doc was able to do any better tonight and get some input from the dayshift RN.

Thanks for all the advice and commiseration! Man, one would think it should be an easy shot, no problem....it's so much more complex and frustrating than that!

One more questions--does it help to have the fellow change position? This gentleman was severely dyspneic; I couldn't have him lay flat, he was at a 45 degree angle, he was just so SOB. I wondered if dropping him flat for a few seconds would have helped, but I didn't want to chance it.

[Agnus]

Yes the change of position might have helped. Keep in mind no one get the foley in every time. I had to call in the urologist to do it the last time.

[Ms Kylee]

I was told "Hold the penie (and that's exactly how I was told) at a 60 degree angle and insert". Never had a problem....