Is it normal to take 4 Tries and Catheters to finally get it right?

Nurseinthemaking · Mar 18, 2005

you guys, you have all made me feel so much better. I am going to make a list of tips and I am going to turn it in with my nursing notes for my clinical instructor to see, she might get a tickle out of the bed pan one.

OK the one about the meatus being "north" of the clitorus has me very befuzzled.

Thank you so much for all your great advice and support.

Doing this was a great learning experience. I cannot wait to get the next one, I will jump on it thinking about all the great I got from each of you. Big huggins to you. :nurse:

grimmy, RN · Mar 19, 2005

the first ten foleys you put in will be the hardest. i do them everyday (i'm an or nurse) but when i was a student, it was a nightmare. i remember my first was on a morbidly obese woman on an oncology floor. there i was, my instructor behind me with a *flashlight*, two of my fellow students holding her legs back, and me, in the hole, stabbing in this poor woman's nether regions, hoping i would get it! :lol2: first try, the thing went into the lady parts. thankfully, i had gloves and another foley in my pocket, and tried again. got it on the 2nd try, but wow, what a picture. you'll get it, i promise. women are generally harder to do, little girls are extremely difficult, especially if they are awake, and older men with prostate problems may be impossible. don't assume you're making a mistake. i've had to call a urology resident a few times to do a scope-assisted catheterization because of an enlarged prostate. time and experience will be your best friend.

KacyLynnRN · Mar 20, 2005

Hahaha....often takes me 2 tries on a woman, and I have been a nurse almost 3 years. My best advice is leave the catheter in the lady parts, so you know where not to go on your next try. But believe me, you are not the only one who needs multiple tries, and I am not even in school anymore! LOL

Fiona59 · Mar 20, 2005

If possible, get Lidocaine gel for men with prostrate issues. I've found that talking to a lot of men about anything often relaxes them and in it goes (eventually). That's where the lidocaine come in handy..

closatssl1 · Mar 20, 2005

Oh, don't let that bother you! Some women have strange anatomy. And some men do too.
We spent about an hour trying to cath one poor fella, finally gave up and had to have the urologist come in and do it. Turned out that the patient had a "blind passageway!" We felt awful about trying so hard to get it in.

Yes, Angie O'Plasty, could you explain a "blind passageway" in terms of nursing. Thanks :uhoh3:

RN92 · Mar 20, 2005

Luckily, cathing a lady parts is (most of the time) not painful. One way I can tell Im in the right place is by the shriek!

leslie :-D · Mar 20, 2005

definitely there are women that are anatomically incorrect. i always bring 2 caths w/me just in case. and if i have difficulty with them on their backs, i find the side-lying position much more conducive to finding the correct meatus.

allnurses Guide · Mar 27, 2005

you guys, you have all made me feel so much better. I am going to make a list of tips and I am going to turn it in with my nursing notes for my clinical instructor to see, she might get a tickle out of the bed pan one.
OK the one about the meatus being "north" of the clitorus has me very befuzzled.
Thank you so much for all your great advice and support.
Doing this was a great learning experience. I cannot wait to get the next one, I will jump on it thinking about all the great I got from each of you. Big huggins to you.

The bedpan thing works for a quick lady partsl exam too, when you can't get the woman to a pelvic bed (I work ER).

"north": think of a road map, north is always "up" or to the "top", so ...

the meatus being north means above everything else, or "on top". Gone south, means whatever it is you're talking about is going "down".

And you're welcome, from all of us :balloons:

nurse96 · Mar 27, 2005

Someone once told me if I had difficulty inserting a foley cath on a male to have him strain,usually goes right in.

mysticalwaters1 · Mar 27, 2005

Just takes practice and all the advice already mentioned. I lift the area up and look for an area someone refered to as a butterfly. I don't kow but anyway it just takes practice. I used to never get it and needed someone else to do it and now it's a lot easier but at times definitely get it in the lady parts. I also leave the catheter in when this happens and if it's proving difficult get someone to hold the legs or shine a light but it does get better and sometimes just can't do it. I had one male pt kept saying if i put a foley in he needed to be sedated and i'm like WHAT! Anyway His member was so tiny. I tried to find the smallest catheter and started a little and he started screaming i stopped. Really stunk because the guy had a retroperitoneal hematoma from a liver bx, kidney failure, the h/h droping fast and the doctor not sending him to icu :madface: and in the midts needed this urethral catheter. Finally i called and told the doctor who said he'd come up and do it and ordered an analgesic cream to put on the member which i did and said my god come on up. He tried to put the catheter in and the pt screamed and held the doctor's hand so tight i think the pt really hurt him. When the pt let go the doctor said don't you ever do that to me again. The pt was difficult yes he member was small but he was uncooperative with his care at times and wanted every detail from a scratch to more complex things solved in the midts of hime becoming unstable. Yeah harsh but it really was awful. Anyway finally the next day after over 7 units of blood and i can't remember how many ffps we hung just i believe in one day not counting the previous day all on a med surg floor when night shift gets 10 pts. My charge nurse gave me 3 pts that night (3-11p) and I couldn't keep up it was awful. Anyway back to catheters not even the doctor could get. I don'tknow if the urologist did either.

stevierae · Mar 27, 2005

A OB head nurse gave me this tip once. Spread the labia and lift slightly. By lifting, the meatus presents itself better.

And it works especially well if, instead of using your thumb and index finger to retract the labia, you use your index finger and middle finger.

Do it like this.

Get your Foley tray opened, (on a little prep stand or bedside table, or even on the the bed, between the patient's legs, which are "frog-legged"--just make sure it stays sterile)

Put your gloves from the kit on

Attach the syringe of H2O to the Foley--test the balloon if you include this step as part of your technique

If your patient is awake, and you want to make the catheterization as atraumatic as possible, open the syringe of KY (If she has an epidural, she may not feel the catheterization, so you can skip this step)

Pour your Betadine over your cotton balls, keeping one or 2 dry in case you need to wipe some Betadine off for better visualization of the urethra

Make a "V" with the index and middle finger of the OPPOSITE hand (that is, NOT the one you will prep and insert the Foley with---to insert the Foley, you will use your DOMINANT hand) You will maintain this traction throughout the entire procedure.

Put your "Vd" fingers at the very top of both sets (inner and outer, together) of labia and pull upwards, towards the umbilicus

Prep, using your Betadine soaked cotton balls, with the opposite (dominant) hand per usual technique, while maintaining traction--the privy parts should be quite visible, and should be aligned with the umbilicus--

Look down, and while still maintaining traction upwards with the "V'd" fingers of the opposite hand, inject a tiny bit of KY--perhaps a cc or 2-- directly into the urethra, if you want to (you can skip this step if your patient will most likely not feel the insertion---just make sure you have used plenty of Betadine for lubrication)

MAINTAIN YOUR TRACTION THROUGHOUT with the "V'd" fingers of your non-dominant hand!!!! If the Betadine has made things a bit slippery, "hook" the tips of your "V'd" fingers in and under the labia a bit, and adjust upward traction, still maintaining it

Pick up the Foley (you can gently coil it around your fingers, if you'd like, so as to make the the excess length easier to handle, and lessen the chance of contamination) insert the Foley with your dominant hand all the way to the hub into the urethra (which should be visible a short distance down, but usually aligned with, the privy parts)

When you see a drop or two of urine (if need be, you can have someone very gently Crede the bladder to push a bit of urine out and ensure you are in the right place) and then inject the entire 10 cc of H20 into the balloon port (to which it is already attached)

(Alternately, if you are certain you are in the bladder, but would still like to reassure yourself by seein gurine, you can now release traction and use your non-dominant hand to Crede the bladder)

Now pull the Foley gently down (with your dominant, still sterile hand) until it stops. You're done!

Get rid of the trash. Put the Foley drainage tube under the patient's knee (at the "hollow" in back of the knee; that is, the popliteal space) and make sure it isn't kinked or urine flow obstructed in any way. If your policy calls for the catheter to be taped to the thigh, do so.

Hang Foley bag below bed level.

Chart size of Foley, amount, color and charcter of urine initially returned, and the amount of fluid you put into the balloon (this is so anyone who uses a syringe to deflate the ballon when it's time to d'c the Foley will be aware that they need to aspirate 10 cc. of water, not 5 cc. (An easier way is to simply use a scissors and cut the Foley at the hub of the balloon port to let the water drain out)

If you do use KY, (on a female) don't use too much, as it can form a plug that can discourage the immediate free flow of urine--making you think you are not in the bladder, when you really are. If this happens, just disconnect the catheter from the bag and irrigate with a catheter tip syringe filled maybe 5-10 cc of H20--it will dissolve the KY and allow the urine to flow freely. Then you can reattach the bag. Be careful not to contaminate anything.

When you catheterize a male, inject the entire syringe into his urethra, rather than coating the tip of the catheter with KY---much better lubrication, and far less mess.

stevierae · Mar 27, 2005

The bedpan thing works for a quick lady partsl exam too, when you can't get the woman to a pelvic bed (I work ER).
"north": think of a road map, north is always "up" or to the "top", so ...
the meatus being north means above everything else, or "on top". Gone south, means whatever it is you're talking about is going "down".
And you're welcome, from all of us :balloons:

Well, no; actually, the urethra is SOUTH of the privy parts.

Think of it this way:

Umbilicus at the top (North)

Then the privy parts (going further South)

Then the Urethra (going even further South)

Then the lady parts (final Southern stop)

Even if you work UPWARDS from the lady parts, the privy parts is still above (North of) the Urethra

Orient yourself from the umbilicus, and work downward. Everything is generally anatomically lined up--except for people who have had various surgeries that tamper with nature, or whose abdomen is distorted by either major weight gain or loss