Female Foleys... I STINK AT THEM>>> HELP!!!

  1. Any tips, please? I just havent dont them much in my career, so I am not good at female foleys. I mean, the pt is asleep, froglegged, how much easier can it get , right? I must be missing something. I feel like a half a nurse!!!! It's so embarrassing......Do you just have to do them over and over again to get the landmarks right? Everything looks the same to me "down there" !!! Please give any advise you can. Nothing is too basic. I get my own seperate gloves, use the betadine of course to look for that wink (that I cannot locate) , and the positioning is optimal, being they are supine, froglegged, and asleep!!!! Thanks in advance!!!
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  2. 14 Comments

  3. by   jmgrn65
    Have someone go with you and hold a flashlight, then you will have a second set of eyes to help you locate the urethera (sp).
  4. by   LoriAlabamaRN
    My best tip is to avoid the hooded landmark that looks like it might be an entry port- it's the clitoris. Go below that, even if it means going part of the way down the entrance to the vagina, and you should be able to feel the tip of the catheter slip into the urethra. Feed it in and look for the telltale urine drain. If you are in the vagina, you may need to just leave that one in so you know where NOT to go, and take a new foley and try going above the old one. It does take practice. Good luck!
  5. by   Marie_LPN, RN
    And don't forget to aim one of the spotlights to shed some light on the subject.
  6. by   mystcnurse
    are you a female or a male? If you are a female, get out the mirror and locate the landmarks on yourself, if you know where they are on you, it will be easier to find them on someone else. Never have your sterile kit out, until after you have looked and located the urethra on your patient first. You will be calmer when you are in a sterile situation. Finally, if you are having trouble finding the urethra, before you have the sterile field, gently grab both sides of the labia majora, while someone else holds the flash light, or you have a good light source and pull downward and outward. This doesn't hurt, unless you are very rough, it is actually how we do forensic exams on children, and it is called "gentle traction". You will have a much better view of ALL of the landmarks. Finally, ask your peers if you can put all of the foleys in for a few nights in a row, especially on patients who aren't as with it, as you won't feel so intimidated. Like someone else said on this thread, practice makes perfect.
  7. by   NurseRoRo
    Don't stress, it is a very tiny opening you're looking for while everyone is gowned, gloved and staring at you to get it done faster!! You may check with your educator, but I have seen nurses leave a sponge stick in the vagina after prepping that and before inserting the foley. That way you're sure to get it in the right opening. Like I said, I'm not sure if that's kosher policy-wise to do that. Also, I guess if you're doing spine cases or whatever, then it's rather inappropriate to do a vag prep just for a foley!!

    I never see the >>wink<< either. I just aim for the top of the area, below the vagina, and yes, I have tried to catheterize a clitoris before. Talk about embarrassing!!

    Having the spots on the whole area helps. If you have a larger patient, it is most definitely a two person job (one to hold labia apart, one to cath). During the prep, with each swipe of the cotton ball from top to bottom, I stare at that urethral opening, like "Okay, it's right there...." Aim towards the top...it's a subtle slit until you get used to seeing it.

    Good luck!
  8. by   teetertot
    Another good tip is to save some of the k-y jelly(if it is syringe form, like kits we have) that you squirt out for your foley and after you have cleaned with betadine swabs just squirt some of the ky jelly into the urethra, or the area that u think is the urethra to test and it just opens it up for you to see better, plus also provides the extra lubrication. Works everytime! May God bless, Teetertot
  9. by   elcue
    RELAX!
    Take your time and retract the labia very well with your left hand. Locate the clitoris - this is usually an easy landmark to locate and is how I always start. Then look down (posterior) until you see the little "dimple", which is the urethral meatus. Take your time visualizing where you're going rather than just going for a blind stab.
    Hold the catheter close to the tip (maybe an inch or 2) so it doesn't flop around when you try to intriduce it to the meatus. The length of the catheter should be curled up in your right hand so that once you introduce the catheter tip to the meatus, you can feed the rest of the catheter in smoothly.
    Try to relax. Everyone misses sometimes! Good luck. Linda
  10. by   tessa_RN
    Yeah Females can be hard to get foleys in sometimes...The main thing I do is shine a light in there...And someone gave me a great tip..They told me to aim for the flower..Which is kind of weird but that is how I think it is shaped..Plus if you miss leave the catheter in the vagina and get another and aim for the other hole..It takes alot of practice you will get it..I was on evening shift and I was putting in the foley on a large lady..I couldnt hardly retract anything so I asked the doctor to retract (this doctor was very nice and helped out alot) and that helped out...Good luck!
  11. by   NurseyBaby'05
    I was helping a co-worker insert a foley on a spunky LOL. She said an old school nurse showed her to prop a bedpan under a woman's hips. This seemed to put everything at a better angle. It was easier to see. More light was hitting the right area and the pt. kept her legs apart better.
  12. by   stevierae
    Try this---it's how I've taught students who happened to be in my O.R. rooms over the years. I think it will help you, too--soon you will be teaching your OWN students this way:

    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 "V'd" 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 clitoris 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 clitoris)

    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 seeing urine, 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.

    (Just remember that,when catheterizing females, the technique works especially well if, instead of using your thumb and index finger to retract the labia, you make a habit of using your index finger and middle finger. It's just less awkward.)

    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.
    Last edit by stevierae on Sep 7, '06
  13. by   Rezidentura
    Third orifice from the bottom!
  14. by   jonamb
    Have you tried turning the pt. on her side with her knees bent (imagine the position her legs would be in if she were sitting in a chair)? A veteran nurse taught me this, and sometimes it makes things easier to see. I work in LTC, and the landmarks are often very hard to find on elderly women. Quite often, I could not find the "flower" and would have sworn I was cathing the vagina, only to be pleasantly surprised to find I was indeed in the right place. And don't worry, I'm sure we have all tried to cath a clitoris or a vagina.
    I had to smile when I read about the "flower". That's what I always referred to it as (I've gotten some strange looks from co-workers, but that is what it looks like). I, too, have never seen the "wink". I thought I was really missing something -- glad to know I'm not the only one.
    Everyone had good advice! I'm going to keep in mind the one about the bedpan. Always glad to learn something helpful!

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