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Discussion

Blood after foley insertion

I've been an ICU nurse for a year and half, and had an issue come up during foley insertion on an elderly male at the end of shift yesterday who was agitated and going through DTs.

The insertion - 18 french - went rather smoothly. Plenty of lube jelly. Slight bump around the prostate and then plenty of normal urine output further in. No problems inflating the balloon. Light tug felt normal. Came back about 15 minutes later to see hematuria and a few clots with slight leakage of urine around the meatus. Patient didn't seem to be experiencing any pain and was actually less agitated than prior to insertion.

Nothing about the patient, labs or history, or procedure indicated anything like this should have happened. And nothing was forced (I know better). Not sure if the patient may have tugged on the catheter somehow.

Aside from the patient tugging on the catheter, is there anything else that could have caused this?

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    Is the patient on any anticoags? It could be that even that small "bump" around the prostate would have been enough to cause some hematuria.

    -girlpolice

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    If he's a DT patient then he possibly has etoh liver issues/clotting issues, just a thought.

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    18Fr? Seems a little large unless the pt has had an indwelling for sometime. None the less I have a pt that is straight cath'd q 6 with a 14Fr. We tried an indwelling initially, and he pulled it out. Not sure how well rounded you are on urology, but when a male pt pulls out a foley, it's basically a prostatectomy. Scant amounts of blood and clots are common, and not of concern but this is specific to the pt. How large was the balloon? It's been my experience that the larger balloons 30cc, seem to cause problems, particularly leakage around the tubing. I was taught 5-10 cc's, which is what I always inflate unless instructed otherwise. Also, did you insert the catheter all the way? I was taught by a urologist to insert on males up to the Y, then inflate and retract.

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    18Fr is a big catheter. Anesthetic lubricants such as lidocaine jelly (urojet) can also help keep the sphincters and urethra relaxed which in turn can help prevent tissue trauma, so long as you allow it time to work.

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