Can I do this to help me insert a Foley?

[allthesmallthings]

I have some trouble inserting Foley's in women by accidentally inserting it into the lady parts. I expect I'll get better with experience, but to help me, is it okay to put an empty 10-mL syringe in the lady parts at the start to mark "not here" (insert the barrel of the syringe, with the broader edge and pump sticking out so that I can see it -- I'm not talking about shoving the whole thing in there right up to the cervix)? Things get kind of all mushed together in the vulva, especially if the Pt can't move her legs into frog-legs position (we have little old ladies who fall and break a hip and need FOley's before surgery), and it seems like I need more than my one free non-sterile hand to spread all the folds, and still try to keep the procedure sterile.

I know the rule about temporarily leaving the Foley in the lady parts if you insert it incorrectly so that you can get a second kit and do it right; but it seems simpler and cheaper to use a 10-mL rather than have to use 2 FOley trays. Why risk having to charge the Pt for 2 Foley trays if I could just use a cheap 10-mL?

Obviously, I would make sure to take the syringe out right after the Foley insertion. Women aren't really looking "down there" when I'm inserting Foley's, so hopefully they wouldn't feel the 10-mL and ask questions, but if they did, what would I say? Is this okay?

[highlandlass1592, BSN, RN]

I would say no it's not ok but you need to check and see if your facility has a policy covering this topic. The issue for me would be no matter how good your intentions, the possiblity of injury could exist if it would be taken in thru the lady parts.

I have to be honest here, why are you worrying about the charge for an additional foley when patient safety is at risk? My concern is always for the patient first, charges second. I'm not saying I'm wasteful of supplies but if I put the all-mighty dollar first, I need to be dealing with numbers and not patients. I'm not going to be comfortable endorsing a behavior that isn't taking patient safety into account.

On a side note, the more experience you get inserting foley caths, the better you will be. I've dealt with ortho patients over the years as well as pt's in full blown pulmonary edema and congestive heart failure. I did have one pt that I couldn't lay down any further than about a 40 degree angle. Took a couple of people helping me but we got the foley in. Then about 30 minutes later, they finally intubated which would have helped me a great deal..but as we were giving 100mg of IV Lasix, we couldn't wait. Just be patient and get all the practice you can. The more you do, the better you'll become ..and the foley in the lady parts trick will be very rare.

[agldragonRN]

umm...no

leave first foley in the lady parts and use a second foley kit. make sure someone is there with you to help you position the patient properly.

[resumecpr]

Definitely not. Try putting the bed in trendelenburg and enlist in the help of other staff to help hold legs. The meatus looks like a winking eye fyi. And if you're able to spread the labia apart, it should be easy to locate. Further, landmark after you clean with iodine because it sometimes makes it easier to locate.

I hope this helps.....please don't put anything in anyone's lady parts unless you have a doctor's order. It's unnecessary.

[GRUNGE]

grab a cna get all up in the pt buisness ( in other words dont be timid, push and spread firmly, also pull up becaus the meatus sags in older women.) when you cant see aim up and slide back. keep advancing even if your not sure cuz somtimes i think ive missd and the i get urine. the meatus kinda looks like an orifice to me in that it seems to have that pursed apperance. when you clean with iodine wait for the involuntary contraction. (the wink)

[merlee]

I had a home health pt for many years that was not able to spread her legs very well. We put her on a bedpan to help tilt her pelvis up slightly, while she was flat in the bed. You might try having someone shine a light on the area.

Other tips - before you clean the pt, be sure you have tested the bulb, and spread the jelly on the foley, so you won't have to try to do those one-handed.

Bring a 2nd cath with you, if possible, and have someone open it if that is all you need.

Remember that the meatus is just under the privy parts.

Happy hunting!

[coastalcattery]

Sometimes with older females it goes easier to have them lay on their side with the top leg bent up as far as they comfortably can and cath from behind.

[mom4josh]

A seasoned nurse taught me this trick: pull the blankets up from the feet so the patient doesn't get cold by being completely uncovered. Take a warm, soapy wash cloth and clean the area thoroughly, trying to visualize where you're headed. Then, wash your hands start the procedure. Amazing how much this has helped me.

[canesdukegirl, BSN, RN]

I do the same thing Merlee does. Prepare your foley kit FIRST, donning a separate pair of sterile gloves. Then use the gloves in the kit to do the insertion. When you are prepping with the Betadine, the urethra will look like a Mercedes symbol. Go ahead and insert and watch for that liquid gold! Don't use a syringe to mark the lady parts.

[ohgoodnessgracious]

NO!! Definitely not!! Goodness forbid something happens, you poke and make the patient bleed, etc. how are you going to explain the 10 ml syringe stuck up there? And what about infections???

[P_RN, ADN, RN]

The sims position is great. have her lie on her good side withe the top leg flexed and held slightly up by another person. Use the betadine liberallly especially right below the privy parts, then hold the Foley well lubricated right at the tip with your index finger and go right at the privy parts just slightly below. The betadine should pool in the meatus. Good luck, It;s been working this way for 200 years so should work for you.

[nurseygrrl, LPN]

I had a friend just recently teach me to ask the patient to cough and the meatus will 'wink' at you. Placing something in a patient's lady parts can get you into a lot of trouble for a lot of reasons. No good.