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?
I would say "No", because a 10 ml syringe is hard, and there is no way of knowing how active a woman is especially an older woman, and this could very well hurt her. I actually had a woman in her 80's who was a virgin (and many older women have never even inserted Tampons).
You might not think they can feel it and maybe some can't, but I know I would feel it if you put something in my lady parts (even just a little), and weren't aiming for it. And there's a big difference between that small rubber cath, and a hard plastic 10 ml syringe. For one if they do feel the cath it was a medical procedure gone awry. If they feel the 10 ml there is no medical protocol to back that up, and you could be in a slew of trouble for sexual assault if the woman wanted to push it.
For the majority of women you should be visualizing the opening before heading in that direction. Sometimes you can't (extremely overweight women), but for the majority you can. As you stated step 1. sterile field, and use one hand to separate, and visualize. If you cannot do this then stop, get help or hand it over to someone who can. Then try again next time. Practice makes perfect.
I'm going to agree with hours, just practice and always take a second cath in with you as insurance. The syringe is just a bad idea for so many reasons.
I do have to give you credit for creativity though!
I am a student nurse and feel like such an idiot. I am now 0 for 3 doing female foley insertions. My instructor just sends me into the room to do it myself - no help. And then I come out and say - well we need another kit I missed - and then she does it. Now I am freaking out that I'll never be able to do it. Help. I need advice.
One reason not to stick a syringe in there is what the rest of y'all explained, the risk of hurting the patient plus the risk of them getting very upset about a foreign body stuffed where it don't go.
The other reason is just the fact that the meatus is frequently IN the lady parts, you don't want to block where you might need to stick the foley! If you can't find it anywhere else, you can try the anterior wall maybe an inch or so inside the lady parts, putting gentle pressure on it with the tip of the foley. And always apologize for doing so, prior to said action, even if you don't think the patient is oriented at all. That way you won't be surprised by complaints.
Specializes in Trauma Surgery, Nursing Management.
Southern, don't sweat it...it will come with practice, but you must be assertive in asking your instructor to let you actually do the foley insertion.
There have been many helpful hints in this thread as to how to do a foley insertion. Here is how I do it:
1. Have your kit, and extra pair of sterile gloves and an extra foley at the bedside. Open your kit on a mayo stand or on something similar. Pull a trash can beside you.
2. Open and don your extra pair of sterile gloves. Take the betadine and squeeze it out onto the cotton balls. Put the foceps in the cotton balls and make sure they are all saturated with the betadine.
3. Squeeze out the lubricant in the corner of the bottom of the box. Discard the lubricant. If you know that you aren't going to take a sterile urine specimen, throw out the container and the label.
4. Take the plastic off of the foley itself. Take the syringe and test the balloon (there is controversy on whether or not you should test the balloon, but this is how I was taught. You should go by what your instructor teaches you.) Leave the syringe attached to the foley and ensure that it is tightened.
5. Dip the foley tip into the lubricant that you squeezed into the corner of the box.
You are now done preparing the foley for insertion. Doff your gloves and begin to position your patient. It helps when you are just beginning to learn to place foleys to have a surgical light aimed at the perineum. You can't very well go hunting for the meatus of the urethra in the dark, can you? Any facility will have mobile surgical lights, so ask for this in advance. If they don't have one, ask someone to hold a flashlight for you. You may feel kinda silly doing this at first, but when you place the foley correctly, you won't feel so silly!
6. Don sterile gloves included in the kit. Place your sterile towel (the one with the hole) on the pt. Put the other sterile towel close to the buttocks, taking care not to contaminate yourself.
7. Some women are very posterior, but you will not know this until you actually begin to prep. If you are right handed, you will use your left hand to spread the labia and your right hand to prep. You are working with one hand at this point because your left hand is considered unsterile. ***This is precisely why I prepare my foley IN ADVANCE of insertion.***
8. Take your first cotton ball and wipe superior to posterior. The betadine will almost show you exactly where you need to go. Continue to prep, making sure that you are tossing the used cotton balls into the trash. When you are done prepping, put the bottom of the foley tray onto the sterile towel.
9. The privy parts is waaaay up there, out of range. Don't bother her. Lift up with gentle pressure and you will see the meatus. It looks like a peace sign (how appropriate, huh?)
10. Take your foley and put it right in the middle of the peace sign. Sometimes women will have very prominent Bartholin glands, and it will throw you off. These are flanking the meatus, so if you can't tell, aim for the one in the middle. The lady parts is posterior, so if you have doubts, then aim high. Advance the foley slowly and if you encounter pressure, then stop. The pt may have strictures. If you have advanced without pressure, then you should see some urine. If you don't see any, take your left hand and gently press on the bladder. Sometimes it is helpful to let gravity aid you and you can take your right hand and lower the foley bag a few inches (but not so low that you contaminate yourself). If this still does not produce urine, you are in the lady parts. You must then re-prep and get another foley.
It is imperative that you tell your pt everything that you are doing. When you prep, tell them that you are prepping and that they will feel cold liquid. Before you insert the foley, tell them that you are doing so. Some women feel a very sharp pain when the foley is inserted, and it is normal to feel this for a moment. However, if it is agonizing pain, then stop.
With older women, sometimes it is very painful to position them in a frog leg position because it hurts their hips. This is another reason why I prepare my foley beforehand. It is very helpful to both you and the patient to ask if they can withstand this position for a few minutes.
It is hard to learn how to do a foley. It takes practice. You WILL master it, though. Pretty soon, you will be teaching others how to do it!
Specializes in Nurse Leader specializing in Labor & Delivery.
One thing I find helpful to do is use the betadine soaked cotton to hold the labia apart. First cotton - swipe the labia, then put it between my left thumb and one labium. Next cotton - swipe, then put it between the labium and my fingers on the other side. Using the cotton to aid my left hand in holding the labia apart is less slippery than just my gloved hand, and the labia tend to stay apart better.
Specializes in Nurse Leader specializing in Labor & Delivery.
4. Take the plastic off of the foley itself. Take the syringe and test the balloon (there is controversy on whether or not you should test the balloon, but this is how I was taught. You should go by what your instructor teaches you.) Leave the syringe attached to the foley and ensure that it is tightened.
That's how I was taught too, but it's no longer recommended. Research has found it to cause more injury to the urethra as it's being inserted if it was inflated/deflated first.
That's how I was taught too, but it's no longer recommended. Research has found it to cause more injury to the urethra as it's being inserted if it was inflated/deflated first.
I actually heard the same thing, research is showing not to test the balloon first. However, I've been unable to locate any research articles to get our educators to work on changing the policy...do you have any links for such data?
Honestly, I don't know why they aren't taking the lead on this...as education is supposed to be their area of purview not mine. But whatever......
Specializes in OR, Nursing Professional Development.
I actually heard the same thing, research is showing not to test the balloon first. However, I've been unable to locate any research articles to get our educators to work on changing the policy...do you have any links for such data?
Honestly, I don't know why they aren't taking the lead on this...as education is supposed to be their area of purview not mine. But whatever......
Try contacting the company your hospital buys foleys from. We changed our policy based on the manufacturer's recommendations, and I would assume that the company provided research to support their recommendation.
I am a student nurse and feel like such an idiot. I am now 0 for 3 doing female foley insertions. My instructor just sends me into the room to do it myself - no help. And then I come out and say - well we need another kit I missed - and then she does it. Now I am freaking out that I'll never be able to do it. Help. I need advice.
Don't feel like an idiot. It takes a while to learn. If your instructor won't go in with you have a classmate or the RN assigned to that patient help. Having an extra pair of hands in there goes a long way. I used help until I did quite a few, and honestly if available even after a year of doing them consistently we go in for assistance. Like someone said, always take in extra gloves and an extra catheter with you. If you miss and go into the lady parts leave it in until the second one is placed correctly. Take a flashlight. And remember, it is normal to need lots of practice. You'll get there.
Specializes in Hospital, clinic, research, hospice.
After 42 years as a nurse and hundreds of Foleys inserted, this old dog learned a new trick. A hospice nurse colleague learned a new way to insert a Foley. Place the patient on her side (for me, that has to be her left side) in Sims' position. Locate the perineum and pull open the labia, and VOILA, there is the meatus!. Cleanse with betadine and insert the catheter. My elderly patients are grateful that I don't put them on their backs and try to pry open their legs. The technique came from a nurse from Africa, my success rate is 100%, the procedure is faster and, most importantly, the patient is much more comfortable.
Specializes in ER/Tele, Med-Surg, Faculty, Urgent Care.
After 42 years as a nurse and hundreds of Foleys inserted, this old dog learned a new trick. A hospice nurse colleague learned a new way to insert a Foley. Place the patient on her side (for me, that has to be her left side) in Sims' position. Locate the perineum and pull open the labia, and VOILA, there is the meatus!. Cleanse with betadine and insert the catheter. My elderly patients are grateful that I don't put them on their backs and try to pry open their legs. The technique came from a nurse from Africa, my success rate is 100%, the procedure is faster and, most importantly, the patient is much more comfortable.
That method has been around for many years! I learned it as a new grad RN in 1980. The LPN that was working with me on the wound care unit showed me that method. It's come in handy over the years especially in the emergency room, with paraplegics, people with arthritis, hip replacements etc.
coolpeach
1,051 Posts
I would say "No", because a 10 ml syringe is hard, and there is no way of knowing how active a woman is especially an older woman, and this could very well hurt her. I actually had a woman in her 80's who was a virgin (and many older women have never even inserted Tampons).
You might not think they can feel it and maybe some can't, but I know I would feel it if you put something in my lady parts (even just a little), and weren't aiming for it. And there's a big difference between that small rubber cath, and a hard plastic 10 ml syringe. For one if they do feel the cath it was a medical procedure gone awry. If they feel the 10 ml there is no medical protocol to back that up, and you could be in a slew of trouble for sexual assault if the woman wanted to push it.
For the majority of women you should be visualizing the opening before heading in that direction. Sometimes you can't (extremely overweight women), but for the majority you can. As you stated step 1. sterile field, and use one hand to separate, and visualize. If you cannot do this then stop, get help or hand it over to someone who can. Then try again next time. Practice makes perfect.