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?

[cayenne06, MSN, CNM]

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???

Well.... I think the risk of making a patient bleed and giving them some terrible infection is vanishingly small. The actual reason not to do it is we should never, ever insert anything into a person's orifice without a darn compelling reason.

This is definitely a skill that comes with practice and gaining familiarity with vulvar anatomy. It's really not hard at all, once you get familiar with the territory.

Use the privy parts as a marking point...less then half an inch down is the meatus....5 to 1.0 inches...always works for me. Any further then .5inch you have the lady parts...

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Vulvar anatomy is quite variable and you can't really give general measurement for the placement of landmarks. The urethra can be anywhere from right under the privy parts to inside the introitus.

And as an aside, I remember learning that grown adults are sometimes sadly unaware of their own anatomy, when I realized that my fellow nursing student genuinely thought that the privy parts was the urethra, and did not have a clear idea of what a privy parts actually was. And I have a lot of patients who think that urine comes from their lady parts and are unaware of the existence of a urethra at all.

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.

Huh. It never even occurred to me to try this. It might be a really helpful trick for L&D; some laboring moms are so so uncomfortable flat on their back, even with a good epidural. I often do cervical checks in all sorts of weird positions to avoid that. Thanks for the tip!

[nutella, MSN, RN]

This is interesting...

If I was the patient, and a nurse leaves some stuff in my lady parts to point her into the right direction, I would wonder...

No, this is not the right way to go about it.

It is all about visualizing where you actually have to go. So preparation is most important and often one more person is needed. After careful positioning make sure you have enough light and check out the anatomy. Once you have seen the urethra, prepare and make sure you have a second person so that everything stays clean/sterile. I would think that your problem is due to poor visualization.

[nutella, MSN, RN]

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.

Yep, this is actually a "very old" method....

[sailornurse]

I had a student and the first Foley she inserted it this way the patient was paraplegic and rigidity muscle atrophy we could not do it the traditional way. My student was very surprised but we did it.

[heron, ASN, RN]

I second the side-lying position, especially for elders. I think it is sometimes more psychologically comfortable too. I get the best results when I have a helper and a really good light.

[PHNMike]

Generally, you should try to hit the meatus and then, if you miss and insert the foley lady partslly, you leave it there and try again with a new foley. I don't think assuming that you're going to miss is good practice.