Catheter Change Question (May seem stupid!)

[lauragou]

Hi all,

I am a nurse who recently got hired at an outpatient setting, so everything is a little different and the patients come and go for quick appointments.

My question is, what is the proper procedure for a Foley catheter change? My issue with this in the outpatient setting is directly changing a catheter without urine return. It's uncomfortable for me to a) inflate the balloon and b) send someone home without urine output in the bag - but how else to do it when their bladder was already being drained prior?

Our facility doesn't have a proper protocol on this and the other nurses are vague and haven't offered me concrete advice. Any thoughts would be appreciated!

[Sour Lemon]

I think it's an interesting question and I don't know the answer to it. When I change a foley, the path is so well-established that I've never thought of it as a concern. I'm in acute care, so I do eventually see urine.

[brownbook]

Assuming you're changing catheters on patients who have had indwelling catheters for days....or months... I would feel comfortable sending them, or their care giver, home with documentation that they knew to call their PCP, or go to the ER, if no urine appeared within ????? an hour or so?

[brownbook]

And please.... there are no stupid questions. I've been a nurses over 35 years and I have never come across this issue. I maybe giving you had advice. It's best to ask the doctor.

[shortie08RN]

were you able to flush/irrigate the foley? to check for obstruction maybe? we usually try to introduce 50-100 ml of NS. if without resistance, we usually let it drain back to the bag.

[BettyGirard, BSN]

Yeah, I ran into this same concern last year. In my prior experience, I had placed and removed foleys but never was in the position of replacing one until then. I'm usually not that rushed that I don't see urine start to flow again. I always tell the kids (and the care info to the parents) that if they don't see urine flowing over time, they need to get back to me or their doctor. I hadn't considered inducing a little irrigation. My orders just say replace. I'll have to check with the district supervisor.

[canadawali]

No question is ever stupid. I worked in the community setting and often did routine catheter changes. I always found them tricky if the patient had a empty bladder. I often would ask my patient to drink a glass or two of water prior to the catheter change. I also would try to palpate the bladder if I did the catheter change and no urine has returned. This often helps with the urine flow. Lastly I always flushed the catheter and ensured it flushed with no problem and no pain. Also after inserting the catheter I would have the patient walk around for 5–10 mins, often this would help to see if any urine would return. I also felt uneasy and did not like it if there was no urine return because it always questioned me if I was in the right spot. Lastly patient education about returning to the ER, MD etc if no urime return would be a safe bet and just run it by the doctor as well and see if they have any other suggestions.

[BettyGirard, BSN]

Yeah, we give general care instructions telling them to seek help in a variety of conditions including no urine flow. I hadn't thought of squeezing the kid to see if I could start the flow ? Maybe, I'll offer some water or other drinks as a precursor to the procedure. In my case, usually the kids come in before classes start to get this done. I guess I could retain them through homeroom (about twenty minutes) without difficulty.

[litbitblack, ASN, RN]

Can you clamp the catheter for a short time right before changing it then you would get some urine flow in the tubing?

[BettyGirard, BSN]

You've lost me. All the urine between the clamp and the bladder end of the catheter will come out with the catheter. You don't want to reflux urine into the bladder.