Well, I consider myself pretty skilled with most hands-on stuff but this is a procedure that causes me a great deal of trepidation.
My 50 year old patient with urinary retention had an order for an indwelling, so in I go supplies at hand with intent to complete this task in 10 mins or less. My previous experience has told me that, especially with the larger ladies who can have many, many hills and valleys down below, it's sometimes like trying to navigate through the Grand Canyon but I was having a good day so felt overly optimistic. I've seen many nurses go in blind but no... I like to visualize the urethra so after peeling back the various folds, and then more folds... you think I could find the urethra? Anatomically, I found where it should be, but when I got the catheter in and it dropped, I quickly realized I was in the lady parts. So, left that Foley in to landmark what not to repeat, and started over, determined to find that darn urethra, with my face far closer than should be legal, found the same urethral wannabe, insert AND... right back in the lady parts.
Two strikes, you're out.
Anyone else have this problem with the big ladies?
One piece of equipment I use when cathing females is a miner's/camper's flashlight; the one that sits on your forehead with a strap. It looks like I am going mining. I am! I can point the light exactly where I need it.
I had my first successful catheterization when the patient was on her side. I found it right away.
Of course the urethra was still "open" because her catheter had just fallen out.. lol..
I still consider it a success because I did not have to use the 2nd catheter and I maintained sterility (which usually just goes out the window when catheterizing little old ladies when their urethra's are hiding in a place where one wouldn't even think it would be.)
I had my first successful catheterization when the patient was on her side. I found it right away.
Of course the urethra was still "open" because her catheter had just fallen out.. lol..
I still consider it a success because I did not have to use the 2nd catheter and I maintained sterility (which usually just goes out the window when catheterizing little old ladies when their urethra's are hiding in a place where one wouldn't even think it would be.)
good job, dj.
i'll never forget how proud i felt upon cathing my first pt.
also agree that side-lying is a great position to see urethra...
my god, all the time. Female anatomy is as diverse as personalities. Some easy, some not so much, some just impossible. Sometimes putting a patient so far in Trendelenburg can help, especially if they have a lot of folds.... but they will turn blue from all that pressure of being nearly upside down!
I learned once from a good instuctor, look for the "wink" when you put the betadine on, ( meatus may re-act by opening up a bit-) and look for the "dimple" in the chin (look).. so to speak. all above posts -wonderful advise!!
On a similar note, if you have the patient cough, it will also cause the "wink" mentioned above.
Sometimes putting a patient so far in Trendelenburg can help, especially if they have a lot of folds.... but they will turn blue from all that pressure of being nearly upside down!
exactly.
while it's a helpful position for the nurse, it is NOT good for the (obese) pt.
leslie :-D
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aw, i want one of those.:)
(loving the visuals.)
leslie