Completely confused about this Foley Catheter issue...

Nurses Safety

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So I work in ED... pt is in and has a UTI per her labs and the doc confirms. He orders a FC...and I insert it. Everything I do is textbook, including as soon as urine starts flowing into foley I advance 2 more inches before inflating balloon. About half hour later I return to room and pt is looking like she is in pain....she says "it burns - the catheter." Now based on how she characterizes the pain and the UTI being present, I am not thinking for one second that the balloon is in the urethra. I get an order for 1 of Dilaudid and push, and she feels ok after that. About 2 hrs later however, ultrasound calls (she is admitted to hospital for UTI) and tells the doctor that the balloon is in the urethra. Now, before assuming I am the culprit I did some research...apparently the balloon could be at neck of bladder and subsequently pulled into the urethra past neck of bladder. If given a good tug.

All I know is I am losing sleep over this because the catheter went in smooth, plenty of urine flowed into bag after insertion (200+ mLs) and I even brought the catheter back gently after the 2 inch advance to make sure it was at neck of bladder. I have put in hundreds of these and never a problem. What the heck happened!

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Specializes in Emergency & Trauma/Adult ICU.

It probably got tugged during the transfer to U/S.

Dilaudid, for c/o catheter discomfort? Hmm.

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Pt had a raging UTI....I mean the white cell count was off the charts. I think the doc was thinking the foley irritated her urethra and the dilaudid was necesary - it was his idea/order. Now that u mention it I am not sure why he didnt order Morphine in this situation.

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Specializes in retired LTC.

I tend to agree with the probability that the cath was pulled on during a transfer. Pt could have tugged on it too. But it does make you question yourself. :confused: I feel for you though.

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Specializes in PICU, NICU, L&D, Public Health, Hospice.

ya, sounds like it got tugged. Shoot I had one lady that routinely pulled out her foley with an inflated 30ml baloon!!

Generally speaking, if the baloon is inflated in the urethra it results in immediate pain and frank blood in the urine as the urethra is fractured. You would presumably have known (as would the patient).

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Ya, I'd interview the ultrasound techs or transfer team, not that anyone will claim responsibility. I had a patient once, who's cath kept "falling out or it was replaced into the lady parts"...ha! Of course urine had been draining so it was not in the lady parts! Then one day it fell out again and I asked the nurse on duty to pull the cath out of the trash and inspect it. No leak, nothing. Come to find out, we suspected the daughter was deflating the balloon while visiting. People!...document , document , document.

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Specializes in Med-Surg.

Haha! We give dilaudid for headaches, stubbed toes, hang nails. That's pretty much all we do around these parts: push dilaudid.

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Specializes in Trauma, ER, ICU, CCU, PACU, GI, Cardiology, OR.
ya, i'd interview the ultrasound techs or transfer team, not that anyone will claim responsibility. i had a patient once, who's cath kept "falling out or it was replaced into the lady parts"...ha! of course urine had been draining so it was not in the lady parts! then one day it fell out again and i asked the nurse on duty to pull the cath out of the trash and inspect it. no leak, nothing. come to find out, we suspected the daughter was deflating the balloon while visiting. people!...document , document , document.

in 1994" i had a case very similar to the one you have describe, the relative of the patient kept deflating the balloon while they visited, however, in this case it was the husband who did this in order to have intercourse with his wife :madface::banghead:

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Specializes in MS and LTC.

well nothing happened and that is good. i guarantee noone will fess up to tugging on that foley during a transfer. i think if Jesus started working in healthcare He'd become a liar also.

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Specializes in M/S, ICU, ICP.
in 1994" i had a case very similar to the one you have describe, the relative of the patient kept deflating the balloon while they visited, however, in this case it was the husband who did this in order to have intercourse with his wife :madface::banghead:

gross. like could he not just let the poor woman be sick and go without! he was a dog!

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Specializes in PCU.

Had that foley been in the urethra to begin with when you started inflating the balloon, the c/o pain and expression on the patient's face would have been enough for you to cease and desist from inflating the balloon. That fc was pulled after the fact.

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Specializes in Rehab, LTC, Peds, Hospice.

It is not an uncommon thing that a foley will get displaced. In fact - occasionally they get dislodged with balloon fully intact - ouch. Can't count the number of determined dementia patients I've had that deliberately pull theirs. I'm with the poster that stated you would've known when you inflated the balloon.

Don't beat yourself up.

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