Couldnt put in a foley!!

SunnyAndrsn · Jul 18, 2008

Ask for somone else to hold a flashlight or a pen light to help you visualize the opening. During my first solo experience at a straight cath on a woman I failed miserably. I felt terrible! She was suffering from retention and was so uncomfortable. It turned out the meatus was much lower than I anticipated, basically on the top of her lady partsl wall.

Now when I have to cath women I use regular gloves first, and perform peri care to get a chance to look at everything. If I'm having trouble, I look closer to the lady partsl opening. It's worked so far...man, it's nothing like the manequins in school!

So it was my first day on the job as a nurse tech and I tried to put in a foley on a female patient twice and failed both times. Im kinda bumbed out about it. Any tips on easier ways on inserting on a female? Anyone have a similar experience?

leslie :-D · Jul 18, 2008

it is helpful to have someone hold flashlight, but i do most of my caths alone.

make sure you pull labia up and out...

nice, tight hold.

between the 'grip' and swabbing w/the betadine, gives much better visuals.

leslie

fat cat · Jul 18, 2008

I also follow SunnyAndrsn's steps of peri care and having someone to shine a flashlight also. Once I place it I let the person assisting me leave unless patient is confused / uncooperative. One thing I always do - although was not taught to do but it is almost fail proof- is as I go down with the last cleaning prep stick, I push it partially into the lady parts. The catheter then seems to be easier to place into the urethra. One caveot- you must NEVER forget to remove it as soon as you inflate the bulb. If you think you will forget it , then don't do it. It is just that it works for most of the difficult cases as saves me time and charging another cath set.

suespets · Jul 18, 2008

If you see your in the lady parts, leave cath there(marks where not to go) then w/ new cath,once it starts to go in,I go up w/o pushing hard, if resistant, then aim downward. good luck!

FreezeRN · Jul 18, 2008

I have found that in most cases the urethra is lower than I expect it to be. I assume that I don't pull the labia back far enough so it seems as if the urethra is even a little inside the lady partsl opening. I have found if I insert the catheter oriented upward then I usually get it the first time. I do this by applying some downward force approximately .5 to 1 inch down from the tip of the catheter once i believe i have the catheter at the right spot for insertion. This seems to allow the catheter to slide easily into the urethra. Also, I usually take an extra catheter in with me. If i miss the first time usually I am in the lady parts. The second catheter usually slides in easily. This also helps prevent infection rather then pulling the catheter out of the lady parts and then attempting to hit the urethra.

janis9799 · Jul 18, 2008

Don't feel bad about not finding it, it can be hard to find especially on women because we are all made differently. It can be hard to find especially in an elderly woman. Luckily, I worked in a LTC so I had watched an RN put in a foley on an elderly woman before I went to nursing school. When I was in med/surge my friend had to put one in an woman who was obese. This lady was so sweet and kind enough to let four of the students (including one male student) watch my friend try to put it in. My clinical instructor was busy so we had a male nurse telling my friend how to do it. Of course because she was elderly it was hard to find...so much so the nurse couldn't find it either after SEVERAL attempts. The male nurse got so frustrated, he started telling the woman it was because she had so much fat they were having trouble getting it in. The poor patient who was such a lovely woman had tears coming down her face as he repeatedly told her it was because she was fat. I was outraged, especially since I knew how she must have felt since I am a big girl. They were about to give up, and I quietly told my friend look for it kinda towards where the g spot is supposted to be...you know top of the lady partsl wall. We could see it when she started to look there. BINGO...got it right in. I knew I needed to say something to the lady who was so mortified...waited until the nurse left the room, and said I was so sorry he said that, and it was not appropriate. She said it was ok...but you know big people often blow comments like that off because it is so embarrassing you don't want people to know you are embarrassed. I said I knew how hard hearing comments like that can be.I also told her that it was not because of the weight, but that the skin gets more elastic when you get older and it slips inside a little bit. I told her I had seen that on older women of all sizes. She thanked me and said it made her feel better. I told my clinical instructor what the nurse said, she said she was going to talk to his supervisor. I gotta tell you a year and half later I still get mad at that nurse LOL!

GadgetRN71, ASN, RN · Jul 18, 2008

Wow, that's awful that he would say something like that to the patient...abusive if you ask me. Kudos to you for talking to her afterwards-you must be an awesome nurse! :yeah: :up: :nurse:

leeae85 · Jul 18, 2008

Don't feel bad! What helped me was always volunteering to put one in if someone needs it. I work in LTC and I put in a lot more foleys than I thought I would be doing, I also do an lot on in/outs for UA/C&S. The nurse I work opposite of has a hard times with caths, but is good at blood draws, and I'm the opposite, so we pretty much help each other out.

One trick I've learned is if you are having a REAL hard time seeing the meatus, and even visualizing the anatomy, sometimes it helps having the patient lie on their side, kind of like in a fetal position with their legs drawn up. I have to do that alot esp. when the little old ladies can't get their legs open wide enough for me to get in there. Good luck & keep on trying!:nuke:

SmileyCNAII · Jul 18, 2008

On some patients if you will lay the catheter on your upside down index finger (holding it with your thumb) and insert it while pushing upwards a little it helps to guide it into place.

Vito Andolini · Jul 18, 2008

try the side-lying position.

or try (don't laugh, it works) using a headlight, like a miner would wear or a surgeon. only costs a few bucks (about $3 at the auto parts store) & you won't need anyone else to hold a flashlight. keep it in your locker and you will always have it. tax deductible if you itemize, too!

try placing a rolled up blanket, a pillow, or a cushioned bedpan under the buttocks of the supine patient.

do leave in the lady parts any catheter that makes its way there by mistake but of course remove it after you do get another cath into the urethra.

don't be mortified. we've all been there. you will soon be expert at this skill and be able to teach others.

what a rude thing to tell a patient (the nurse who blamed the fat. not incorrect, imho, but rude to say aloud).

sharona97, BSN, RN · Jul 18, 2008

One struggle I remember was during a straight cath on a ped girl. She was actually occluded. Yikes!