Couldnt put in a foley!!

heaverboo · Jul 18, 2008

I know exactly how you feel. Every time I have to straight cath or insert a foley I usually take someone with me, because I'm also not great with inserting in the right place. I like to take an extra kit with me and keep the old one in place, like someone else had posted, so you know where NOT to go. It's very complicated.

I had an elderly patient once where we had about 6 people try to cath the poor lady, they ended up putting her on a bedpan, I guess which helped with placing things where they needed to be, and eventually got it. Guess cathing women just isn't my thing and takes lots of practice.

pagandeva2000, LPN · Jul 18, 2008

I did two catheters in my life, and I swear, it was luck that got it both times. I had an RN with me the first time, a CNA that instructed me the second. I do hope to get more experience at it, and plan to take advantage of any opportunity I can to practice this. It's harder for me, working in a clinic, but, now that I am doing med-surg per diem, I'll try and help do things between medication passes.

leslie :-D · Jul 18, 2008

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.

you put the betadine swab in the lady parts????

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!

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.

i'm trying to visualize suepets and freezern's methods.

neither one breaks sterile technique?

i guess i'm just not understanding it...

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.

that male nurse should have been reported to the bon for mental abuse.

idiot.

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.

again, i'm not getting these visuals.

if you're already in the urethra, there's no need to guide it upward or downwards.

just straight ahead.

now, if you're not in the urethra, then sterile technique has been broken.

leslie

Ms Kylee · Jul 18, 2008

After I'm done with the Betadine, testing the balloon, and getting the lube on the tube, I ask the patient to cough. This usually results in a drop or two of urine to come out of the urethra, and voila.. I know where to go.

Works like a charm every time.

And don't feel bad.. you're not the only one that this has happened to and you won't be the last.

Elderly females are difficult.

So are males that have a penile implant and don't bother to tell you.

mianders, RN · Jul 18, 2008

I always found it easier to put the patient in slight trendelenburg, and then have them do a frog leg position. It seems to open everything up so you can visualize it easier.

leslie :-D · Jul 18, 2008

I always found it easier to put the patient in slight trendelenburg, and then have them do a frog leg position. It seems to open everything up so you can visualize it easier.

yep, same concept what vito was referring to as well.

problem with that position, is sometimes bladders are dry and even though you're in the right place, no urine comes out...

which you then have to raise hob and hope if flows out by gravity.

or, give pt drink(s) and wait...and wait...and wait.

oy.

leslie

Roy Fokker, BSN, RN · Jul 18, 2008

A Urologist once taught me to find the privy parts and to use it as an anatomical marker. Follow in a straight line down (and slightly up) and you'll almost never miss.

Her little hint/trick has helped me cath countless dehydrated little old ladies - including one with a bilat hip fracture (that one was a painful, painful case, despite the morphine. Yikes!)

cheers,

leslie :-D · Jul 18, 2008

After I'm done with the Betadine, testing the balloon, and getting the lube on the tube, I ask the patient to cough. This usually results in a drop or two of urine to come out of the urethra, and voila.. I know where to go.
Works like a charm every time.

wow...

that's an awesome idea, kylee! :yeah:

leslie

imanedrn · Jul 18, 2008

Sometimes they're just plain difficult to do! Some women have a LOT of extra skin and the urethra is either "hiding" or NOT where you expect it to be. The last one I did, I was certain I had inserted the foley in her lady parts, even though I got urine output immediately.

My advice, talk to the patient (if she's alert) while you're doing the procedure. If the urethra is hard to find, stick a finger in the lady parts to make sure you don't stick the foley in there. Let the patient know that you're doing this and why, so she doesn't freak out. Hopefully, the urethra will be just above it and easier to find and, thus, insert the foley there.

leslie :-D · Jul 18, 2008

Sometimes they're just plain difficult to do! Some women have a LOT of extra skin and the urethra is either "hiding" or NOT where you expect it to be. The last one I did, I was certain I had inserted the foley in her lady parts, even though I got urine output immediately.
My advice, talk to the patient (if she's alert) while you're doing the procedure. If the urethra is hard to find, stick a finger in the lady parts to make sure you don't stick the foley in there. Let the patient know that you're doing this and why, so she doesn't freak out. Hopefully, the urethra will be just above it and easier to find and, thus, insert the foley there.

ranaazha, i would never suggest using your finger as a landmark.

rather, stick a catheter in the lady parts and assess from there.

please, no fingers.

oy.

leslie

Keepstanding, ASN, RN · Jul 18, 2008

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?

what is a nurse tech ? and i thought catheterization was only performed by licensed nurses.

aquamarineyesRN07 · Jul 18, 2008

My first foley placement couldn't have been easier when I had the opportunity on a female as a nursing student. I had practiced on the mannequin so much, I only expected I would get it. Little did I know how fortunate I was for this first experience! After feeling so dejected when I missed my first couple attempts as a new grad nurse, my mind was eased when three nurses shared their own botched attempts. One went on to say that it's just like starting IVs: it's all dependent on the patient's own unique anatomy, and you're not always going to get it on the first try! There are methods to simplify it for you and the patient, as it's a skill that just come with practice in the real world. I work on a med-surg floor with a lot of urology patients, and an aide generally always comes in as a stand by assist to the RN.

This was a really helpful article I found at the time, too:

https://allnurses.com/forums/f300/helpful-hints-female-patient-urinary-catheter-insertion-261915.html

I also want to add that men aren't necessarily easier, either, especially those with prostate issues.