foley catheter change

[Kirstie]

I am a new graduate LPN and just started working at a clinic; I have been assigned to work with the Urologist, but I do not have a lot of experience with this field.

First, when you change a foley catheter, do you need to instill sterile water into the foley 1st before pulling it, so that there will be return since they have the catheter in all the time and there would be very little or no urine in the bladder to determine if you are in the bladder or not? We were not taught this, but I have heard about from around the clinic.

Second, there are two sphincters, right? How do you know you are past both of them if urine will come when you get past the external one? Or will it? Is it possible to inflate the balloon while in between the two sphincters?

Any advice would be of great importance.

[lady_jezebel]

Actually, I found a site that describes 2 sphincters:

http://www.theleakybladder.com/bladder.htm

However, for all practical purposes, you can't feel the internal sphincter when inserting a catheter.

[suzanne4, RN]

lady jezebel:::::: thank you :balloons: :rotfl:

[Kirstie]

I recently changed a supra pubic catheter for the first time----I didn't realize once you pulled the catheter out, the site would continue to drain urine.......needless to say, the patient was a bit wet by the time I got the other catheter in......ooops!!! .......how do you keep a sterile field, if you can't clean the site with betadine and put sterile drape around before inserting new catheter..........because you have to quickly take one out and quickly put the other one in before it voids everywhere? right?

The patient plugs the end of his catheter, does not wear a bag...if I opened it up and let the urine drain out, would I have more time to properly insert new catheter? or wouldn't that matter?

Kirstie

[lelectra26]

What kind of problems do you run into with older men with prostrate strictures? My 90 year old father requires catherization because of BPH and he says the catheter insertion is excruciating. We are reluctant to go ahead with TURP because of his age. His doctors refuse to sedate him and he now says he rather face the risk of surgery than be have another catherization, the pain is so bad.

[tewdles, RN]

What kind of problems do you run into with older men with prostrate strictures? My 90 year old father requires catherization because of BPH and he says the catheter insertion is excruciating. We are reluctant to go ahead with TURP because of his age. His doctors refuse to sedate him and he now says he rather face the risk of surgery than be have another catherization, the pain is so bad.

Are you kidding me? The man complains of excruciating pain with insertion and the doctors refuse to sedate him???? How about pain control, do they refuse that too?? Sounds like legal torture to me...hey, maybe we could use this practice on terrorists....

[lelectra26]

Kaiser.

[NurseBlueBear]

I recently changed a supra pubic catheter for the first time----I didn't realize once you pulled the catheter out, the site would continue to drain urine.......needless to say, the patient was a bit wet by the time I got the other catheter in......ooops!!! .......how do you keep a sterile field, if you can't clean the site with betadine and put sterile drape around before inserting new catheter..........because you have to quickly take one out and quickly put the other one in before it voids everywhere? right?

The patient plugs the end of his catheter, does not wear a bag...if I opened it up and let the urine drain out, would I have more time to properly insert new catheter? or wouldn't that matter?

Kirstie

I have worked in a Urology office for almost a year now. We probably do about 7-8 SP changes a week. We usually do it as a two person job. We have them lay back, usually they have a leg bag connected, we will unhook the tube and just put a few tissues under the leg bag nozzle. That will elevate it enough to keep if from leaking, if for some reason it still does the tissues will catch it. We fold a chux in half and put that across their lap. If the opening oozes urine after the tube is out, just press the chux against the abdomen to soak up the urine to keep the pt dry. Once the oozing is done, the first person will wipe with iodine, the second will insert the tube, and the first person will inflate the bulb. I know that sounds like a lot but we can usually get the whole process done within about 15-20 seconds.

[pussycat66]

We too were taught there are two sphincters: external and internal urethral.

you must be thinking anal sphincters:nurse:

[pussycat66]

What kind of problems do you run into with older men with prostrate strictures? My 90 year old father requires catherization because of BPH and he says the catheter insertion is excruciating. We are reluctant to go ahead with TURP because of his age. His doctors refuse to sedate him and he now says he rather face the risk of surgery than be have another catherization, the pain is so bad.

Terrible -poor man!