ED admission post catheter insertion

[regerterb]

I currently work in community nursing and had a male urethral catheter to change. Have previously done many male ones before, no issues-however this was a new patient. All was fine (clear urine return) until I started inflating the balloon (which was checked prior to insertion) when the patient stated he felt "stinging", i immediately deflated the balloon and waited 5 or so minutes to try again-urine still flowing freely during this time. I advanced the catheter another inch (there was about 10-15cm until Y section) and tried again-still slight stinging however 8.5ml on water went into balloon. I inserted the catheter at about 8am...called him about 3pm to see if all was ok-stated felt stinging at tip of member however urine still flowing fine-he said this has happened before when his bowels were not open. I called him again the next day to check and he stated at about 4:30pm no urine coming/increased pain to abdo so called an ambulance to take him to ED. He stated they said it was either in too far or not in far enough-he couldn't remember. I am not sure what could have caused this...if it was not in far enough, the balloon would not have inflated and he would have been in immense pain whilst inflating it...any ideas?? I feel horrible and am dreading going back to change it again---i am sure he is too.

[dishes, BSN, RN]

A catheter can drain urine if the eye of the catheter is in the bladder, urine draining doesn't mean the balloon is in the bladder, that is why it is recommended that you advance the catheter all the way so that the Y is just outside of the meatus before inflating the balloon (see SUNA male urethral catheterization guidelines). Also, the patient should see his urologist for a cystoscopy, it will rule out whether there was any trauma done to the urethra, stricture, enlarged prostate or bladder stone as all of these factors can interfere with urinary drainage. It is unlikely that a catheter can be inserted too far, if you think about anatomy, the catheter balloon is either inside the bladder or inside the urethra, as it is too big to fit inside a uereter.

[regerterb]

Thanks, he does have enlarged prostate aswell so that could have been a factor too.

[dishes, BSN, RN]

Regarding your question about experiencing pain if the balloon is inflated in the urethra, does this patient have any medical or neurological conditions that can cause urinary retention and diminshed sensation (diabetes, CVA, TBI, SCI etc)?