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Discussion

ER Tips

The most interesting thing, have never encountered and now have had it happen twice in recent events. What? Trying to cath a little old post-menopausal woman and not being able to find the urethra anywhere and found it behind the pubic bone in the lady parts! slide the index finger of the non cath hand over the pubic bone and slightly into the lady parts and you will feel a circular dimple. Use a coude catheter and insert it around the pubic bone and up into the meatus. The second lady was very difficult, very atrophied with an opening in the labia less than the size of a quarter it took two of us, one nurse located the meatus with a sterile gloved hand and left the index finger just under the meatus for the second nurse to use as a guide to insert the catheter.

I don't know about you, but I they never told me in nursing school that you'd find the darn thing there!

Anyone else have any handy tricks or tips?

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A nurse showed me what you are describing a few years ago, and I've used this trick over and over with many little old ladies! With the older male pts, I leave a little lube in the syringe to squirt directly into the urethra if I encounter any difficulty.

In the case you described I usually have another nurse use a sterile gloved finger to "push" the lady partsl opening down exposing the urethra...yes, them there parts don't look like no textbook picture I ever seen :chuckle

The other thing that works really well is to turn her on her side and have her pull her upper leg up to the chest as best as she can. Approach the pt from her butt side. This shifts things around and you can usually see the meatus right off the bat. I have done this on several female pts that were impossible to cath. Several nurses had tried and then I just walked in and popped the cath in.

I changed a foley last week on a resident on my new unit -it was my first time changing hers...My co-worker said " I'll come with you the first time you do her-she has this "strange flap of skin" Strange? Yeah... It was her privy parts-I didn't measure it but looked as long as my thumb....I've seen that in textbooks but never in practice.i did have a patient once that said she had 2 uterus (uteri? uterusis?) Yep- whenever she met a new staff member "I'm so and so and I have 2 uterus" She was more then a little off...

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You don't generally need a coude, I use my left hand, slide the index finger to the flap, then just slide the catheter along the top of it with my right hand. Totally by feel, important if there is a hip fracture or something that means you can't move them much.

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