Recently at work, I had a really tough pt that needed a foley. Myself and a very seasoned PCT (they are allowed to place them where I work, and do so very frequently) tried to get it in MANY times and the doc was unwilling to try themselves.... (pt had a hx of urinary procedures, etc)..
The doc looked at the placement of the caths I tried to get in and said they looked correct and the pt was prob. "spasming"..
Long story short, they were in the wrong spot, and another nurse got it in for me.
My shift ended with the doc saying in front of all of the staff (who were standing around the desk) "Wow, I guess you really need an anatomy lesson down there, huh?!"
:imbar
Sooo... am I being overly sensitive (usually true) or was that kind of mean?
My confidence is really shot and it sort of tainted the way I feel toward this doc. They are great at their job, one of my favorites to work with, and now I feel almost .... degraded?
i get the impression that the woman still has 2 openings, except it's located intralady partslly.
leslie
I think that's what she's referring to. I occasionally find the urethral opening just inside the lady parts. Aiming upward as someone previously mentioned, works well for me too.
As for seeing 3 urethras... maybe the nurse saw an extra dimple of tissue or perhaps the skene's glands? Those are small (pinpoint) openings on either side of the urethra. They aren't usually very visible, but I have seen them when I've had a very good view and bright lighting.
It just -looked- like there were three possible urethras. My first try went in a bit, but wasn't it, so we left the in/out cath there and tried again in the right spot. Probably just funny bits of tissue.
Specializes in Critical Care: Cardiac, VAD, Transplant.
From one nursing student to another:
I had a real tough clinical instructor that was more like a drill sergeant and I did NOT want to screw up. He insisted that I do the first foley on a 93 y.o. lady, so I waited 'til he was out of the room talking to the Dr. and did 'peri care' on the patient in order to help locate the spot before I made a complete fool of myself. It worked so well that the instructor was yelling at me how I was in the wrong spot when...it slipped right in and we saw the gold. There was a collective sigh of relief from the group and the instructor actually smiled and backed off for the rest of the rotation. I still use the peri-care routine with 100% success. Besides, the patients often appreciate it.
I'm usually pretty good, but occasionally I still miss. It happens, and you shouldn't feel bad, and if the doc really meant to make fun of you, then shame on him.
I will share a couple of things that have worked for me. To elevate the hips & give you a better angle (and view!), try flipping a bedpan upside down and put the pt on it. Also, you can ask the pt to bear down as if to pee to help you find it.
One time when I was a PCT, there were no fewer than five staff, plus the pt's daughter (an RN herself) trying to find the meatus on a particular pt. We had all tried to insert & were at a loss. Pt coughed & had stress incontinence, and lo and behold, we knew where to go - but it wasn't near where you would have thought. More like where her privy parts would be - way high. Good lesson for all of us.
Specializes in Cardiothoracic Transplant Telemetry.
i don't know how a woman could have 3 openings????
even researching "intralady partsl urethra", it sounds like it is an anomoly.
when i googled it, i only got 6 hits, none that described what it was but implied it was a malformation.
still, i get the impression that the woman still has 2 openings, except it's located intralady partslly.
leslie
I think that what most of us are referring to as intralady partsl urethras are the cause of gravity causing everything to collapse and cave in over time. I don't think that these women started out life with urethral openings within their lady partsl canal per se ( though I think that it is possible)- but things end up that way after multiple deliveries, and with the acts of gravity.
Let me tell you about the first catheter I ever put in. I was green, green, 18 years old, fresh out of high school, first semester nursing school and let's say "sexually nieve". I don't think we had even covered cath insersion or female anatomy in school yet, but I was working as an "aide" (before certifications for CNAs), on a med surg floor, and the RN was eager to let me try new things.
Well, the patient was a 40 something female, I explained what I was going to do, got everything ready, and much to my surprise, there were more openings than I expected. So I just headed for the one most visible, up high. The patient jumped every time I touched her, said a little "oh, oh", squirmed and giggled. I just couldn't get that catheter to enter, but I was persistant! Once the RN could control her giggling, she suggested I try a little lower. Well, what do you know, it went right in. Only after the fact, did I find out what I was actually trying to "catheterize!
I wonder if that incident was as memorable to the patient as it was for me!:chuckle
In my facility, I was taught never to force a foley cath-if the nurse has a problem placing it, the surgeon tries, and if that doesn't work, we get a urologist down there. This can often be the case in older male pts(prostate issues) but can happen to any pt for various reasons. In older females, the anatomy can get real wacky and if the pt is obese, you can have even more trouble. There's been plenty of times where other people have placed the foley-no one made fun of me.
Sounds like this doc needs a refresher on anatomy AND a class on how to treat co-workers respectfully. As the years go on, you'll develop a mouth(I did, and I used to be very meek!:)) and you'll be able to put a rude doc in their place. In the meantime, rest assured you did nothing wrong-the female urethra can be a wily, elusive beast.
Everyone has horror stories about finding a hiding meatus. I have even placed my index finger in the lady parts to occlude it, then try to slide the foley over the top and it usually hits the spot. Sometimes it is just buried in there. I have been in a situation with 3 people, 2 holding back the lady parts and one trying to insert the foley....with overhead lights on, a patient in trendelenburg!
As far as having your feelings hurt....if you can learn to laugh at yourself, you will find that life will treat you better. I know the situation was frustrating, but if you can find humor in things, you will live a lot longer and suffer less! I have told stories on myself that has staff howling with laughter, and chiming in on similiar situations they have found themselves in.
Nursing is a tough job. We are humans working with humans, nothing is the same from person to person, job to job. Do the best you can, and learn to lighten up.
Don't worry about the doc laughing too, I have seen plenty of them make mistakes. The ones you love are the ones who can take things in stride, not try to blame others, and just get the job done.
If you can laugh at yourself, you will find you have a lot to laugh at!
That sums it up right there. I could not have said it better myself.
I would have told the doc in front of everyone that we could go to the anatomy class together, since he could not locate it either! (That's my mouth shooting off again!!) And laugh it off with everyone else.
Just yesterday I saw the meatus, (VERY EASY to find) but the foley cath would not go in. Tried the stiffer 14f in-and-out, would not go in. Finally placed the 8f cathkit catheter, slid off the test tube and held it in place for 10 minutes while it drained a liter of urine out of this lady's bladder. BIG sigh of relief from her! In 22 years, that is the first time I can say that has happened. I can only guess some kind of urinary meatal spasm.
That's exactly what I did... and I placed a second in what I thought was the urethral orifice.... as it appeared to be a separate hole.....
aaaaaaaand they were both in the wrong spot.
When I was precepting my senior semester of school I was in the ER and this woman came in. She was a frequent flyer for UTI's and the nurse I was with told me she would be a good one to practice cathing. I tried once, no go, left the cath in. Tried again, no go, left the cath in. I ended up with FOUR caths hanging out of this patient. When the other nurse came in she busted a gut and told me that I was persistent. Turns out this woman had one of those intralady partsl meatus and the other nurse go it in one try.
I was really ticked off that she didn't tell me beforehand, but she explained she wanted me to see that not every woman is built the same and to think outside the "box" if I wasn't successful the first time.
I have had that happen one other time in the 13 years since and astonished my co-workers by knowing where else I could possibly look.
i always thought there was the vag opening and urinary meatus.
you mean there's more???
leslie
I figured it was a reference to a fistula.
Anywho, SN here, I had a male, no trouble finding the urethra, of course. Elderly gent has a large grapefruit sized bladder. This is my first ever live insertion. With unsteady hands, and a decidedly unfirm grip, I simply could not get past the sphincter or prostate (not sure which was giving me the resistance, but I hear it was likely d/t enlarged protate). I thought I was pushing hard enough. After a quick word or two from the Doc, then my Instructor, then about 5 of my classmates, and the gent riasing his eyebrows in a "Hey buddy, this sucks, could you HURRY IT UP?!" kind of way, I got it through. That must have been among the longest 2 minutes of my life. Still, I felt great when it was over, to give such relief, the poor guy voided about 2L.
leslie :-D
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