Failed foley insertion

raindrops1234 · Jun 8, 2017

As a new grad you need to be aware of your scope of practice and with new skills that you have not done. Utilize your resources as a nurse- contact your manager and ask for more training (not sure how home visits work but it's not safe to practice something if you don't know how). Read up on your organization's policies and procedures. Contact a practice consultant through your regulatory body. Just a few ideas! You will get better with practice! (I am a new grad as well so I feel ya!).

big bear · Jun 8, 2017

Thank you ashleykirsten112. I actually was confident when I went for the home visit and when the family member mentioned that patient needed a foley change that day cause it has been over a month...I didn't think much and went ahead and did it. I am going to RN school while working as an LVN so I know how to do the procedure and have practiced it on a dummy before, but I have not done a successful foley insertion in an actual person. I also don't do foley insertions a lot so that also contributed to my failure.

With home visits, basically you drive to patient's homes and help them with whatever needs they have and do follow ups when they were hospitalized and sent home after. The only disadvantage, which I realize now is that you are mostly alone when doing this line of work. You don't have anybody to call to guide you or train you. Families rely on you heavily as well.

I talked with my supervisor at the agency and was asking if I would have more training with that and she just told me to watch a lot of youtube videos and to teach and train myself. (I don't know how to do that exactly though). I did watch videos and I think I know where I went wrong. I held the member at a 45 degree instead of 90 so I was not inserting the foley on a 90 degree angle as well. Other than that, I can't think of anything else that I did different.

Floor_Nurse · Jun 9, 2017

Don't sweat it. You probably didn't insert it far enough. The difficulty is that sphincter which can really be like a tightly enclosed little ring.

Cactus Nurse · Jun 10, 2017

This is why home healthy sometimes isn't good for new grads. I was terrified that something like that would happen to me when I first graduated and did home health!

How to do f/c:

1. Push it in the almost all the way. It's just going to coil up in the bladder, won't hurt the pt, remember it's soft and flexible. You should have see. Some urine come out, hopefully, if not just meant it was empty, that's why you out so much in to make sure it's in there.

2. So you have pushed the Cather , almost all the way in, leave about half a fingers length out, gather your saline syringe (have this already done before beginning- filled to amount it should be- go by MD orders, some people have diff balloon sizes. )

3. Fill balloon. Twist syringe and disconnect.

4. Now slowly pull catheter out, when you think it's almost all out, go slower then you feel resistance, do a SLIGHT tug, you are at the end of the bladder.

5. you're done!!!!!

Clean up, make sure the bag is connected securely.

Practice is the only way you will learn. If another pt needs a change don't be scared. Do it confidently, you will be fine!

Stupid dummies at school don't help at all lol, it's always easy at school lol

Good luck

big bear · Jun 12, 2017

Thank you so much for this. I am slowly trying to gain my confidence back. I do know how to change a foley theoretically, but it is still different doing it in an actual person.

The weird thing was I did insert the foley all the way and did see urine coming out of the tube...but for some reason, I was meeting resistance with inflating the balloon. The RN said that there are times when the catheter can coil in there especially if patient has BPH so that could probably be why I couldn't inflate it.

I am in the process of moving on though :) No use for me to get stuck in this as it is in the past. I just know it is going to make me a better nurse.

regencyfarms · Aug 7, 2017

Just so you know, you are not alone in this! Foleys are not my favorite either and even though Ive been doing them a few years I still run into issues a lot. My first mistake was not inserting far enough as well. Try to get fairly close to the y when inserting. Also for pts with tons of bladder spasm-y issues use 100% silicone. For pts with frequent UTIs try the silver tipped. When all else fails find someone to help you (Im a RN but my LPN has been doing this for 20 years!) and ask for tips! Someone will likely always have something to teach you.

big bear · Aug 7, 2017

Thank you. Unfortunately, I am currently working in home health so it is hard to get different supplies since they are not as readily available and sometimes, we have to make do with the car supplies that we currently have.

Although, as an update to this post, I was finally able to do a successful foley insertion. I talked with my supervisor and asked for more training and thankfully, an RN was willing to train and supervise me while I did the insertion.

I am still developing this particular skills as I am currently learning right now that there are a lot of problems associated with foley catheters and it is not all skies and rainbows after an insertion. But, I shall continue to move forward and build my skills upí ½í¸€

Avill, BSN, RN · Aug 14, 2017

I'm an RN and still struggle with this! you live and you learn.

I once did a folley that didn't drain and I saw in the notes that another nurse was called to re-do it. All I did was ask for constructive feedback.

I am fortunate that I work for a very good company who is always willing to help me learn as I have about 2 years experience.

grateful_RN · Aug 19, 2017

Happens to all of us! Only practice and different experiences will help you feel more confident with f/c insertion. Once I went to a visit for a foley change on a patient I was not familiar with...I have everything prepared, removed the old foley, cleased area and was ready to reinsert the new one and the family member says "She has a different anatomy, the previous nurse described it as 'you go down main street and make a right turn on 10th st'...needless to say I was like WHAT? to myself. I had to attempt it twice to get it in! So just keep at it and perhaps ask if you can go with another nurse who is putting one in? Just for more exposure. Good Luck!