Foley Balloon Test

[OR male nurse]

In school we were taught to pre-inflate the balloon on the Foley to make sure there weren't any pin holes. In reality, the urologists don't want you to pre-inflate because they say it makes the ribs on the balloon stick out which could cause irritation to the urethra when you do insert the Foley. I've put in hundreds of Foley catheters on my patients and never had any problems until yesterday when one of the general surgeons was watching me and had a huge pissy fit because I didn't pre-inflate the balloon ? I responded that the urologists say otherwise and he wasn't impressed with my answer.

Just wondering how many of you out there either inflate or don't when putting in the Foley. I've never had a balloon not work in my hundreds of times of putting one in and figure that if there is a hole, you'll find out when you pull back on the catheter and it comes back out because it's not inflated. I feel it's pretty much a non-issue but now they are making a big deal out of this where I work.

[GadgetRN71, ASN, RN]

I was taught to pre-inflate so I pre-inflate. Now, I have heard of urologists saying that you don't need to and when I did alot of GU and Cysto, I'd play along. Most of the docs in my specialty now(ortho) have been taught about pre-inflating as well, so now I always test the balloon. When in Rome...

Actually, a lot of them are getting away from Foleys unless the patient really needs one. It probably makes the PACU and floor nurses a little aggravated, but I think because Medicare will not be paying for care due to nosocomial infection and UTIs are considered in that category, that they figure why take that risk.

[ewattsjt]

All our uro docs say not to inflate it because they have been practicing for xxx amount years and have never seen one fail. Within the same token, just a couple of years ago I saw one with a pin hole. Unfortunately, the uro docs had convinced a few of our circulators of their notions and the balloon was not checked. It fell out during the start of the procedure but not before the patient had been opened.

Fortunately the case went on the quicker side and the patient did not need to be re-cathed during the procedure. Had it went on the longer side, we would have had to try to figure something out. As you already know, a patient that has already been incised presents it own set of issues with re-cathing.

[RNBelle]

i have always checked the ballon before inserting. some balloons are bad and you wont necessarily know right after insertion and then pulling back on it.

[RacheloneRN]

I'm also a new OR nurse, and in our facility we do not test the balloons on our foleys. The rationale at our facility though is because the manufacturer instructed us that it is not necesary as the foleys are pretested prior to shipment. You may want to check if that is the reason your facility does not test the balloon. I am not sure what they do on the floor though, I only know the OR policy.

Our facility does take foley safety pretty seriously though - they have a new policy that Residents cannot start foleys in the OR because of poor technique.

[mcmike55]

This is a subject that has been covered over and over here for some time.

I guess I can see some catheters not going back to original shape after inflation.

When you DC one, ever look at the balloon? Not primo, at least the ones I've seen. That said, that's after one has been indwelling, sitting in urine,etc, so not really sure that's a good example.

If your docs, or supplier is don't do it, I'd suggest that it be put in writing, in the form of a policy, or what-ever, to cover yourself.

My self, 30 year vet of the biz, I check every balloon.

I'll admit that I often don't fully inflate the foley, but I'll put in 5-7 ml's of 10 ml balloon, pull the syringe off, and give the balloon a little squeeze while it's still in it's protective wrap. Then I'll deflate it, take the cover off (ours are Bard), lube it, and insert.

I've seen a few with pin holes, more frightening, I've found a few valves that were faulty.

My worse case story was a penile prosthesis case. Tested the balloon (per Dr), inserted, did case, no prob. A day or two later, doc went to remove foley, the valve wouldn't release the fluid, he cut the valve off, no good. Doc went further down the foley with the scissors, still no good.

He, or someone, then cut the entire cath, but no one thought to hold on to the end closest to the pt.......you guessed it. In it went!!!!!

Bottom line, went back to OR, cytoscopy, fished the thing out, still had a full balloon by the way, punctured it with a pair of flex. scissors thru the cystoscope.

Could checking ahead avoided this??? Don't know, maybe,,,,maybe not.

But at least I would have known it was OK when inserted.

Mike

[ShariDCST]

this is a subject that has been covered over and over here for some time.

i guess i can see some catheters not going back to original shape after inflation.

when you dc one, ever look at the balloon? not primo, at least the ones i've seen. that said, that's after one has been indwelling, sitting in urine,etc, so not really sure that's a good example.

if your docs, or supplier is don't do it, i'd suggest that it be put in writing, in the form of a policy, or what-ever, to cover yourself.

my self, 30 year vet of the biz, i check every balloon.

i'll admit that i often don't fully inflate the foley, but i'll put in 5-7 ml's of 10 ml balloon, pull the syringe off, and give the balloon a little squeeze while it's still in it's protective wrap. then i'll deflate it, take the cover off (ours are bard), lube it, and insert.

i've seen a few with pin holes, more frightening, i've found a few valves that were faulty.

my worse case story was a penile prosthesis case. tested the balloon (per dr), inserted, did case, no prob. a day or two later, doc went to remove foley, the valve wouldn't release the fluid, he cut the valve off, no good. doc went further down the foley with the scissors, still no good.

he, or someone, then cut the entire cath, but no one thought to hold on to the end closest to the pt.......you guessed it. in it went!!!!!

bottom line, went back to or, cytoscopy, fished the thing out, still had a full balloon by the way, punctured it with a pair of flex. scissors thru the cystoscope.

could checking ahead avoided this??? don't know, maybe,,,,maybe not.

but at least i would have known it was ok when inserted.

mike

guess it boils down to this - no matter what you do, don't do, think about doing, think about not doing, or forget to do - nothing is foolproof, and everything carries a certain amount of risk.

i think we just have to do the best we can, and hope that it's the right thing, and that if it doesn't come out well in spite of all our efforts, we fix it as best we can and move on.

[OR_nurse_Britt]

We were told that we were not to test the foley balloons because of the ribs from urology and also because they are "pretested" at the factory. To me this is new since in school they always told us to test the ballons but i'll do anything to keep infection rates down.

[mcmike55]

guess it boils down to this - no matter what you do, don't do, think about doing, think about not doing, or forget to do - nothing is foolproof, and everything carries a certain amount of risk.

right on sheri, i guess much of what we do on a daily basis, is essentially a combination of training, experience, policy, intuition and good old fashion luck!

mike

[openheartmary]

I always check the balloon first before inserting. I have had defective balloons that would not go down. Could be a huge problem if it was already inserted into a patient!

[SandraCVRN]

Always check them.........

[nurse137]

I am a nursing instructor, I have taught fundamentals for 14 years. I always taught to test the balloon, however, the newest edition (7th) of Potter and Perry Fundamentals of Nursing page 1156 states "pretesting of balloon is no longer recommended because catheters are pretested during manufacturing and inflation may distort the balloon, leading to trauma." The citation given in Potter and Perry is from Smith, JM: Current concepts in catheter management. In Doughty DB: Urinary and fecal incontinence: current management concepts, ed 3, St Louis, 2006, Mosby. I am in the process of looking into this further to find other references saying the same thing.

[coteaux]

As of June 2008, we do not test the balloon in the OR where I work