foley catheter change

suzanne4, RN · Feb 22, 2004

I have been a nurse for over 25 years and this is the first time I have ever heard of instilling anything before pulling the catheter out. I am not sure where your team members are getting their anatomy from, but you have one sphincter only for urinary control, both in men and women. The way we learned to insert them long ago, was to insert all the way in, fill the balloon, then gently pull back until you met resistance. You want to make sure that you are in the bladder before blowing up the balloon. You never want to inflate the balloon while the tip is still in the urethra.

Havin' A Party!, ASN, RN · Feb 22, 2004

We too were taught there are two sphincters: external and internal urethral.

gwenith, BSN, RN · Feb 22, 2004

Yes It is possible to inflate the balloon while it is still in the urethra - I have seen it done on a male. (Okay guys you can wipe your eyes and try to stop wincing) - since I work ICU this was a sedated pt. Usually though the urine will not flow until the catheter is in the bladder and inflating the balloon is more difficult if it is not fully in the bladder.

I have never heard of instilling water/saline but I can see the rationale especially if you work with patients who, for one reason or another may have unusual anatomy and making catheterisation difficult.

suzanne4, RN · Feb 23, 2004

If you look at any MEDICAL anatomy chart, you will find only one urethral sphincter listed. You will find both an internal and external anal sphincter.

You need to have the tip of the foley in the bladder before blowing up the balloon. Please tell me what book you saw this in, about the two urethral sphincters, as it is in none of mine.

Gwenith: They were talking about instilling a liquid BEFORE removing the foley. Have you ever needed to do that?

georgia peaches · Feb 23, 2004

The internal and external urinary sphincter muscles regulate the flow of urine through the urethra.

http://www.mhhe.com/biosci/ap/seeleyessentials/student/olc/chap18summary.html

The pudendal nerve is the somatic component of bladder innervation and innervates the external sphincter. When stimulated, it produces contraction of the external urethral sphincter. The external sphincter plays an infrequent role in maintaining continence, since it is only able to remain tightly contracted for a short period of time. This sphincter normally contracts with transient increases in intra-abdominal pressure such as occurs with coughing sneezing, and laughing.

The parasympathetic nerve fibers arise from the 2nd through the 4th segments of the sacral spinal cord, and innervate the detrusor muscle. Stimulation occurs when the individual desires micturition. When stimulated, the detrusor contracts resulting in elevated intravesicular pressure. The internal urinary sphincter is innervated by the sympathetic nervous system. These nerves originate from the lower thoracic and upper lumbar segments of the spinal cord. When stimulated, the internal sphincter relaxes.

http://www.incontinent.com/store/articles/previous/urinaryinco0901.asp

You guys are great - I always see something that bugs me to find out the answer, and it helps keep my brain going (which is sometimes VERY hard for me to do!)

thanks!

John

Kirstie · Feb 23, 2004

If you look at any MEDICAL anatomy chart, you will find only one urethral sphincter listed. You will find both an internal and external anal sphincter.
You need to have the tip of the foley in the bladder before blowing up the balloon. Please tell me what book you saw this in, about the two urethral sphincters, as it is in none of mine.
Gwenith: They were talking about instilling a liquid BEFORE removing the foley. Have you ever needed to do that?

The reasoning behind instilling the sterile water before pulling the foley is so you will know you are in the bladder because if the patient has a catheter in place for long-term there will be little or no urine when the foley is replaced, so you will not be "sure" you are in the bladder before you inflate the balloon - that is the reasoning I got anyway and was wondering if anyone else has done this

In my A & P book, there is an external and internal sphincter

Kirstie · Feb 23, 2004

Yes It is possible to inflate the balloon while it is still in the urethra - I have seen it done on a male. (Okay guys you can wipe your eyes and try to stop wincing) - since I work ICU this was a sedated pt. Usually though the urine will not flow until the catheter is in the bladder and inflating the balloon is more difficult if it is not fully in the bladder.
I have never heard of instilling water/saline but I can see the rationale especially if you work with patients who, for one reason or another may have unusual anatomy and making catheterisation difficult.

The patient would feel this if this happened, so you should know right away and be able to deflate it and move it in further, right?

suzanne4, RN · Feb 23, 2004

I stand corrected, but in the medical anatomy books there is only one sphincter. You are still concerned only with the one when putting in the catheter, the internal sphincter.

suzanne4, RN · Feb 23, 2004

From a standpoint of someone needing a neo-bladder, you only worry about the internal sphincter. Same as with a woman who hs urinary incont. problems after having several children. The thickness of the external sphincter is extremely thin, so I have never worried about it, and consider it not to even be there. You are either in the urethra or the bladder when putting in the foley, bladder is the preferred site.

I wouldn't worry about this, it just comes with practice. Where you can have problems is with an older male patient who has a stricture at his prostate.

gwenith, BSN, RN · Feb 23, 2004

As I said I work ICU and a lot of my patients are unconscious or at least heavily sedated and FAR FAR more worried about the garden hose down thier throats than the tube in the bladder so yes it is possible for the catheter to be inflated before it is truly in the bladder esp with the smaller balloons we are seeing on the catheters these days. I have never instilled saline into a bladder but I have waited until I thought I had some urine before recatheterising. Out patients are usually on hourly urine measures so we have a similar problem of finding the bladder when there is no urine to drain.

lady_jezebel · Feb 24, 2004

Actually, the internal and external urinary sphincter muscles overlay one another, don't they? There are NOT two sphincters -- rather, the muscles surround the same sphincter -- one more internally than the other. I'll check my books, but I believe this to be true.

The orifice has 2 sphincters, not the urinary tract.