Foley Catheter Issue?

Nurses General Nursing

Updated:   Published

So, the other day, with the help of a coworker, I successfully placed a Foley catheter into a male for the first time...or, did I?

My coworker had me keep inserting the catheter into his member until we got urine return. When we saw urine output, we inserted the syringe to inflate the balloon. What I noticed was that, although we were able to insert about 10cc into the catheter, it was a little difficult to do so. I'm not sure if it is because I wasn't used to the amount of pressure needed to insert fluid, or if there was something else going on.

Anyway, we get the catheter inserted, and urine is draining. Urine is yellow and clear with no order. In a couple of hours, his entire leg bag is more than half full.

However, the patient also complained that the new catheter felt like it was "burning." I consulted with a couple of other nurses, as to what may be going on, and they didn't have much of a comment. They said the discomfort was likely due to having the catheter being changed, and that the previous one hadn't bothered him because he'd gotten used to it. They also did not have any good suggestions as to what may help relieve the patient's discomfort. However, one of the nurses thought it possibly could be the material on the catheter causing the discomfort. I don't remember if the catheter had latex in it, as my coworker selected the catheter for me to use. At the same time, I did look at the patient's chart and he wasn't known to have any allergies.

Anyway, there were no supervisors around, so, because it was draining well, I left the catheter in for the oncoming nurse to take a look at. Initially the oncoming nurse didn't seem too concerned about it either. Also, I did see the patient get up and start ambulating, so I'm wondering if he was actually in that much pain.

Needless to say, without any good answers, it's been bothering me a bit. Any ideas of what may be causing the problem?

Specializes in Pediatric Critical Care.
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Ditropan can be used for bladder spasms too. Also if they are really bad a B&O suppository.

B&O? What is that?

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"The discomfort was likely due to having the catheter being changed" Sounds like the patient just had a catheter change. The change would be an irritant in itself. If adequate amounts of clear urine was obtained.. nothing else can be done.

In the future, use a Urojet for a catheter change.

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Specializes in Pediatrics, Pediatric Float, PICU, NICU.
Julius Seizure said:
B&O? What is that?

Belladonna & Opium suppository - works wonders for extremely bad spasms.

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Specializes in Cardio-Pulmonary; Med-Surg; Private Duty.

Ditto on the "might not have been inserted far enough" comment.

Getting urine return isn't enough -- insert even farther, to make sure the balloon is fully inside the bladder before inflating. After inflating, give a gentle tug to seat the balloon at the urethral opening in the bladder. When you feel that resistance on the tug, you know that the balloon is seated.

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Specializes in Mental Health, Gerontology, Palliative.
JustANurse2018 said:
So, the other day, with the help of a coworker, I successfully placed a Foley catheter into a male for the first time...or, did I?

My coworker had me keep inserting the catheter into his member until we got urine return. When we saw urine output, we inserted the syringe to inflate the balloon. What I noticed was that, although we were able to insert about 10cc into the catheter, it was a little difficult to do so. I'm not sure if it is because I wasn't used to the amount of pressure needed to insert fluid, or if there was something else going on.

I always watch the patients face when I'm inflating the balloon. My logic is that if the balloon is still sitting in the urethra and I try to inflate it with 10mls sterile water, the patient is going to respond with a grimace or other such indicator of discomfort.

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Anyway, we get the catheter inserted, and urine is draining. Urine is yellow and clear with no order. In a couple of hours, his entire leg bag is more than half full.

However, the patient also complained that the new catheter felt like it was "burning."

I had this the other day, changed an SPC on a patient with a long term SPC. Cathether change went without incident, patient was comfortable however an hour later was complaining of wanting to pee urethrally. Output in the bag was clear and draining well. Gave reassurance and about an hour later and when seen by the MD stated to the MD "I feel great.

I have found often when people have a long term catheter, due to ongoing health issues there can be anxiety related to those health issues which can manifest as physical symptoms.

It could be that the burning feeling was a result of having a foreign item removed from a body space and another foreign item placed into a body space, the fact is that the human body does not like having things such as long term catheters in-situ and responds accordingly

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However, one of the nurses thought it possibly could be the material on the catheter causing the discomfort. I don't remember if the catheter had latex in it, as my coworker selected the catheter for me to use. At the same time, I did look at the patient's chart and he wasn't known to have any allergies.

Did the discomfort settle for the patient? if it settled, I would imagine that a latex allergy was not the case

Sounds like you did well.

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I've inserted a male foley until the bifurcation and it took quite amount of pressure to inflate a balloon. The catheter is thick 18f? so I believe it is going to take some effort to push the saline.

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Specializes in Med/Surg/Infection Control/Geriatrics.

Sometimes the saline can be a bit irritating for some, but I haven't seen it much. If you have a good urine return and no visible blood, and he's functioning fine, you should be fine.

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The only issue with Pyridium I can think of would be that it would be that the discoloration is causes could mask any blood or other issues in the urine. Otherwise, I could see how that would be very comforting - I always scream when having a Foley inserted. It's extremely painful for me. :(

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.

Here's another thought: before inserting the Foley, did you test the balloon? Occasionally you will get a defective one. The other reason to test is to see how many mls it takes to get it to inflate symmetrically. The balloon will fill to one side first, then fill to become spherical. You want to make sure it will do that, before you insert the catheter.

An asymmetrically-inserted balloon puts uneven pressure on the bladder neck and is irritating, often making the patient feel the need to void. Whenever I got that complaint on a fresh postop patient I checked the balloon amount to make sure the full amount was present. If it was short I added the requisite amount of sterile water. Unfortunately this didn't immediately alleviate the discomfort because the irritation was already present. But at least it kept it from worsening.

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Specializes in Critical Care.
TriciaJ said:
Here's another thought: before inserting the Foley, did you test the balloon? Occasionally you will get a defective one. The other reason to test is to see how many mls it takes to get it to inflate symmetrically. The balloon will fill to one side first, then fill to become spherical. You want to make sure it will do that, before you insert the catheter.

An asymmetrically-inserted balloon puts uneven pressure on the bladder neck and is irritating, often making the patient feel the need to void. Whenever I got that complaint on a fresh postop patient I checked the balloon amount to make sure the full amount was present. If it was short I added the requisite amount of sterile water. Unfortunately this didn't immediately alleviate the discomfort because the irritation was already present. But at least it kept it from worsening.

This while likely being an ongoing area of conflict, but you really shouldn't test the balloon first. The balloons are rigorously tested during the manufacturing process and there's no evidence that testing just prior to insertion finds any faulty balloons not found during the manufacturing process, but more importantly when the balloon is deflated after checking it does not return to the same position. When balloons are deflated during the manufacturing process they are deflated using a device that ensures they are smooth and have a consistent diameter throughout, which reduces urethral trauma during insertion.

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Specializes in Emergency, Telemetry, Transplant.
MunoRN said:
This while likely being an ongoing area of conflict, but you really shouldn't test the balloon first. The balloons are rigorously tested during the manufacturing process and there's no evidence that testing just prior to insertion finds any faulty balloons not found during the manufacturing process, but more importantly when the balloon is deflated after checking it does not return to the same position. When balloons are deflated during the manufacturing process they are deflated using a device that ensures they are smooth and have a consistent diameter throughout, which reduces urethral trauma during insertion.

I remember that there was a long thread on AN several years ago debating this issue. My hospital policy is clear...it is in bold letters, underlined...do not test the balloon--rationale is that wrinkles left after deflating the balloon can increase urethral trauma.

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.
MunoRN said:
This while likely being an ongoing area of conflict, but you really shouldn't test the balloon first. The balloons are rigorously tested during the manufacturing process and there's no evidence that testing just prior to insertion finds any faulty balloons not found during the manufacturing process, but more importantly when the balloon is deflated after checking it does not return to the same position. When balloons are deflated during the manufacturing process they are deflated using a device that ensures they are smooth and have a consistent diameter throughout, which reduces urethral trauma during insertion.

Good to know. Thanks. It was a while ago that I worked urology and that was the conventional wisdom then. But an underinflated balloon still causes irritation. I've occasionally found less than 10 mls in a 10 ml balloon in a postop patient complaining about bladder pain an an urge to void. I think it is a good educational piece to make sure to fill the balloon to capacity.

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