Foley Catheter Lubrication

[Twinmom06, ASN, APN]

Can someone please assist me? I'm a new grad and in my orientation class are 2 of my friends that graduated with me. The foley insertion we were taught in school and clinical (as well as how I inserted as a STNA in a magnet facility) had us dip the end of the foley in sterile lubricant that we squeezed into the sterile catheter tray.

Yesterday 2 of my friends were assigned to the floor we will eventually be working on with a completely horrible instructor that really got in their face and and one of the things she was lecturing on was that the nursing literature now states that we should be instilling the sterile lubricant into the meatus? I've done numerous searches via PubMed, Google (using sites such as mayo clinic and NJM - NOT Wiki) and have found nothing of the sort except for 1 article from 2005 that indicated instilling lidocaine gel when introducing a Coude catheter into men with BPH that were a difficult insertion. I wouldn't consider 2005 to be "the latest literature" - not sure if she was just being a witch or if there is something I'm not finding. Have any of you heard of this, or can you tell me where else I can look?

both of these normally unflappable classmates of mine are ready to bail because of this instructor.

[Morainey, BSN, RN]

I think the only time I've seen lubricant put directly in the meatus was in my nursing school clinical skills book (Taylor's Handbook of Clinical Nursing Skills). IRL I squeeze the lubricant in the tray and run the catheter tip through it as you mentioned.

[aachavez]

Ive only ever seen it done as you mentioned, never heard of applying directly to the meatus.

[Caffeine_IV]

I don't have any fact based evidence but I have been told that squirting lube into the meatus for males can make insertion a little easier/less uncomfy.

[VANurse2010]

I've never personally done it, but I've seen a urology PA do it. It's not the big deal you think it is - but it's also not the big deal your instructor is making it out to be. It's all sterile and water soluable. It won't matter either way.

[RedHeaded2bNurse16]

I've been taught meatus for males and dip in tray for females.

[dishes, BSN, RN]

Pre-loaded syringes of xylocaine/ lidocaine jelly are commonly used to instill topical anasthetic into the meatus prior to catheterization. The trade names of two them are Urojet and Instillagel. The instructions on how to use them are available on the companies websites. No need to bail on the instructor.

[Sun0408, ASN, RN]

Male's yes, female's no..

[OB-nurse2013, BSN, RN]

I only have female experience and do it the way you are stating. Dip the tip in the sterile lubricant on the tray. What is your hospitals protocol? Do it that way and you are safe.

[MessyMomma]

Pre-loaded syringes of xylocaine/ lidocaine jelly are commonly used to instill topical anasthetic into the meatus prior to catheterization. The trade names of two them are Urojet and Instillagel. The instructions on how to use them are available on the companies websites. No need to bail on the instructor.

Have ypu noticed that patients complain of less pain/discomfort when the topicals are used? These are not available in my hospital, but I am very curious as to how it works.

Also---do you have to wait a little nit for the anesthetic to work? Or just proceed as if using plain KY?

[MessyMomma]

Have ypu noticed that patients complain of less pain/discomfort when the topicals are used? These are not available in my hospital, but I am very curious as to how it works.

Also---do you have to wait a little nit for the anesthetic to work? Or just proceed as if using plain KY?

BIT, not nit!

If I see nits down there, we got more problems! ;-)

[MunoRN, RN]

I don't think this requires a PubMed search, simple rationale will do. It's a long distance from the meatus to the bladder in a male, a journey filled with various highly sensitive spots. If you dip the tip in some jelly and then insert that tip will be dry by the time you're a third of the way to the bladder, meaning the rest of the way you're pushing a dry foreign object through someone's urethra. In males at least, always inject the lubricant directly into the meatus, this will advance some of the lubricant ahead of the tip of the catheter, providing lubrication beyond just the first inch. And I also think lidocaine jelly should be mandatory (as a male who has had a catheter placed before). There's no downside to injecting directly into the meatus, but it means less torture for the patient, which is pretty much the whole basis of Nursing.