Foley catheter question

[clemmm78, RN]

I've been a nurse for 25 years and I came across a situation last week that I've never seen before. I'm still waiting to see the outcome of it, but I thought I'd ask if anyone here had any ideas.

The patient is an 84 yr old man with a long med hx, including prostate cancer, bone mets, and severe cardiac disease. He came to long-term with an indwelling catheter that blocked after 10 days. It couldn't be irrigated so the nurse on duty took it out and reinserted another foley. There was no resistance going in with the new one.

The second one, the new one, blocked after 8 days, so the nurse tried to irrigate without success. She then decided to take it out again. She couldn't withdraw the saline from the balloon. There was resistance and nothing would come into the in to the syringe. This does happen on occassion, so she cut the catheter tubing just above the Y junction, to allow the balloon to drain, which it would normally do. It didn't. The catheter still wouldn't budge and any attempt to move it, forward or backward, caused pain to the patient.

Being a long-term care institution, we had no other means of trying anything and now we had an open catheter due to the cut and a straight opening inviting infection, so we sent him to an ER to have the urology people remove the catheter.

Any ideas what may have happened? Because he has prostate CA, I asked the nurse who inserted the catheter if she met any resistance and she hadn't. She said it was one of the easiest caths she'd ever done, it slid right in.

Thanks.

[TheCommuter, BSN, RN]

We recently had a situation similar to what you described, and the culprit was pus. Our patient's catheter was constantly becoming blocked due to large clumps of pus in the bladder. Yes, the patient had a raging UTI...

[clemmm78, RN]

That's interesting. His urine was slightly cloudy, but not foul smelling yet. How did they get the catheter out? Cystoscopy?

Marijke

[Medic09, BSN, RN, EMT-P]

Even though there was no resistance going in, my money is on severe edema or pus or the like.

[leslie :-D]

i'm thinking sediment, whether it is pus, crystals, dead cells...

leslie

[CoffeeRTC, BSN, RN]

Probably all of that...edema, sediment, pus, spasms??

What is the game plan for preventing other problems with this?

[qpmz]

we had this happen to a pt, no uti, can't remember why the balloon didn't deflate. A urologist was consulted came by took an 18 gauge needle, I guess palpated the balloon, and inserted the needle between the scrotum and the orifice and popped the balloon. The foley came out with no problems. He did it all at the bedside.

[mpccrn, BSN, RN]

my money is on edema, tumor encrochment and/or sediment. we recently had a patient with prostate ca mets with urology inserted foley and were instructed to deflate the balloon if the patient c/o having to pee or pain, pull the catheter back a bit, irrigate and reinsert followed by reinflation of the balloon.

[clemmm78, RN]

Thanks for your input. I'll be back on that unit tomorrow so I'll have a look to see what the report says.

Marijke