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Foley insertion on a male patient

Posted

Specializes in ICU, medsurg/tele.

Now I know the general technique to place a foley and have done this many times. Where i run into a problem is with BPH or strictures. What are some tips on how to advance the catheter into the bladder. Any specific position? Movement of the catheter? And has anyone heard of a foley becoming coiled in the testicles? I have never heard of it until recently when another RN was describing a difficult cath. Any advice on how to deal with the difficulties that arise with male catheterization would be greatly appreciated!

KayRN910

Specializes in ER. Has 1 years experience.

I tell them to take a really deep breath, and advance the catheter when they exhale. It seems to work pretty well.

ChristineN, BSN, RN

Specializes in Pediatric/Adolescent, Med-Surg.

have you tried a coude catheter? I know some facilities (like mine) make us get a dr order if we want to use them, but they can make it so much easier.

Jenni811, RN

Specializes in Intermediate care. Has 3 years experience.

Try using a silicone foley. What happens when you run into something like BPH is the foley bends and can't "push through it." so if you use a narrower silicone one, it won't bend like that, so you won't have as much of an issue. is this the same the Coude??

Also, another option is Condom catheter, but those are never fun.

jennybean14

Specializes in Diabetes/Med/Surg/Stroke/Onc/Hematology. Has 22 years experience.

The coudes do work great! I hate when those caths coil. You can feel it bunching up......just imagine what it feels like for the patient.....:(.

A Coude catheter is the only way to go with BPH - works wonders! If you meet resistance, tell the patient to take a deep breath in and exhale strongly. While they exhale, finish advancing the catheter. Works every time.

Best of luck to you!

Amanda

Now I know the general technique to place a foley and have done this many times. Where i run into a problem is with BPH or strictures. What are some tips on how to advance the catheter into the bladder. Any specific position? Movement of the catheter? And has anyone heard of a foley becoming coiled in the testicles? I have never heard of it until recently when another RN was describing a difficult cath. Any advice on how to deal with the difficulties that arise with male catheterization would be greatly appreciated!

I had a few patients that had enlarged prostate and I tried and I tried and It coiled. So the doctor told me to use lots of lubricant and it works.

merlee

Has 36 years experience.

Coiled in the testicles??? Check your anatomy book, please!!!!

Also, I have gotten orders for lidocaine gel, and used plenty of it, when there was a difficult placement.

flyingchange

Specializes in MPH Student Fall/14, Emergency, Research. Has 2+ years experience.

This post was very timely. We had a difficult foley on an older male pt today. 3 attempts using a coude by 3 different people (me, RN, and finally the resident). Stricture was so tight we caused some bleeding to the urethra. I am not sure how the resident got it. I've never used a coude before today - do you insert with the curve going down towards the base of the penis or up? or both, with twisting as needed? I did it with the curve going down but I could feel it bulging and bunching.

tyvin, BSN, RN

Specializes in Hospice / Psych / RNAC.

The coude caths that people are talking about are made for persons who have concerns connected with a compromised urethra.

The coudes are made with silicone or are silicone coated and probably made from other materials as well depending on the manufacturer. Everywhere I've worked I have got management to order and have in stock the coudes. One never knows when you'll need one. As far as insertion and the curve as you call it; I never thought about it. I've inserted a few of them and it wasn't an issue ... I had no problems. Interesting question though.

Edited by tyvin

canesdukegirl, BSN, RN

Specializes in Trauma Surgery, Nursing Management. Has 14 years experience.

If you are cathing a male pt with known BPH and you meet resistance AT ALL, STOP advancing. Let the MD know. The MD will more than likely want a Coude catheter (and in response to Canundergrad, you would insert the Coude curved tip toward the umbilicus as you insert, with NO twisting.) and would also probably want Lidojet jelly for insertion of the Coude catheter.

Also note that you should NEVER inflate the balloon of the catheter under ANY circumstance unless you see urine. I have seen far too many urethra injuries from the inflation of the balloon before it was advanced all the way. If you advance all the way and still do not see urine, drop the bag to see if gravity will be your friend and produce some urine. If not, then stop and remove the foley. Call the MD and let them know your findings.

RH-CC2011

Specializes in Med/Surg. Has 2 years experience.

Did my first foley a couple of weeks ago and had a doc tell us afterward that he learned years ago to (..get this) "Pull on the shaft until you can see six-inches of daylight under the patient's buttocks." > Apparently this was some sage wisdom passed down to him from an old Urologist years ago.

I have not yet seen a coude, but the "You-Can't-Pull-It-Off" method, I will never forget. Physically, it does make sense to fully-straighten the urethra to facilitate insertion, but... Wow!

RH-CC2011, I know it sounds funny, but after working ER & ICU, the "reach for the sky" method (shall we call it) really does help! I'm in CRNA school now and we've learn all about aligning axis, so if you think about it, it aligns and allows gravity to be your friend! lol Also, the deep breath, lube, and lidojet/urojet are helpful! And you definitely CAN feel it coil in the testicles. As awkward as it may be (esp. at first) go ahead and feel for it. Learn what it "should" feel like/the norm, and then always check there with a difficult cath! Practice is the key! ;)

GOOD LUCK!!!

cherrybreeze, ADN, RN

Specializes in Med/Surg.

Have never felt a cath coil in the testicles. Bunch up in the urethra, yes.

MrWarmHearted

Specializes in Emergency.

agreed with the above on coude and lido if possible. Also if you have an extra set of hands, try having the other person hold the penis and the testicles up as you insert

P_RN, ADN, RN

Specializes in ORTHOPAEDICS-CERTIFIED SINCE 89. Has 30 years experience.

I always put the curve point down. When meeting resistance, slowly rotate it. while asking him to cough forcefully. You can ask the doc if you can insert some lidocaine gel with a slip tip syringe (not a luer lock) that will lubricate and give some topical anesthesia to the meatus and urethra.

Edited by P_RN

canesdukegirl, BSN, RN

Specializes in Trauma Surgery, Nursing Management. Has 14 years experience.

Have never felt a cath coil in the testicles. Bunch up in the urethra, yes.

Agreed, cherry. It is impossible to coil a catheter in the testicles.

I'm sorry, I guess my terminology was incorrect....:jester: What I should have said was that the cath coils in the urethra and can be felt in the scrotum upon palpation. This is due to the cath not being able to pass the enlarged prostate. Personally, if I have inserted a foley (without resistance, never force it) and am not getting urine output, I will feel there first. This lets me know if I've coiled.

Also, once inserted but not getting output, pressing downward on their stomach a little sometimes helps. In ICU we had a lot of incontinent/oliguric pts so getting an instant nice yellow flow to confirm placement was out of the question.

Hope this sounds more correct....:yeah: