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Discussion

Foley Insertion

I inserted a Foley into a male patient with my instructor. We did not get any urine output does that mean it wasn't in the bladder?

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  • Author

My instructor thought it was in the bladder because as she let go of the foley it would slowly come back out. Do you understand what I'm trying to say?

  • Author

Pt already had a previous Foley which was pulled out and as a result some tissue trauma occurred, and blood was escaping the member. Maybe a clot had formed and it did not allow the urine to flow? My instructor decided to inflate the balloon.

  • Experts
My instructor thought it was in the bladder because as she let go of the foley it would slowly come back out. Do you understand what I'm trying to say?

Yes. The foley was not in the bladder. If it was slowly coming back out, it was coming up against a narrowing or an obstruction, maybe a clot closing off the passageway. Eventually, this patient is going to become distended with urine. He will require catheterization with a caude to get the catheter past the narrowing.

Did you watch the video? We were taught to inject 10cc of lidocaine or water based jelly directly into the male urethra to help the passage of the catheter. However, if there is narrowing the catheter may not pass and will just coil up and you will get trauma, bleeding and no urine return.

  • Author

It was slowly coming out before inflating the balloon. Are you saying if it were in the bladder before inflating the balloon the foley wouldn't have moved.

We were never taught to inject 10cc of lidocaine but we did lubricate the catheter. What do you think will happen to us? I had a feeling the foley was not in the bladder. It was the first time I have ever put a foley in. I should have advocated. What if they deflate the balloon once they notice no output has been detected?

When we inflated the balloon it wasn't painful for the patient, but that's because they gave him morpine 15 mins prior so I couldn't assess if the patient would have been in pain .

  • Author

I do not understand why an order was placed when the patient had a previous injury. Wouldn't they want that to heal? The problem was this was not my patient. And my instructor was looking for someone who had never placed a Foley. Will the patient have to suffer more with a( caude catherization). I do not know what that is. I looked it up in google and no results. I'm still downloading the foley procedure. Is there a slight chance the foley could have been in the bladder and still get no urine output?>

If an elderly gent, I am willing to bet his prostate is swollen, and you are not getting in. (obviously if theere was previous trauma, someone elese had athe same problem, makeing it 2X as difficult for you, with 2 different problems.) I sure hope there is no further injury from the 2nd inflation, but I would bet dollars to dimes that there will be. If I couldn't get it in all the way, I would change out the tubing, lube up big time and give it another shot or get help/ collaboration before inflation. I will have to remember the lidocaine.Thanks Daytonite...

Yes, it is possible that the Foley could be in the bladder and no urine was noted, however, that usually is not the case. I have inserted MANY a Foley in my days, and have ran across a couple that had no urine return. Is it possible that this particular pt happens to be on Dialysis? It is usually better to re-insert a Foley ASAP after a Foley has been pulled out. Espicially if it was a traumatic removal. If you wait too long, there will be swelling of the urethra making re-insertion more difficult.

  • Author

We did immediately re-insert the Foley after the Foley had been pulled out.

Do you think if a suit is filed, I'll be kicked out of nursing school?

We did immediately re-insert the Foley after the Foley had been pulled out.

Do you think if a suit is filed, I'll be kicked out of nursing school?

If you were there with your instructor, following his or her orders and direction, it is their license and career on the line. Not yours. If you had done it on your own, or made a decision to do something you shouldn't have, then it would be your problem. You are practicing under your instructor's license and he or she is liable for anything you do.

  • Author

oh ok... I understand now it's my instructor license on the line, but I wouldn't want my instructor to lose her license. I might have misunderstood why she thought the Foley was in the bladder. She is full of knowledge, and has been a nurse for a long time! And I'm confident she knows what she is doing. I just need to ask her again why she thought the foley was in the bladder.

Thank you all

  • Experts

it was slowly coming out before inflating the balloon.

that tells me that there was some internal pressure pushing against the catheter to push it out. that's not normal if the patient is relaxed and breathing in and out in a calm manner as instructed during the insertion. the catheter will be pushed out if the patient bears down or there is muscle spasm.

we were never taught to inject 10cc of lidocaine but we did lubricate the catheter.

lidocaine ointment usually has to be ordered by the doctor or has to be part of a facility protocol. many hospital patient care techs are taught this technique since it is much more comfortable for male catheterizations.

http://www.drugs.com/pro/lidocaine-jelly.html
- 2% lidocaine gel for urologic procedures

what do you think will happen to us?

??? probably nothing at the facility. have faith that the problem has already been dealt with since it's been almost a day now and, hopefully, the patient has gotten relief. that should always be your first concern. remember, you are a student and the instructor was with you. she was in charge and directing you. the less said by you, the better. it's all past history now, so "should have said" isn't going to make it right. the instructor should have known what she was doing. she should have been the one who had a feeling that the catheter wasn't in the bladder. let her take responsibility for that. your instructor was supervising this procedure along with you and if any fingers get pointed at you, remind them that it was your instructor who decided to inflate the balloon of the catheter, not you. you did what your instructor approved. but study up because you will probably get grilled at school on what you should have known and done. tell them you hit the books over it this weekend looking for information on complications of foley catheter insertion since you were quite puzzled over this. show curiosity and initiative.

http://findarticles.com/p/articles/mi_m3225/is_n5_v48/ai_14282695
- managing the foley catheter

what if they deflate the balloon once they notice no output has been detected?

oh, i'm sure they will. someone will eventually assess the patency of that catheter if the patient has no output and begins to become distended or starts to pass urine around the catheter. he is probably going to have some hematuria. they will probably try to irrigate it or just remove it. they will reinsert a new one. if they have trouble re-inserting, they will call the doctor.

also. . .

http://www.fpnotebook.com/urology/procedure/urthrlcthtrztn.htm
says

(urethral catheterization) management: general

  • urinary catheter blockage
    • maximize patient hydration

    • consider methanamine preparations to prevent blockage

    • consider bladder irrigation

    • change catheter before expected time to obstruction

    • change catheter if no urine flow in 4 to 8 hours

    • evaluate for uti for more frequent catheter blockage

when we inflated the balloon it wasn't painful for the patient, but that's because they gave him morpine 15 mins prior so i couldn't assess if the patient would have been in pain

the morphine relaxed him or his bladder spasms. this man will most likely end up having a dilation or a turp. in any case, he's probably going for a cystoscopy quite soon.

it's coudé. i spelled it wrong. "elbowed (coudé) catheters. . .have balloons for self-retention, have a bent tip to ease catheterization through strictures or obstructions." (http://www.merck.com/mmpe/sec17/ch226/ch226e.html) both that and this website explain a little about the different foleys.

http://en.wikipedia.org/wiki/foley_catheter

i worked on a surgical unit where we had a lot of urological patients and one of the urologists took the time to train us. men with prostate problems and urinary retention because of it have this happen. the added trauma of unsuccessful foley insertion attempts add to the problem as the body's inflammatory response sets in. i've seen urologists have to use a metal stylet inserted into the catheter to get it pass through the narrowing or obstruction in the urethra--ouch! these patients end up having turps. if you can't pass the catheter, you can't pass the catheter. it shouldn't be forced, and i definitely wouldn't have inflated the balloon if i even suspected that there was a chance that the tip of the catheter never entered the bladder (saw no urine coming out).

always check the patient's chart and know what their diagnosis is and why the catheter is being inserted before doing the procedure. replacing a previously removed catheter is not a good enough reason to do a procedure.

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