Foley Insertion

[araujojr]

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?

[Daytonite, BSN, RN]

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.

• http://www.emedicinehealth.com/inability_to_urinate/article_em.htm - inability to urinate
  • http://www.emedicinehealth.com/inability_to_urinate/page7_em.htm

[Daytonite, BSN, RN]

i re-read your posts again. you said this patient pulled his catheter out in the first place? something is wrong in this patient's urethra. foley catheters, possibly an earlier one and not necessarily the one you and the instructor put in, are probably aggravating the problem. someone could have messed up a previous catheter insertion. when the patient pulled his catheter out, bulb intact (ouch!) he damaged himself. i think that if you have a chance to go back and review his chart you will find that the problem taken care of. all this catheter business is just plugging holes in the dam until the doctor can get in to see the patient and do his thing. that is what really needs to be done. who knows what the doctor has said to the family. remember that the doctor is the captain of the ship and runs the show most of the time. if anyone is going to have a finger pointed at them, it is going to be the doctor for letting this man be in agony for so long. urethral strictures don't happen overnight.

quite worrying about a lawsuit. ain't gonna happen. i've seen way worse than this. you'll be fine. read up on urethral obstruction, bladder spasm and catheter complications because if you do get called on the carpet that is what you are likely to get asked about. better to say you have been looking up information about these things than look like you don't know what in the blazes they are talking about.

[icunurse42066]

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?

I don't think there is going to be a suit. If it wasn't in the bladder, it's not the first time and it won't be the last. No, I don't see you getting kicked out of nursing school.