Foley pain

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If a pt complains of bladder pain with a Foley catheter they have had a few days (and I know it could be bladder spasms but just to troubleshoot..)...my thoughts are to bladder scan and make sure the catheter is draining urine and that the urine is normal and not clotty or bloody then if that’s OK check the cc’s in the balloon to make sure it’s not lost any fluid and is asymmetrical and causing discomfort from that and refill the balloon to the fill cc’s recommended by the manufacturer ...if the balloon is OK then maybe reposition tubing to the other leg and make sure catheter is secured.

Anything else you’d do or not do?

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Specializes in Surgical, quality,management.

Lucy, this is your second foley catheter related question in a row.

If you are a nurse please talk to your TL CN educator or someone more senior.

If you are a patient/ family member of a patient please ask to speak to the nurses supervisor if you are having issues.

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Lucy, this is not a dumb question and shows that you want to improve your nursing knowledge and patient care. It’s very possible you already asked someone at work about this and you did not get a satisfactory answers so coming to a forum like this with questions is a good choice. Checking the output for color, presence of clots and quantity is a good idea. Bladder scanning for retention also makes sense! As far as deflating it and re inflating, I wonder if the integrity of the balloon could be compromised by doing that? Sometimes if there’s not enough slack on the catheter on the outside it can pull and be uncomfortable as well. Never stop asking questions. It makes us better nurses!!!

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On 5/20/2019 at 8:07 PM, 8130 said:

Lucy, this is not a dumb question and shows that you want to improve your nursing knowledge and patient care. It’s very possible you already asked someone at work about this and you did not get a satisfactory answers so coming to a forum like this with questions is a good choice. Checking the output for color, presence of clots and quantity is a good idea. Bladder scanning for retention also makes sense! As far as deflating it and re inflating, I wonder if the integrity of the balloon could be compromised by doing that? Sometimes if there’s not enough slack on the catheter on the outside it can pull and be uncomfortable as well. Never stop asking questions. It makes us better nurses!

On 5/20/2019 at 8:07 PM, 8130 said:

Lucy, this is not a dumb question and shows that you want to improve your nursing knowledge and patient care. It’s very possible you already asked someone at work about this and you did not get a satisfactory answers so coming to a forum like this with questions is a good choice. Checking the output for color, presence of clots and quantity is a good idea. Bladder scanning for retention also makes sense! As far as deflating it and re inflating, I wonder if the integrity of the balloon could be compromised by doing that? Sometimes if there’s not enough slack on the catheter on the outside it can pull and be uncomfortable as well. Never stop asking questions. It makes us better nurses!

Thank you 8130!

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Specializes in LTC, assisted living, med-surg, psych.

Some people can have nasty bladder spasms with Foleys. I am one of them. Every time I've had to have a catheter, I've needed medication for the spasms. My bladder just doesn't want that in there! I don't know if it's a latex problem and I'd do better with a silicone cath, but I'm not otherwise allergic to latex so I don't think it's that. I think my poor bladder and urethra are simply trying to reject the foreign body.

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Specializes in Vents, Telemetry, Home Care, Home infusion.

Remember to use the smallest size possible, usually with a 5- to 10-mL capacity.

I've found that many patients with bladder spasms (not due to Multiple Sclerosis) tolerate silicone catheter or silver impregnated foley catheter, especially those with recurrent UTI's.

Good article: https://aacnjournals.org/ccnonline/article-abstract/22/3/84/766/Ask-the-Experts?redirectedFrom=fulltext

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Be sure to assess what "bladder pain" means. Assess for other signs of UTI.

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I think you are doing the right things. You might review causes of bladder pain. You might try a less irritating catheter, meaning smaller, silicone.

Just make sure everything is where it should be and is working. Make sure it's bladder pain, ask a lot of questions of the patient.

Never be afraid to ask questions here or of a mentor at your place of work. We weren't born knowing it all.

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Specializes in School Nurse.

I agree with Forest. In our situation, when a student complains of "bladder" pain they often mean urethral pain. Silicone and smaller does go a long way there.

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Specializes in LTC, assisted living, med-surg, psych.

That's good to know. I'll ask for a silicone catheter the next time I have to have a Foley for any length of time. Thank you.

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Specializes in ICU, trauma, neuro.

This is a great question and causes me to ponder several that are related:

a. Why are repeated straight caths preferable to a foley? I cared for a new quad. patient after a MVA who had Q 6 hour straight Caths ordered. By morning I was getting clots, blood and signs of uti or urethral trauma. Why is repeatedly sticking something in the urethra considered less of a risk than simply leaving a foley in place?

b. Why can’t they make foleys with at least low grade local anesthetic integrated and or antibacterial agents?

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Specializes in School Nurse.

While there can be urethral trauma associated with repeated intermittent cathings, I suspect the benefit is that they're out more than their in. Foreign bodies inside the body are typically prolonged irritants and holding bacteria in place no matter what you do. There's also the infection risk. You can find lots of articles on this.

Anesthetics doesn't mean the inflammation and damage isn't occurring. Don't believe that antibacterial coatings hasn't been thought about. There are tradeoffs. Some patients find the silicone caths (due to their being a little stiffer) more uncomfortable than the latex ones. On the other hand latex has more issues with allergic reactions and harboring infections. The silver coated ones have a marked decrease in infection rates. Other novel caths include teflon coated (though I've not seen these on the market).

Here's a very nice (albeit from the manufacturer) guide:
http://media.bardmedical.com/media/1679/a-guide-for-nurses.pdf

I did a bit of research on this when I had to start doing indwelling caths again (something I never thought I'd have to do as a school nurse).

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