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Foley pain

Nurses   (861 Views 15 Comments)
by lucy8686 lucy8686 (New Member) New Member Nurse

220 Visitors; 5 Posts

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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? 

Edited by lucy8686

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K+MgSO4 has 12 years experience as a BSN and specializes in Surgical, quality,management.

1 Follower; 21,593 Visitors; 1,526 Posts

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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2,087 Visitors; 97 Posts

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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220 Visitors; 5 Posts

53 minutes ago, 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!!!

 

53 minutes ago, 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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VivaLasViejas has 20 years experience as a ASN, RN and specializes in LTC, assisted living, med-surg, psych.

8 Followers; 142 Articles; 247,877 Visitors; 9,623 Posts

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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NRSKarenRN has 40 years experience as a BSN and specializes in Vents, Telemetry, Home Care, Home infusion.

5 Followers; 10 Articles; 159,910 Visitors; 14,474 Posts

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: http://ccn.aacnjournals.org/content/22/3/84.full

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778 Visitors; 286 Posts

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

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2,021 Visitors; 334 Posts

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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1,516 Visitors; 83 Posts

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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VivaLasViejas has 20 years experience as a ASN, RN and specializes in LTC, assisted living, med-surg, psych.

8 Followers; 142 Articles; 247,877 Visitors; 9,623 Posts

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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myoglobin has 11 years experience as a ASN, BSN and specializes in ICU, trauma, neuro.

2,989 Visitors; 280 Posts

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?

Edited by myoglobin

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1,516 Visitors; 83 Posts

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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