Foley placement in COPD exacerbation pt

[DVorahRN, BSN, RN]

I have an obese female pt on BiPAP for COPD exacerbation who needs a Foley catheter placed. She cannot tolerate supine or lithotomy position, or lateral position. Has anyone else faced this circumstance? The only thing I can think of to try is reverse Trendelenburg to keep her breathing comfortable, and raising the bed up off the floor so I can see what I'm doing. Suggestions?

[heron, ASN, RN]

Side-lying with helper to keep the “top leg” elevated enough to allow you to see and access from behind.

[SmilingBluEyes]

I put in many a catheter in OB when I was there. Side lying is easiest in some OB patients and best (as they should never lie flat). Have a helper (or two) for sure. If she is big, have another nurse don sterile gloves and spread the labia apart; this helps immensely.

 

Good luck.

[VivaLasViejas, ASN, RN]

I used to have to change a Foley every month in this superobese, 550-lb. lady who also was on supplemental oxygen. She couldn’t handle lying flat at all and panicked when she felt she couldn’t breathe (who wouldn’t?). It took five of us to do the procedure: two staff to hold her legs apart, one to hold up her belly, one to hold the flashlight, and me. We turned up the oxygen and laid her down as far as she could tolerate, then I got down to business and had her cleaned up and the catheter changed within 30 seconds.
 

Ordinarily I would have turned her on her side and approached from the back, but there was no way we could hold up her top leg to access the entrance. Her thighs were like tree trunks and extremely heavy. The poor patient had to have the Foley because she was unable to take care of her own toileting needs. Home health couldn’t do the changes at home because of her size, so they sent her to my hospital for us to do the job. Lucky me, I got the cath in so fast the first time I attempted it that she didn’t have time to panic, and thereafter I was the nurse with the dubious honor of performing the monthly changes. But it took a team.

[Emergent, RN]

And who doubts that nursing is a glamorous, action packed job??

I call these kind of cases 'Close encounters of a third kind'.

[NRSKarenRN, BSN, RN]

If not super obese, can try placing bedpan upside down, covered with chux under buttocks to allow pubic/thigh skin to hang down.  Increase O2 slightly, lower head if tolerated.   Prep equipment.  At least two persons --one cleans and holds labia open, sterile RN inserts cath. 

Very heavy thighs -4 person team- have used pillowcase /drawsheet wraped around each leg with 1 staff  at each leg, gently pulling leg to the side --other 2 did cath as above.    Otherwise best is side lying position --cath from behind.

[marienm, RN, CCRN]

If you have the equipment...a hoyer or ceiling lift that allows you to lift the pt in a semi-seated position? If you arrange the sling correctly, I think you can separate the legs (vs drawing them together in standard transfer-to-a-chair configuration) but you probably still need a couple of helpers to hold the legs apart/shine a flashlight/etc...