Foley placement

TakeTwoAspirin, MSN, RN, APRN · Mar 13, 2015

Our policy is "no urine return, no inflation of balloon". If there was 100cc of urine in the bladder, if it was placed correctly you should have been able to get some kind of a return. Ask someone else to evaluate for you if you are ever unsure.

dishes, BSN, RN · Mar 13, 2015

The lack of urine return and blood indicate that the balloon was inflated in the urethra, the catheter should be removed and if the patient recovers from the sepsis, they should be referred to a urologist to assess for trauma to the urethra.

MunoRN, RN · Mar 13, 2015

If you've used sufficient lubricant you often won't get blood return immediately since the tip is covered in water soluble lubricant, although the blood returning could have been a sign that there wasn't enough lubricant.

Foley's don't actually drain every drop of urine from the bladder it's not at all unusual for some urine to remain. You have to consider the position of the drainage holes in the catheter which are above the balloon which is what sits in the bottom of the bladder.

mymichael2009 · Mar 13, 2015

I reported it to preceptor and doc..no one seemed concerned but it worried me..was never told to remove it...should I expect to be disciplined... Nervous nellie over here

dishes, BSN, RN · Mar 13, 2015

If you've used sufficient lubricant you often won't get blood return immediately since the tip is covered in water soluble lubricant, although the blood returning could have been a sign that there wasn't enough lubricant.
Foley's don't actually drain every drop of urine from the bladder it's not at all unusual for some urine to remain. You have to consider the position of the drainage holes in the catheter which are above the balloon which is what sits in the bottom of the bladder.

Do you mean you won't get urine return immediately? If you do not get urine return, flush the catheter with saline to remove the lubricant blockage and the urine should start to drain. Once urine starts to drain, the catheter should be advanced up to the Y bifurcation before inflating the balloon.

dishes, BSN, RN · Mar 13, 2015

I reported it to preceptor and doc..no one seemed concerned but it worried me..was never told to remove it...should I expect to be disciplined... Nervous nellie over here

It seems more like this is a learning opportunity for you, if you want reliable catheterization information, suggest you read the Society of Urological Nurses Association (SUNA) Clinical Practice Guidelines on male urethral catheterization.

mmc51264, BSN, MSN, RN · Mar 13, 2015

If the person os really dehydrated, you may not get urine return right away. When I was doing CNA clinical, we put a Foley in a man and afterr about 6 hours and fluids running at 125/h, he started producing a small amount of very dark amber urine. In a man, there really isn't much chance of "missing". If they have hx of prostate CA pr BPH, it may bleed a little.

brownbook · Mar 13, 2015

Dear Nervous Nellie, Maybe, (that is a BIG maybe) you inflated the balloon in the urethra, not in the bladder.

Even IF you did do this.....it probably does not even rate an incident report. I would bet 100's if not 1000's of foley balloons have been inflated while in the urethra. Patients do not die from this, they probable don't even bleed from this. It is very painful and they will tell you it hurts, or a confused agitated patient will try to pull it out.

It is not unusual for there to be a small amount of blood in a perfectly inserted foley.

Many a confused agitated patient has pulled out a properly placed foley with the balloon inflated! YIKES! again, it doesn't even rate a report, it happens frequently.

In the IDEAL foley world you do not inflate the balloon until you see urine coming out, then you know for sure it is in the bladder, then you inflate. HOWEVER it is not at all uncommon to be in the bladder and not see urine. There could just not be much urine in there, an old saggy baggy bladder can have urine in a pocket that the tip of the foley doesn't reach.

You told your preceptor......the doc saw it.....NO ONE WAS CONCERNED for good reason.

dishes, BSN, RN · Mar 14, 2015

Dear Nervous Nellie, Maybe, (that is a BIG maybe) you inflated the balloon in the urethra, not in the bladder.
Even IF you did do this.....it probably does not even rate an incident report. I would bet 100's if not 1000's of foley balloons have been inflated while in the urethra. Patients do not die from this, they probable don't even bleed from this. It is very painful and they will tell you it hurts, or a confused agitated patient will try to pull it out.
It is not unusual for there to be a small amount of blood in a perfectly inserted foley.
Many a confused agitated patient has pulled out a properly placed foley with the balloon inflated! YIKES! again, it doesn't even rate a report, it happens frequently.
In the IDEAL foley world you do not inflate the balloon until you see urine coming out, then you know for sure it is in the bladder, then you inflate. HOWEVER it is not at all uncommon to be in the bladder and not see urine. There could just not be much urine in there, an old saggy baggy bladder can have urine in a pocket that the tip of the foley doesn't reach.
You told your preceptor......the doc saw it.....NO ONE WAS CONCERNED for good reason.

Urethral trauma from a catheter balloon being inflated in the urethra can cause more than pain and blood, it can also cause urethral stricture, false passage and in a few cases a ruptured bladder.

It is not in the ideal world that you do not inflate the balloon until you see urine return, it is the gold standard recommendation by urologists everywhere. Better education for nurses regarding catheter insertion, may prevent thousands of patients from experiencing traumatic catheterizations in the future.

**canoehead, BSN, RN** · Mar 14, 2015

You could have passed the catheter into a blind pouch, not the bladder. I would not inflate the balloon without seeing urine.

KelRN215, BSN, RN · Mar 14, 2015

How do you know the Foley is in the bladder if you didn't get any urine return?

I don't think you should expect to be disciplined though but you should expect more education.