Foley placement

[vxxen]

Hello everyone!

I just have a little question about Foley's. I recently moved to a med/surg floor so there's a loooot of those. I was just wondering: what are the signs that a Foley's balloon is misplaced? When you see some urine flow, should you advance the catheter more or inflate the balloon right away?

Would the catheter still be draining urine or only blood? Pain during inflation must be a sign, but could the inflation be uncomfortable even though the Foley is at the right place?

Thanks to all of you!!

[BettyGirard, BSN]

Male or female. What I was always told is females you could stop when you got the urine flow. On males you need to advance further (variously either two inches or up to the biforcation in tubing). Inflate and then pull back. Seems I get to do more males than females (go figure). But that's what I was taught and what I do. This is because the female urethra is pretty straight and the male may have some convolutions to it (not to mention the prostrate in older patients).

Generally we don't get blood on a foley placement so that would definitely be cause of concern. Pain as opposed to just soreness/discomfort is also a bad sign.

[mrsboots87]

You actually should advance further in both males and females. At minimum 2 inches further if not all the way to the bifurcation once urine flow is achieved. This has nothing to do with the difference in anatomy. It has to do with the fact that a foley tip is about 1 centimeters above where the balloon inflates. Male or female, you need another inch or 2 to ensure the balloon is completely out of the urethra. You can very easily get a bit of urine flowing before the balloon is fully inside the bladder and clear of the urethra in both genders.

[MunoRN, RN]

With both males and females the openings of the catheter will enter the bladder before the balloon has, so if you stop advancing and inflate the balloon as soon as you see urine return then you are inflating the balloon inside the urethra.

[BettyGirard, BSN]

Thanks, I stand corrected. As I said, almost all of the foleys I have to put in are in boys. I'll be careful with the girls next time.

[bgxyrnf, MSN, RN]

Signs of balloon inflation in the urethra: Pain, new bleeding - in the drainage and eventually from the meatus.

Years ago, I had this happen one time as a newer nurse, in a patient who began seizing after I had inserted the catheter but before I inflated the balloon. The catheter had migrated out just enough to place the balloon in the urethra. I don't know why I was so hell-bent on the Foley that I didn't just pull it when he started seizing - probably just inexperience.

To this day, male or female, I always advance to the bifurcation *and* wait for urine flow prior to inflation.

[babeinboots, MSN, NP, CNM]

I don't do foleys on males (I work in L&D) but from what I remember in school, you advance all the way for males because their urethra is so long. As for females, you are suppose to advance another inch or so after seeing urine return. I personally just advance it all the way, inflate the balloon and the '"excess" just slides out anyway. It's an outdated practice to pull or tug on the catheter.

The only time I've had a foley I was numb and didn't feel a thing but I have had pts who say it is uncomfortable even when properly placed. But it should not be painful.

[BettyGirard, BSN]

Well, I did three foley inserts yesterday (two males and a female) and made sure I advanced far enough. Hopefully, that gets me off the hook for a few weeks (I have four students who have them continually, one the parents had already had their own physician place). I may get one or two "two weekers" as the year progresses. Hopefully no more full timers.