Any one else have issues with a Foley cath?

[hattrick7]

so...... im in paramedic school, and i almost passed out while a Dr. was inserting a Foley cath into a patient. and the patient could not urinate. so they go to put the foley cath in, and it hits the blockage. and they cannot get the cath into the bladder. so the Dr. begins thrusting the cath into the member with all his might over and over again. and then blood starts coming through the cath tube and out the sides of the opening of the urethra.

come to find out. the patient has sickle cell. and the shedded cells ended up in his bladder and clogged the urethra. was interesting. any one else ever see this before??

also, i don't know how well im going to handle putting in a foley Cath after that. i felt severely faint. and the room got really got. i had to sit down and put a water bottle on my head lol. any one ever experience this? tips? advice?

[jadelpn, LPN, EMT-B]

Deep breathe. Yes, traumatic foley insertion is not ideal. And once the "thrusting" started, then would be the time to stop. The MD COULD have gotten a coude catheter....lots of things, but anyways, know that this is NOT the norm in catheter insertion. Sometimes if you have the patient take a deep breath and let it out, the foley will go past the prostate and go into the bladder. Women and cath insertion is sometimes a search and rescue.....

There are lots of healthcare people who have "things" that are less than comfortable to watch. Sometimes doing is different, therefore, not as apt to make one feel lightheaded. You may find the more you do it, and the more you watch it, the less sensitive you can become.....

Best wishes!

[NurseOnAMotorcycle, ASN, RN]

Was there no nurse around to do it right?

[KatieMI, BSN, MSN, RN]

Well, you didn't see a good 'ol traumatic emergency intubation with patient being like 90% awake yet, did you? Just to warn you - it looks many times worse:scrying:

Seriously - this happens, like everything else. Take a deep breath, watch it again, get every opportunity to do it - and within a short time you'll love caths, both for your technical skills and for seeing that immense relief on your patient's face. And these guys can actually thank you after!

[hattrick7]

The nurse tried first. But when it got stuck in the urethra. The ER Dr. Came and did it.

[nurseprnRN, BSN, RN]

Cathing a male, always use lots of lube and have the member aimed towards the patient's nose. This makes for a more straight shot up the urethra, anatomically -- check your anatomy reference to see what I mean. Also, secure it to the abdomen in that upright orientation, to decrease pressure on the bulbourethral junction that can damage the urethra. Again, check the anatomy illustration.

In women, always tuck the last prep-solution-soaked cotton ball slightly into the introitus (opening to the lady parts). This prevents you from inadvertently contaminating your sterile catheter by placing it into the unsterile lady parts when the first try misses an elusive urethra. You can try again without having to open a whole new kit and starting over. Remember to retrieve the cotton ball after you secure everything.

[kidzcare]

In women, always tuck the last prep-solution-soaked cotton ball slightly into the introitus (opening to the lady parts). This prevents you from inadvertently contaminating your sterile catheter by placing it into the unsterile lady parts when the first try misses an elusive urethra. You can try again without having to open a whole new kit and starting over. Remember to retrieve the cotton ball after you secure everything.

Seriously, how have I never thought of this!! Great tip. Thank you so much!!

[Rose_Queen, BSN, MSN, RN]

In women, always tuck the last prep-solution-soaked cotton ball slightly into the introitus (opening to the lady parts). This prevents you from inadvertently contaminating your sterile catheter by placing it into the unsterile lady parts when the first try misses an elusive urethra. You can try again without having to open a whole new kit and starting over. Remember to retrieve the cotton ball after you secure everything.

Yep. We had an RCA done after a woman was discharged with a foley prep sponge (we don't use cotton balls) left behind. And if you forget the cotton ball trick, leave the misplaced foley where it is to mark where not to go!

Although I do wonder why the ER doc didn't call urology in when he had issues- we have an entire supply cart the urologist can take with him/her to difficult foley insertions to do a heck of a lot more than just push past an obstruction.

[hattrick7]

The hospital here is small. They dont have any specialist at this hospital. Pretty much. They are a stationary ambulace they just stabilize and transfer.....they suck. No one in this town goes there because they have a bad rep for killing people.

[ScrappytheCoco]

Put this incident far from your mind. If I encounter resistance I go for a coude. It has only failed me once and that person needed a urology consult. Oy-I feel bad for your pt.

[mhy12784]

My first nursing job was in the OR. But I'm surprised they don't train more people to put Foleys in in the OR. For starters you'll do them much more frequently in the OR the anywhere else (I presume)

And the patients will be completely asleep and anesthetized.

It's basically the perfect no stress environment for Foley practice.

[hattrick7]

To be honest. i've talked with other paramedics. and one guy who has been on a Rig for 20 years said he's only inserted a foley cath 3 times in his career. so i mean, getting used to them just well enough to perform one, would be ok with me. because like i said, its going to be a rare case when one needs put in anyways.