How to decrease pain during foley cath or straight cath procedure

Nurses General Nursing

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Hello Nurses! New grad here. I am looking for advice on how to decrease pain during catheter placement. Any advice is much appreciated. Thank you!

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Specializes in Home health was tops, 2nd was L&D.

As I had interstitial cystitis and was catheterized more times that I could ever count..my advice is explain what you are doing before and as you are doing it. Have pt take some deep breaths and makes sure pt is not holding their breath in anticipation. if female have knees as far to the sides as possible..get assistance if needed for patient. Visualize the urethra and DO NOT PROBE around! I have also found that instead of just holding the catheter I actually support it with middle finger of sterile hand as index and thumb guide it in.. This takes practice, never was taught this by anyone learned when I was self cathing multiple times a day..But my patients always request me when possible to do their catheterizing.

By the way disease got worse and I now have ursostomy so catheter now means straight cathing stoma for sterile urine sample if UTI s/s come up.. Good luck ..practice and keep your self calm and relaxed.

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Some facilities have standing orders for this, others will require a physician order, but definitely use Urojet which is lidocaine jelly. Basically it comes prepared as a prefilled syringe that screws into the deployment device. You put the tip into the urethra and inject and let it dwell for a few minutes before catheter insertion to let it take effect. You can also use it to lubricate the catheter. Again check with your facility to see if you already have standing orders to use it, else if you happen to be talking to a physician, get an order for this, it's a lot more comfortable for patients.

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Specializes in Home health was tops, 2nd was L&D.
Some facilities have standing orders for this, others will require a physician order, but definitely use Urojet which is lidocaine jelly. Basically it comes prepared as a prefilled syringe that screws into the deployment device. You put the tip into the urethra and inject and let it dwell for a few minutes before catheter insertion to let it take effect. You can also use it to lubricate the catheter. Again check with your facility to see if you already have standing orders to use it, else if you happen to be talking to a physician, get an order for this, it's a lot more comfortable for patients.

Excellent idea.. no one ever used that with me but that would really help.. In HH have never seen it ordered or even heard of it.. but excellent idea..

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Specializes in Family NP, OB Nursing.

We used lidocaine jelly to lubricate our catheters as well. It works well, but sometimes there is an initial stinging sensation before the numbness kicks in so it is best to explain it to the patient before hand.

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A lot of nurses on our unit had no idea we had it as a system-wide policy standing order. Unfortunately now they took it off our policy orders because apparently someone thought a pt could become lidocaine toxic if say for ex they were getting it from other sources like IV etc. etc. What a joke, it's only like 2% and barley anything...

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Specializes in LPN.

I am glad to see this post. It is something I have always tried to be gentle with, but I have never supported the cath as nlmoore suggested. I think any time I learn something that will improve how I do things, is a great day. I look forward to all the other advise given here. Again thank you for this post.

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I have been cath'ed and have cath'ed. I would call it annoying, but not especially painful.

One of my HH pts who needed q2wk changes had me put her on a bedpan - it makes it easier to keep the legs spread, and the additional few inches makes it easier to locate the urethera.

I had one male pt who 'needed' lidocaine, but I really believe it was just the extra attention to his privates that he wanted.

I like the idea of lidocaine for some patients, but it may just be prolonging the procedure for others.

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Lidocaine is *not* just prolonging the procedure for some patients. If the lidocaine gel is applied to the meatus and urethra and allowed to work for a few minutes, and then mixed with the sterile Surgilube during catheter insertion, it can make the procedure almost completely free of discomfort.

I speak from personal experience. I've used an indwelling cath 24/7 for the last six years and have hypersensitivity in My vulva due to spinal cord damage. Using the procedure I described, I have zero pain when doing cath changes at home every three weeks.

The only time I have pain during a cath change is when I am hospitalized and I have a nurse(s) who refuse to either order the lidocaine gel or won't take the few minutes needed after application to allow it to work before doing the insertion.

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Specializes in Med Surge, Tele, Oncology, Wound Care.

I have them wiggle their toes to take their minds off of it.

I had one done before my epidural insertion when I was in the hospital having my baby. It didn't hurt until the balloon was inflated, I told the nurse and she said "it is normal" I had no urethral discomfort, but it hurt inside. Turns out the balloon was pushed against the baby's head and when the MD checked me he pushed the balloon by hand into my bladder and I was bleeding like I needed a CBI. I was ******.

If it is hurting terribly, there may be something wrong.

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Specializes in Home health was tops, 2nd was L&D.

Yes, patience is key.. I have had lidocaine used on me to start IV's and if they only wait for it to work it is usually pain free.

Please do not ever assume if you just get a procedure over with the patient will be happier. This could cause trauma to your patient...You do not always understand the underlying pathology of other diagnoses that could cause one patient to not tolerate any procedure the same as another.

Be kind!

On another note: since getting urostomy in 1995 I have had no nurse willing to catheterize my stoma not even urology nurses. They always ask me to do it... and how simple can you get..no nerve endings no chance of pain(well I guess if you miss the opening?)

Us nurses we are a funny bunch ;)

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Specializes in Home health was tops, 2nd was L&D.

And please do not leave the room and go to nurses station or actually speak out loud that you think your patient is a "cry-baby" or worse... Sounds travel in hospitals. If you want to think it .. that is your business but do not share. Many woman have had trauma to vulva or urethra and my word for that kind of pain is ... now imagine this.."sex with scissors" and I have a high tolerance for pain and am no cry-baby. So again Be Kind!

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