Is it normal to take 4 Tries and Catheters to finally get it right? - page 3

Oh Lord, do I ever feel stupid. It was my first try at it today. SHE was definately not easy to get at. I was really focusing on the sterile technigue rather then just using 1 catheter tube. BUT, is... Read More

  1. by   KacyLynnRN
    Hahaha....often takes me 2 tries on a woman, and I have been a nurse almost 3 years. My best advice is leave the catheter in the vagina, so you know where not to go on your next try. But believe me, you are not the only one who needs multiple tries, and I am not even in school anymore! LOL
  2. by   Fiona59
    If possible, get Lidocaine gel for men with prostrate issues. I've found that talking to a lot of men about anything often relaxes them and in it goes (eventually). That's where the lidocaine come in handy..
  3. by   closatssl1
    Quote from Angie O'Plasty, RN
    Oh, don't let that bother you! Some women have strange anatomy. And some men do too.

    We spent about an hour trying to cath one poor fella, finally gave up and had to have the urologist come in and do it. Turned out that the patient had a "blind passageway!" We felt awful about trying so hard to get it in.

    Yes, Angie O'Plasty, could you explain a "blind passageway" in terms of nursing. Thanks
  4. by   RN92
    Luckily, cathing a vagina is (most of the time) not painful. One way I can tell Im in the right place is by the shriek!
  5. by   leslie :-D
    definitely there are women that are anatomically incorrect. i always bring 2 caths w/me just in case. and if i have difficulty with them on their backs, i find the side-lying position much more conducive to finding the correct meatus.
  6. by   JBudd
    Quote from Nurseinthemaking
    you guys, you have all made me feel so much better. I am going to make a list of tips and I am going to turn it in with my nursing notes for my clinical instructor to see, she might get a tickle out of the bed pan one.

    OK the one about the meatus being "north" of the clitorus has me very befuzzled.

    Thank you so much for all your great advice and support.

    Doing this was a great learning experience. I cannot wait to get the next one, I will jump on it thinking about all the great I got from each of you. Big huggins to you.

    The bedpan thing works for a quick vaginal exam too, when you can't get the woman to a pelvic bed (I work ER).

    "north": think of a road map, north is always "up" or to the "top", so ...
    the meatus being north means above everything else, or "on top". Gone south, means whatever it is you're talking about is going "down".

    And you're welcome, from all of us
  7. by   nurse96
    Someone once told me if I had difficulty inserting a foley cath on a male to have him strain,usually goes right in.
  8. by   mysticalwaters1
    Just takes practice and all the advice already mentioned. I lift the area up and look for an area someone refered to as a butterfly. I don't kow but anyway it just takes practice. I used to never get it and needed someone else to do it and now it's a lot easier but at times definitely get it in the vagina. I also leave the catheter in when this happens and if it's proving difficult get someone to hold the legs or shine a light but it does get better and sometimes just can't do it. I had one male pt kept saying if i put a foley in he needed to be sedated and i'm like WHAT! Anyway His penis was so tiny. I tried to find the smallest catheter and started a little and he started screaming i stopped. Really stunk because the guy had a retroperitoneal hematoma from a liver bx, kidney failure, the h/h droping fast and the doctor not sending him to icu and in the midts needed this urethral catheter. Finally i called and told the doctor who said he'd come up and do it and ordered an analgesic cream to put on the penis which i did and said my god come on up. He tried to put the catheter in and the pt screamed and held the doctor's hand so tight i think the pt really hurt him. When the pt let go the doctor said don't you ever do that to me again. The pt was difficult yes he penis was small but he was uncooperative with his care at times and wanted every detail from a scratch to more complex things solved in the midts of hime becoming unstable. Yeah harsh but it really was awful. Anyway finally the next day after over 7 units of blood and i can't remember how many ffps we hung just i believe in one day not counting the previous day all on a med surg floor when night shift gets 10 pts. My charge nurse gave me 3 pts that night (3-11p) and I couldn't keep up it was awful. Anyway back to catheters not even the doctor could get. I don'tknow if the urologist did either.
  9. by   stevierae
    Quote from payday
    A OB head nurse gave me this tip once. Spread the labia and lift slightly. By lifting, the meatus presents itself better.
    And it works especially well if, instead of using your thumb and index finger to retract the labia, you use your index finger and middle finger.

    Do it like this.

    Get your Foley tray opened, (on a little prep stand or bedside table, or even on the the bed, between the patient's legs, which are "frog-legged"--just make sure it stays sterile)

    Put your gloves from the kit on

    Attach the syringe of H2O to the Foley--test the balloon if you include this step as part of your technique

    If your patient is awake, and you want to make the catheterization as atraumatic as possible, open the syringe of KY (If she has an epidural, she may not feel the catheterization, so you can skip this step)

    Pour your Betadine over your cotton balls, keeping one or 2 dry in case you need to wipe some Betadine off for better visualization of the urethra

    Make a "V" with the index and middle finger of the OPPOSITE hand (that is, NOT the one you will prep and insert the Foley with---to insert the Foley, you will use your DOMINANT hand) You will maintain this traction throughout the entire procedure.

    Put your "Vd" fingers at the very top of both sets (inner and outer, together) of labia and pull upwards, towards the umbilicus

    Prep, using your Betadine soaked cotton balls, with the opposite (dominant) hand per usual technique, while maintaining traction--the clitoris should be quite visible, and should be aligned with the umbilicus--

    Look down, and while still maintaining traction upwards with the "V'd" fingers of the opposite hand, inject a tiny bit of KY--perhaps a cc or 2-- directly into the urethra, if you want to (you can skip this step if your patient will most likely not feel the insertion---just make sure you have used plenty of Betadine for lubrication)

    MAINTAIN YOUR TRACTION THROUGHOUT with the "V'd" fingers of your non-dominant hand!!!! If the Betadine has made things a bit slippery, "hook" the tips of your "V'd" fingers in and under the labia a bit, and adjust upward traction, still maintaining it

    Pick up the Foley (you can gently coil it around your fingers, if you'd like, so as to make the the excess length easier to handle, and lessen the chance of contamination) insert the Foley with your dominant hand all the way to the hub into the urethra (which should be visible a short distance down, but usually aligned with, the clitoris)

    When you see a drop or two of urine (if need be, you can have someone very gently Crede the bladder to push a bit of urine out and ensure you are in the right place) and then inject the entire 10 cc of H20 into the balloon port (to which it is already attached)

    (Alternately, if you are certain you are in the bladder, but would still like to reassure yourself by seein gurine, you can now release traction and use your non-dominant hand to Crede the bladder)

    Now pull the Foley gently down (with your dominant, still sterile hand) until it stops. You're done!

    Get rid of the trash. Put the Foley drainage tube under the patient's knee (at the "hollow" in back of the knee; that is, the popliteal space) and make sure it isn't kinked or urine flow obstructed in any way. If your policy calls for the catheter to be taped to the thigh, do so.

    Hang Foley bag below bed level.

    Chart size of Foley, amount, color and charcter of urine initially returned, and the amount of fluid you put into the balloon (this is so anyone who uses a syringe to deflate the ballon when it's time to d'c the Foley will be aware that they need to aspirate 10 cc. of water, not 5 cc. (An easier way is to simply use a scissors and cut the Foley at the hub of the balloon port to let the water drain out)

    If you do use KY, (on a female) don't use too much, as it can form a plug that can discourage the immediate free flow of urine--making you think you are not in the bladder, when you really are. If this happens, just disconnect the catheter from the bag and irrigate with a catheter tip syringe filled maybe 5-10 cc of H20--it will dissolve the KY and allow the urine to flow freely. Then you can reattach the bag. Be careful not to contaminate anything.

    When you catheterize a male, inject the entire syringe into his urethra, rather than coating the tip of the catheter with KY---much better lubrication, and far less mess.
    Last edit by stevierae on Mar 27, '05
  10. by   stevierae
    Quote from JBudd
    The bedpan thing works for a quick vaginal exam too, when you can't get the woman to a pelvic bed (I work ER).

    "north": think of a road map, north is always "up" or to the "top", so ...
    the meatus being north means above everything else, or "on top". Gone south, means whatever it is you're talking about is going "down".

    And you're welcome, from all of us
    Well, no; actually, the urethra is SOUTH of the clitoris.

    Think of it this way:

    Umbilicus at the top (North)

    Then the Clitoris (going further South)

    Then the Urethra (going even further South)

    Then the Vagina (final Southern stop)

    Even if you work UPWARDS from the Vagina, the Clitoris is still above (North of) the Urethra

    Orient yourself from the umbilicus, and work downward. Everything is generally anatomically lined up--except for people who have had various surgeries that tamper with nature, or whose abdomen is distorted by either major weight gain or loss
    Last edit by stevierae on Mar 27, '05
  11. by   Jamesdotter
    Quote from stevierae
    Well, no; actually, the urethra is SOUTH of the clitoris
    Yeppers. Except the lady in question had a urethra that was indeed "north"--superior to--in front of (what's the opposite of "dorsal"? I can't think of the word) her clitoris. I've never seen that before or since.

    Great instructions, by the way. You could be my teacher any time!
    Last edit by Jamesdotter on Mar 27, '05
  12. by   dazzle256
    Quote from Nurseinthemaking
    Oh Lord, do I ever feel stupid. It was my first try at it today. SHE was definately not easy to get at. I was really focusing on the sterile technigue rather then just using 1 catheter tube. BUT, is there anyone else that did this in Nursing School, I feel like an idiot. My instructor was there and she was soooooooooooooooooooooooooooooo sweet about it and very supportive. I could not get it in, I had 3 tubes in her sitting there, all were in the vagina and finally she said, here let me try, I felt so bad, but the lady was so miserable from other pain, she felt nothing and was so thankful when we got it, because within 5 minutes she had drained 1000CC's of urine. Poor thing.

    Do you always get it the first try? After it was over, I kept thinking, I want to do this again and do it right and get it myself, but dang, how much can one person take before enough is enough.
    My first female foley insertion on a real person was after I graduated. It was on an alert and oriented 42 year old woman with MS that just so happen to be a former ICU nurse. She was so sweet... OK honey if you missed just leave it in so you know where not to go next time and get another foley (you learn not to ever go in the room with just one). I think it took me about 4 tries so I know how you feel... I felt like a big doofus.