Help! placing foley in obese females

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At work today I got to try and place 5 caths, which was unusual and pretty cool. I could only get 2 in correctly though. The 1 guy I did had an enlarged prostate, and I was putting in the coude cath tip down, which I'm reading now is exactly opposite of how it should be.

But the women! They were average large women, not 300 pounds, but I was doing good to find the folds of the labia majora, much less visualize the meatus. Is there a trick to seeing down there? Just keep digging down and spreading open with my clean hand? Would it be better to sort of put the pinky edge of my hand in the labial fold and pivot it to open it up? I was taught to drag my palm up over the labia and spread it as I come up superiorly, but that's not working too hot.

Another wrinkle is lots of hip fractures, so a lot of them have at least one leg they can't flop open real well.

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I need to get VERY close to see it, and an aide with a flashlight helps.

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Specializes in Geriatrics, orthopedics.

I like to do a "trial look" with clean gloves before you even start the sterile procedure, that way you can have an idea as to the anatomy of the patient which will help you get to where you need to go before you start the procedure. Flashlights are always helpful too! I also like to have a tech or nursing assistant help "hold things open" so to speak if they are available to do so. The more eyes and help the better at least thats what I think until I feel confident to do them all by myself. Good luck!

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Specializes in FNP, Peds, Epilepsy, Mgt., Occ. Ed.

If you use betadine, try to look and see where the betadine "puddles" because sometimes it will collect in the urethral opening just a bit.

If you insert the catheter and it's in the lady parts, leave it there; you need a new one anyway, and that shows you where not to go the second time.

Having another set of hands to hold might help, particularly if your own hands aren't large and you're having difficulty.

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Specializes in med/surg, telemetry, IV therapy, mgmt.

you place the palm of your hand over the mons pubis and pull it down and backwards while you use your fingers to spread the vulva. the idea is to pull the internal tissue upward to get a better visualization of the urethral meatus. if the meatus is really high up, something we did in the nursing home for ladies with leg contractures who couldn't spread heir legs was to have them turn to the side and have an assistant hold the top leg bent forward and the top butt cheek up and away from the peri area and approach from the rear. you can usually get a good visualization of the meatus from this vantage point.

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One thing my ob teacher taught me is that it will wink when you wipe firmly with the betadine swab. I can't think of putting a foley in now without seeing her wink.

Malia

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Specializes in Nursing Home ,Dementia Care,Neurology..

Sometimes getting them to cough will show you if there is any incontinence.

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you place the palm of your hand over the mons pubis and pull it down and backwards while you use your fingers to spread the vulva. the idea is to pull the internal tissue upward to get a better visualization of the urethral meatus. if the meatus is really high up, something we did in the nursing home for ladies with leg contractures who couldn't spread heir legs was to have them turn to the side and have an assistant hold the top leg bent forward and the top butt cheek up and away from the peri area and approach from the rear. you can usually get a good visualization of the meatus from this vantage point.

this would be my suggestion, as well.........

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Specializes in 5th Semester - Graduation Dec '09!.
One thing my ob teacher taught me is that it will wink when you wipe firmly with the betadine swab. I can't think of putting a foley in now without seeing her wink.

Malia

I do the same thing.. My sister, an RN, first told me about how it "winks" at you. You can also do it by pulling the suprapubic area towards and away from you (back and forth) with the non-sterile hand while opening the labia majora, it will wink at ya again!

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Specializes in Ortho, Case Management, blabla.

I have inserted countless foleys...many of them on obese patients. Visualization is not always the key. I have yet to miss a foley on the first try.

If I can make a suggestion, aim the end of the catheter so it points slightly upwards (all catheters will point slightly at an angle). find the opening of the lady parts. Begin your "poke" with the catheter pointing upwards.

Feed the tube until you get a urine return. I seriously have not missed a foley insertion using this super-simplified technique. I rarely actually see the hole the foley goes into. Visualization of the meatus isn't always the key, just being familiar with the general anatomy of female parts and having a good sense of where the middle is..

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