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!

Specializes in Level II & III NICU, Mother-Baby Unit.

I have no advice for the insertion of urinary catheters but I know they are more painful being inserted rather than they are when being removed. A very admired mentor nurse taught me that when removing a urine catheter to be sure to, of course, let the patient know exactly what you are going to do and then just as you are doing it as well. She reminded me that a lot of people who have not had lots of urine catheters can think it will be as painful or as discomforting as it was to be placed. So, here is the tip. Tell the patient that as you remove the catheter you will tell her to exhale as you do it and practice with her 2 or 3 times the breathing in and breathing out. Then, when you are to the point of removing it tell her, "OK, lets breathe in again and out again for the last time now." and do a sort of loud exhale with her as you slide the catheter out and smile with them. This worked like a charm for me over the years on a post-partum floor. I think the 3 good deep breaths in and out beforehand helps to relax the patient (it's a classic relaxation mini-meditation that Dr. Weil and Dr. Oz have mentioned as well) and then the last breath out just puts the icing on the relaxation cake. Wish I had a tip for insertion but I love the idea of the ointment to help decrease the pain. It's been a very long time since I worked with adults....

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@Love_2_Learn: Excellent advice! The breathing technique you mention works brilliantly, not only for cath removal but for cath insertions and any procedure where there will be a few seconds of pain/discomfort like injections, starting IVs, etc.

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I was taught to (and do) always use lidocaine gel. One syringe for females and two for men (anatomical reasons). Always give it a couple of minutes to take effect before inserting catheter. Some times we have to cause our patients pain in order to help them but if at all possible (like in this case) I believe that it should be avoided.

While this procedure might not be very painful or uncomfortable for some people, others find that it is. With an easy remedy available, I see no reason not to use it.

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I had a catheter when I had surgery and it didn't hurt at all when the nurse removed it the next day. I also had one inserted while I was awake for a urine sample and they didn't hurt.

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Specializes in Med/Surg,Cardiac.

I think breathing techniques work exceptionally well. They are atleast better than just doing it. I also think it's helpful to explain that it will be uncomfortable. I have used the urojet gel before and it does seem to work well if you give it time. I wish we did have a standing order for it. And on a side note, I was taught to always always always insert the Foley all the way to the hub to be sure you don't inflate the balloon while it's in the urethra. The tubing curling in the bladder isn't harmful. Always clean the patient afterwards as well. We miss that step sometimes but the lube staying there is uncomfortable too.

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Well, it's probably best to look at research first. A very well done study on lidocaine and catheters published in 2005 found that a wait time of 15 minutes was required for success. More recent studies have looked at lidocaine and shorter wait times and found no reduction in pain. So, use lidocaine and leave it in the urethra for at least 15 minutes. The problem is keeping it in--there are clamps that can be used that are not painful, but you can use a sterile gloved finger over the meatus--make sure you have a chair handy. Or have the patient cover the meatus with a sterile gloved finger. Also, do the procedure slowly and remove the catheter slowly. And stop when the patient tells you to or shows signs of pain. Some patients (also verified by research) find the procedure almost unbearably painful.

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"Attention to his privates?" "Prolonging the procedure?" Wow!! This is basic lack of empathy.

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Specializes in Med/Surg, Ortho, ASC.
"Attention to his privates?" "Prolonging the procedure?" Wow!! This is basic lack of empathy.

To what are you referring?

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Specializes in Post Anesthesia.

Even without lido the key to a comfortable insertion on men is lubrication. After you have adequate lube to fully coat the catheter, inject(slowly) 1-2cc directly into the meatus. Make sure the member is held straight and at a 90deg relation to the body. If you hit resistance as you pass through the prostate, pull up GENTLY on the member- directly away from the body- this will provide better alignment of the urethra to the bladder through the prostate. Slow steady pressure is most effective to pass a tight insertion.

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Specializes in ER.
Well, it's probably best to look at research first. A very well done study on lidocaine and catheters published in 2005 found that a wait time of 15 minutes was required for success. More recent studies have looked at lidocaine and shorter wait times and found no reduction in pain. So, use lidocaine and leave it in the urethra for at least 15 minutes. The problem is keeping it in--there are clamps that can be used that are not painful, but you can use a sterile gloved finger over the meatus--make sure you have a chair handy. Or have the patient cover the meatus with a sterile gloved finger. Also, do the procedure slowly and remove the catheter slowly. And stop when the patient tells you to or shows signs of pain. Some patients (also verified by research) find the procedure almost unbearably painful.

15 minutes of standing at the bedside...when I could use that time to pee myself? Nope. Compassion is one thing, but I have needs too.

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Specializes in MICU, SICU, CICU.

Here is what a urologist taught me:

Lots of lube or lido gel.. I was taught to inject the lido gel into the meatus and wait a few minutes. Never never check the balloon. That is an old practice from when foleys were made of rubber. The new ones are made of some kind of plastic. When have you ever seen the balloon break anyway. It is not going to cause harm even if it is defective.

When you check the balloon with air and deflate it that leaves sharp ridges on the foley. That is the source of the discomfort.

Some men have a very narrow urethra and the 16 Fr catheter causes very real irritation and pain. Change it to a 12 Fr foley and that fixes that.

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Great advice ladies. I graduated about 1 year ago and I am still learning so much everyday!!!

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