I have the hardest time finding the right location on women. I suppose nothing's going to help me there but practice. But this is really puzzling me:
I've done 2 males now without any urine return. I would swear I'd have to be in the bladder because I'm pretty far in with no resistance. Any ideas??
Also, in the clinic where I work they use KY for the lube on the cath. Do you think that's okay? In the hospitals where I've been we always used individually packaged sterile lube. One of the other RNs thinks I could be using too much and "clogging" the holes at the end of the cath...
The lidocaine that you are using is not being injected into the blood stream, it is being used topically when inserted into the meatus. It is working the same way that licocaine would work topically anywhere else.
And you are not injecting it, there is no needle that is being used, more than likely you are using what is called a Bristo-jet, or are drawing it into a syringe and then squirting it in.
It is instilled for about five minutes in male patients so that is can actually take effect.
Hope that this helps to clear up any issues.
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If the catheter does not come with its own sterile jelly, you can easily squirt some onto your field before you put on the sterile gloves. And it should always come from a tube that has its cap in place, never from one that is just open and lying around.
The lidocaine that you are using is not being injected into the blood stream, it is being used topically when inserted into the meatus. It is working the same way that licocaine would work topically anywhere else.
And you are not injecting it, there is no needle that is being used, more than likely you are using what is called a Bristo-jet, or are drawing it into a syringe and then squirting it in.
It is instilled for about five minutes in male patients so that is can actually take effect.
Hope that this helps to clear up any issues.
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If the catheter does not come with its own sterile jelly, you can easily squirt some onto your field before you put on the sterile gloves. And it should always come from a tube that has its cap in place, never from one that is just open and lying around.
Duh! Thanks so much, that clears up so much!!! I never thought about the meatus vs direct blood stream. Thanks again!
After 10 years of putting in foleys on men, women, and children I have learned a few things
first of all, I usually pull the plunger out of the KY syringe and stick the sterile cath inside it (this keeps it from flopping around outside of the sterile field), on men I inject the KY/Lidocaine in to the meatus/ also, I have found that inserting the tube all the way to the hub without resistence, typically means you are in the bladder, even though you dont always get urine back, if you sit the patient up or ask them to try and void you will usually will get a return//on women, I look for the "winking eye", or turn them on their side and try to visualize the meatus, unfortunately sometimes youre forced to go at it blind. in that case, I aim up and say a prayer..dont sweat it, even the most skilled nurse has a hard time sometimes
This may sound funny. An LPN I work with from Ireland taught me this when I'm having trouble locating the opening with a female. Have the patient cough and the urethra opening will wink at you, it really does work.
I'm doing both. The straight caths aren't in a kit, so they're using the KY.
I haven't been inserting almost to the hub though... there's part of the problem I guess...
I am a student and have FINALLY got this catheter thing down lol
for men here we use sterile 2% xylocaine gel, you use the entire tube(I've even had an order for 2 tubes!) so I really don't think you are clogging the lumen with the KY although I really feel that unless the KY is in separate, sterile packages it shouldn't be used for risk of infection and I always insert right to the hub and wait for urine return before inflating the balloon
for females, I found it a bit harder, some I thought were easy, others near impossible, I had one where I inserted it to the hub, expected returns and all of a sudden saw the tip of the catheter pointing back at me lol! I find having the patient's knees bent really far makes viewing a whole lot easier
Specializes in Rehab, Neuro, Travel Nurse, Home Care.
This may sound funny. An LPN I work with from Ireland taught me this when I'm having trouble locating the opening with a female. Have the patient cough and the urethra opening will wink at you, it really does work.
I was told this too!! But I never saw the wink. When I was a new grad I asked my preceptor why isn't it winking and she laughed so hard.
Specializes in ICU, ER (ED), CCU, PCU, CVICU, CCL.
for some woman... FLIP THEM OVER! Some time even on there side. I can honestly say that I never was not able to cath a female ( was never taught this way but found out when I owned and ALF and had many elderly ladies). The hardest was a 90 year old "virgin" and I couldn't even get my pinky finger into the lady partsl opening to find the meatus. I usually look for the lady parts then head up towards the privy parts. Again, I find that in some cases it is easier to put them on thier side.
Older men are more difficult. An enlarged prostate will deflect a normal foley and allow it to curl up in the urethera. To prevent this you need to get a firm grip with your fingers under the member and pressing on the "tane" area so to speak. Still you mat need a cude cath that is stiffer and ribbed to get through an enlarged prostrate. For this I get the urology cart from the OR. I also keep a few cude cath in my department.
The first time I cathed a male peds client, I felt resistance, but did not get any return of urine. I work in home health and the mother tried to cath her son and it did not work for her either. The mother told me (and my preceptor) that the doctor had said that the catheter goes into the "wrong tube" and that's why there is no urine return. The only logical thing I could think of is that the cath, once in the prostate, is curving into the vas deferens and not into the bladder. I am not sure if that is possible, but that is something I have heard.
espritjolieRN
42 Posts
I used to work in a hospital where they had us inject lidocaine into the urethra prior to cathing a male... then come back in 5 minutes.