I harmed my first patient today.

[starwarrior]

I am a nursing student, and I made my first mistake. My clinical instructor gave me permission to remove a Foley catheter on a male. I've done several times before by myself. Long story short, I deflated the balloon and pulled back on the syringe to make sure all of the saline is out. After I was sure the balloon was deflated I tell the patient to take a deep breath in and let it out, and as he exhaled, I pulled the catheter.

When I pulled it out I saw blood. It was not a lot but it was enough for me to be concerned about. Also, my patient was in pain.

I cleaned him off and called for the nurse. And she assessed him and said that everything was going to be fine. I apologized 1000 times to the patient. He was understanding and said that it did not hurt that bad.

I informed my clinical instructor of the situation. And we went through the steps that I had taken to see where it went wrong. All I could do was cry. I just harmed a patient.

Later that afternoon I checked on the patient again to make sure he was feeling okay. He reassured me that he was fine, and said that I should not let this weigh on me.

I feel terrible for causing the patient pain.

This is the first time I've ever messed up. I thought I took all of the correct step, but I still caused my patient unnecessary pain.

Please offer any advice or words of wisdom that might help me learn from this and move forward. Again I was taught to attach the syringe, let it fill with NS, and then aspirate to make sure there is no more fluid left in the bulb. If you have another technique that will prevent this from happening again, please share!

[starwarrior]

Thanks for your advice and the articles!

[yakov78]

First of all, it sounds like you've done the procedure several times under supervision, was deemed to have performed the procedure correctly, and was also given permission by the nurse to perform it by yourself.

Secondly, it sounds like you did the procedure correctly.

Thirdly, you obviously care a lot about your patients.

Lastly, and most importantly, the patient was ok (a little blood is not a huge deal), and he didn't make a fuss. This is probably (mostly because of your genuine concern for your patient.

You would be surprised at how patients can make a huge fuss over minor issues because medical personnel had poor bedside manner, and conversely, how forgiving patients can be over what should be a huge issue (even a basis for a lawsuit) simply because medical personnel had great bedside manner and genuine concern for their patients. In summary, don't worry about it, and keep having genuine care for your patients.

[LadyFree28, BSN, LPN, RN]

Thanks so much for sharing your experience. That would have broken my heart too! I am sensitive. I know if I don't take control of my emotions the very thing that I love will turn out to be what drains the life out of me!

You need to be very careful with this mindset in bold...I understand that you are sensitive, and that could be an advantage with being empathetic with your patients, however, learning how to hone your skills in terms of reality when interacting with you pts and in this business; like another posted stated, there are things that hurt; people hurt, families hurt...being over-emotive to a fault can be draining and may lead to burnout!

I congratulate you that you realize this...try to seek out avenues to help you cope healthily and help you achieve the best way to handle situations, seek out mentorships or someone trusting and objective to help you with this process.

Best wishes.

[djh123]

... my second comment on this thread, partly serious, partly dark not-quite-humor: look at it this way - compared to what one of 'my' residents did a few months ago when he'd only been there a couple of days, you didn't do *anything*. What did he do? Oh, just ripped out his Foley AND g-tube - and of course, neither of the bulbs had been emptied. Yes... there was blood, and pain. But he's fine. Just didn't want no stinking TUBES!!

[starwarrior]

What did he do? Oh, just ripped out his Foley AND g-tube - and of course, neither of the bulbs had been emptied.

OUCH!! I'm so glad my mistake wasn't quite as bad as that one! But it is definitely more than enough to be a wake up call for me.

[Nurse Leigh]

So I too had a (male)patient with an indwelling urinary catheter. I walked into his room and to my horror found a splash of blood in his bed. Upon further inspection, I found that he had indeed pulled out the catheter with the balloon still inflated. The gentleman had some dementia so didn't seem to realize what he'd done. As I got him cleaned up and assessed him, he assured me multiple times that he did not hurt. That was a head scratcher because just the *thought* made me flinch.

Oddly, later that same shift (and same patient) I removed a dressing from a previous blood draw. He screamed like I was stabbing him. Go figure.

Also, and I still cringe remembering, I had another patient with an indwelling urinary catheter and he was sitting in a chair in his room. I completed my assessment and scheduled med administration, and I was preparing to leave the room when it happened.

My foot caught in the catheter tubing and *yanked* on the line! It didn't come out but gave a good tug that had to hurt like H E double hockey sticks. (No stat lock on him -those make a difference!) He let out a yelp.

I felt *so* awful and when he said he would take a prn dose of pain med, I got it ASAP and apologized many times. He wasn't upset with me - I was way upset with myself though.

So, trust me. You did fine.

[dream'n, BSN, RN]

OUCH!! I'm so glad my mistake wasn't quite as bad as that one! But it is definitely more than enough to be a wake up call for me.

I don't see where you made a mistake? Sometimes removing a foley can hurt and sometimes a patient may bleed a little. There was NOTHING you did that "caused" this. Some people also have a lower threshold for pain than others. Where do you think that you made a mistake, cause I'm not seeing it?

[RAndaRoo]

It will get easier as you progress, sometimes things hurt people! Even just turning people hurts sometimes, and different things hurt different people. Sometimes people yell when you're not even touching them. My friend went to start an IV on a pregnant woman who screamed at the top of her lungs when she didn't even have a tourniquet on yet. [emoji23]

When you get to peds, some kids will cry or say no no no before you even touch them.

I took an IV out of a guys arm and he had super hairy arms...and I tried to be gentle but it's like going slow hurts, and you can't just rip it out either. Well he would yell out or make a face when I pulled the tape a little and then start laughing, which of course made me laugh. It was so weird that we were both laughing at the fact that I was essentially giving him an arm wax.

It gets easier! As others said there's a difference between intentionally causing harm to someone, and performing a task that happens to make them slightly uncomfortable or cause a little pain.

[ArrowRN, BSN, RN]

I did not see how much saline was in the syringe after it was pulled out. A tech came in and assessed the situation. She said there was still a little saline in the bulb. I didn't see for my self because she pushed saline back into the bulb to show me what it looked like when inflated and how it deflates. I already understood how the process went, but I still went wrong somewhere.

Generally a 10ml syringe is used to fill the bulb. To remove the foley I use a 12 ml syringe or larger to make sure I get it all. In addition always pull back the plunger of the syringe until you see the junction of the foley go completely flat. This is the only way to ensure there is no fluid left. However, don't let that CNA/PCA make you feel bad, there will always be some residual fluid left in it because of the vacuum created and the laws of physics. I am certain you did nothing wrong but those are the steps I take.

However, if the pt had BPH (benign prosthetic hyperplasia) the blood could easily have been and most likely was from trauma during insertion of the foley and NOT from your removal technique. The foley would have stopped the bleeding and when you removed it whatever clot that formed during insertion was removed and hence cause a bit of pain and bleeding.

Steps you could take afterwards is medicate the patient and increase fluid intake. Good luck.

[starwarrior]

Where do you think that you made a mistake cause I'm not seeing it?[/quote']

The Tech continued to stress that there must have been saline still left in the bulb. She continued to repeat the correct steps to take (which was everything that I did). She did not mention any other possible causes for what happened. I am still not confident in my knowledge just yet. So I thought well she's been doing this since I was born she must know better than I. I was upset because I hurt a patient, and I didn't know where I went wrong. If I don't know where I went wrong, I wouldn't be able to prevent it from happening again. After reading all of the posts I feel so much better. Everyone is encouraging and informative.

[starwarrior]

try to seek out avenues to help you cope healthily and help you achieve the best way to handle situations, seek out mentorships or someone trusting and objective to help you with this process.

I know there are probably a million posts on here about how nurses cope with the emotional stress that comes with this career. I will do a quick search and see what pops up.

[ohthatswhatthatdoes]

This happens. Could be someone did some damage placing the foley... I've had several patients pull them out with the balloon still inflated. Some people are just tough and/or delirious.

This might be a language thing (I'm not from the US), but why is everyone talking about saline? I learned you never put NaCl (= saline, I suppose?) in a balloon, always Aqua, as the salt could from crystals.