I harmed my first patient today.

Nurses Safety

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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!

Specializes in Cardiology, Cardiothoracic Surgical.

The patient will be fine. I see some blood at the end of my Foley pulls occasionally, and I do everything by the book (deflate the balloon, let it float out a little bit, pull it out when the patient is exhaling). I think older men with enlarged prostates have more issues with it.

The first void after the Foley pull can burn and you may see some blood in the urine, and they're usually fine after that.

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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.

That is a very good question. I'm sorry I don't have an answer. I know that salt can form crystals, but I am not educated on the science behind why it's an accepted practice for inflating a catheter balloon. Hopefully someone else might know. I'm interested to find out! Thanks for bringing that to my attention. I will do some research on this.

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Specializes in Medical-Surgical Acute.

I worked in a urology office and foleys were a daily thing.

I think your patient had some calcification on the tip and it scraped at it was withdrawn. Your technique sounds fine and as long as you disconnected the syringe after pulling out saline. Then you pull back again. If you leave it attached the saline could flow back into the balloon. But if you did those steps, the blood could be from trauma r/t scraping of the urethral from sediment and calcifications.

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Specializes in Critical Care, Cardio-Vascular, RRT.

Hey Star Warrior,

There are almost always steps that we can take to help avoid causing pain or making mistakes. Having said that, there are always ways where your precaution will not be enough. It just happens. I read your story and concern and I can calmly say "Don't worry about it too much". I have seen (and you will too) my fair share of patients who pull out their own foley with the balloon fully inflated. Yep you read that right. In the big scope of things this was a minor boo boo and even the patient told you not worry about so you are all good :)

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Specializes in HH, Peds, Rehab, Clinical.

Um, I'm going to come off as cold-hearted perhaps. But seriously, you'd better learn to toughen up just a touch. And soon!

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!
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Specializes in Cardiac, ER.

Holy cow girl,...breathe! There is a big difference between causing a patient pain and causing harm! You are going to do a great many things that cause pain!! It is just part of the job. This patient is going to be fine!!

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Specializes in Cardiology.

Causing harm and causing some pain are 2 totally different things. There could've been trauma during the insertion of the foley which can cause a painful removal and possibly some blood. Just wait until you rip all of the tele leads off of a hairy man's chest :up:

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Specializes in Mental Health, Gerontology, Palliative.

I had a similar situation. I found that if you gently rotate the catheter while its still insitu it can gently dislodge any crystals/crustyness that has formed on the tip of the catheter.

It sounds like you did everything right

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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.

First off, techs are unlicensed assistive personnel. I get that there are a fair number of them that are awesome at what they do, however, highly inappropriate comment to make (and even more so if in front of the patient.)

She didn't "mention any more causes" because it is not within a UAP's scope in MOST states/facilities to insert or withdraw a catheter.

Do not ever take direction from any unlicensed person. At the end of the day, it will be your responsibility as opposed to theirs.

Sounds to me like the tech was attempting to intimidate you. And she did.

"I appreciate your input, but if you will excuse us please, I can handle this on my own, thank you!"

You did not do a thing wrong. You can not prevent this from happening again. You do need to get ahold of yourself. And you need not have running commentary from the tech.

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Specializes in Med-surg, school nursing..

Like others have said, there is a big difference in causing harm and causing pain. Relax. It's awesome that you care so much, though.

What I do when removing a foley: First always look to see how much saline was supposed to be put into the balloon. Then I deflate the balloon, squirt out the saline into a towel and try again, that way I am positive none will be left.

Hope that made sense.

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You are going to be a great nurse, because you care. As a nurse, there are going to be times you do things that cause pain to a patient, shots, packing a wound, etc. The fact that you care and it bothers you is a good thing. One thing to keep in mind is that is if foley care is not done daily, there can be dried fluids around the catheter head that sometimes that when removed can cause a little bleeding. This is one of the reason daily catheter care is so important.

If it looks unclean when you go to remove a catheter, a warm wash cloth to clean around the catheter before taking it out can go a long way to help prevent a painful removal.

Keep up the good work, don't be to hard on yourself, this is how EVERYONE learns, and always look for the answers!

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Have been many serious good responses here.

An old Huna concept says 'there is no sin, except for DELIBERATE harm'.

For any residual emotions lingering, "you are forgiven'.

Be Well

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