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!
You didn't harm your patient any more than you'd "harm" a patient who bleeds a little when changing a wound dressing. The insertion and removal of a piece of plastic, smooth as it may be, into a very sensitive part of the anatomy that isn't intended to have things going inside it is going to cause some irritation.
You did the member equivalent of causing someone's gums to bleed because they haven't brushed often enough.
Relax and don't worry about it. Focus on doing well in school, and don't let this event cause you to second guess yourself. Hesitation and uncertainty will harm more patients than foleys any day of the week.
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!
I know it! This was my first time hurting a patient and it was so unexpected. I feel like I'm more prepared for unforeseen Events like this. I think this time got to me because it was my first time causing someone unexpected pain. Thanks for the honest advice!
I'm not sure that you did anything wrong but that tech certainly did. She had no business messing with the catheter afterwards. Because of that, you will never know if there was any saline left in the bulb or how much was left. It is not a tech's place to interfere with the education of a nursing student. Who the heck does she think she is?
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.
I once had a client in rehab who had a "lifetime long" foley catheter. It seems it was like a 30 or 32 HUGE one. Her mom changed it maybe 4x a year! Even though it had a large bulb, MOM would overinflate the bulb with about 30cc of air to keep it from pulling out.
I'm happy I never had to be subjected to doing a removal on her.
This will not be the last time in the course of your career that you do what could be perceived by someone as harmful to a patient , or cause a patient pain. Very few of the interventions that we undertake in the care of patients today are completely benign. The important thing to take away from this situation is that, as far as you are aware, you did everything in the prescribed manner, with the best interest of the patient at heart. Learn from the situation and be aware that even the simplest intervention has risks.
Sounds like you did what I would have done. Deflate (Although, after I get 10 mls out, I go back and pull some more just in case!) and then pull out! I have not seen any bleeding before but if the patient has BPH, it can't be helped! You did the right thing and apologized.
as long as you got all the saline out, you did nothing wrong. Pain can be part of it. It sounds like you did nothing wrong.
I do have an issue with you apologizing 1000 times plus. At that point you are making it about you in debuting the patient to make you feel better. You have to have a different attitude.
Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
I feel terrible for causing the patient pain.
The fact that you feel bad about this incident and seem to want to learn from it are indicative that you have an active conscience. To me, this is one of the ingredients of someone who will be a good nurse.
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!
Oh gosh, if I had a dollar for every time an out-of-control ETOH'r performed a self-TURP over the past 25 years, I'd have enough to buy myself lunch...... Just be glad you didn't get hit by someone swinging a fully-inflated balloon-tip catheter fresh from their nether-regions like it was their first rodeo and they were on the calf-roping team. That's Always an unpleasant experience that is shared by both yourself AND your patient.
When you're trying to remove a foley, you can piston the syringe slightly (don't want big pressure changes that can break a fragile balloon) to ensure removal of saline. Pay close attention to the amount of mls removed, and when you start withdrawing, note if their is resistance, pain, and if extra fluid back up into the syringe.
Blood happens, as the inside lining of the urethra is very friable and can become irritated if the foley is in place for some time.
When I read the headline -"I harmed my first patient today" - I really wanted to read what you had to say. What an open, honest headline! You are getting support from fellow nurses, all of which you deserve whether you did something improper or not! Nurses are going to make mistakes, little and big mistakes. When I was a nursing assistant in a psych hospital the admin asked me to do a second shift. My primary job was to make 15 minute rounds in the unit to guarantee the patients safety. Then the charge nurse gave me lots of paperwork to do. Well, one of the patients had a heart attack while sleeping. He was wearing a device which gave him more air or oxygen for respiration. It was noisy. As a made rounds in the darkness, I heard the device, but I didn't pay enough attention to his efforts to breathe. He was obese. When the sun came up it was plain that he was dead! We did CPR to no avail. Of course, CYA was the first thing I did in my charting. Later that day I went to my church. The student vicar (who had a background in physical therapy) heard me out, and supported me greatly with word and prayer. She said blaming others wasn't necessary. I'm a licensed nurse now. I think the best thing I read was written by Atul Gawande. He is the surgeon who also writes for the New Yorker. He said that healthcare workers should practice "negative thinking." What he meant is that the nurse or doctor or aide should always ask himself: "What could possibly go wrong if I do this?" "if I amputate this right foot what could go wrong? Answer- Perhaps the left foot was the one that was supposed to be amputated! "If I give 5 mg of this medicine, what could go wrong." Perhaps the real order was 0.5 mg! Nursing school should have an activity where we come up with all the things that could go wrong! Ha! Wouldn't that be fun!!! Simple and realistic. Yes, nurses need support, because they will make mistakes. They will cause harm. Isn't that right, nurses?
You'll live. What we do isn't always pleasant. NGT insertion is pretty traumatic and especially on a patient with MR or drug withdrawals, I've seen both. Had a patient with ICU delirium begging us not to kill her as we held her down and inserted an NGT down her. It was bloody, it was loud, and eventually we had to restrain her and give drugs to relax after insertion. This is nursing, welcome to the ride and let go of all the Florence nightingale fluff and cupcakes.
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Annath
24 Posts
You didn't harm your patient any more than you'd "harm" a patient who bleeds a little when changing a wound dressing. The insertion and removal of a piece of plastic, smooth as it may be, into a very sensitive part of the anatomy that isn't intended to have things going inside it is going to cause some irritation.
You did the member equivalent of causing someone's gums to bleed because they haven't brushed often enough.
Relax and don't worry about it. Focus on doing well in school, and don't let this event cause you to second guess yourself. Hesitation and uncertainty will harm more patients than foleys any day of the week.