Indwelling catheter question

[tsm007]

One of my classmates and I are having some discussion about indwelling catheters and something she read in the textbook. In one textbook it says to insert the foley cath until you see urine and then 2-3 inches further, let go of the labia and in the videos they let go and hold the cath now in the nondominant hand and inflate the balloon in the dominant hand. Now, in the other book it discusses if the patient feels pain on inflating the balloon to withdraw the fluid, retract the cath and then push it up further in the bladder. Now our question is if you have let go of the labia and held it with that nondominant hand how would you retract the cath and push it up further without contaminating the cath. So two questions one, how likely is that to happen where you have a patient experience pain on inflation and two, is it considered contaminating once you've let go of the labia to then push the cath up further or three, should you just not let go of the labia when you inflate the balloon. Hope this made sense and I would appreciate any feedback.

[Esme12, ASN, BSN, RN]

If the patient feels pain when you inflate the balloon you are in the urethra and can cause the patient harm if you leave it there......You don't "retract" it all they way out....you actually just kind of move it slightly back then advance further into the bladder and inflate again.

When I insert a foley I insert it so that only 2 inches are outside the perineal area to be sure...then I inflate the balloon and gently pull back until I meet gentle resistance. Just to be sure.....but it doesn't really happen that often.

It is a trial in dexterity...but with experience you'll get the hang of it.

[eatmysoxRN, ASN, RN]

I was taught that it is safest just to insert the cath all the way to the hub, inflate the balloon, then pull back the extra. Some extra catheter being in the bladder won't harm the patient. On the other hand, inflation of the balloon before it is in the bladder will. Just be sure to keep the entire thing sterile and hold the labia firmly until it is completely inserted.

[Compassion_x]

We were always told that if we let go of the labia before inserting it all the way or correctly, that you should basically consider it contaminated. So I'd follow Esme's advice here, insert as much as you can, inflate balloon, then gently pull some extra out.

[nurseprnRN, BSN, RN]

My other fave Foley tips:

In cathing women, tuck your last betadine-soaked cotton ball into the introitus. Not so deep that you can't get at it easily, just enough to block the lady parts if your cath doesn't slide right into the urethra on the first shot. If all the Foley contacts is that sterile cotton ball, it won't get contaminated in the unsterile lady parts, and you can try for the urethra again a little higher up and not have to start over again with another sterile catheter. Retrieve the cotton ball when you're all done.

When cathing a male, use a lot of lube, and hold the member upright and pointed at an angle about halfway towards the patient's nose. Sometimes a little gentle traction is useful too. This decreases the bend at the bulbourethral junction and it slides a bit easier. This is also why it should be taped to the abdomen, not the thigh, to avoid damage from pressure on the urethra at the bulbaourethral junction. Check a sideways anatomical cutaway view to see what I mean.

You're welcome.

[tsm007]

Thanks so much for your tips! They were very helpful.