Need advice re: Prostate problems & catheters

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Specializes in Utilization Management.

I know how to Foley--in fact, I'm very good at it.

But frankly, I'm really beginning to hate setting up CBIs and cathing uro-retentive gentlemen because of the extreme pain that they have to go through. I use extra lube, but many times, pushing that cath past the prostate causes such pain that I can't stand to have to do the procedure.

I've seen Uro docs use a cath guide and just go to it without any medications because the procedure needs to be done quickly, but it just angers me to have the patient traumatized by the pain of the procedure.

I'm hoping that someone can direct me to the best meds and techniques to use that act very rapidly to keep the patient from an awful lot of pain while such a procedure is done so that when I request a Foley or CBI that I can use something to help the patient through the procedure besides deep breathing.

One patient said to me, "Now I know what it's like to give birth." I couldn't help but answer, "Actually, this is worse. You don't get a baby at the end of it." :crying2:

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Specializes in ER/PDN.

have you tried xylocaine jelly in front of or as lube? That is what we use in the ER when we are having a rough time getting one in. Also, someone taught me, even with a big prostate, the "shift up, shift down"method works. just a couple of suggestions from an ER nurse.

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Specializes in ER, ICU, Infusion, peds, informatics.

i second the lidocaine jelly (or viscous lidocaine). i don't think it takes all of the pain away, but certainly makes it more tolerable for them.

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Specializes in Utilization Management.

Would we need an order for that?

If so, then my request to the doc should be something like: "Pt is having frank red blood with clots. May we start CBI and due to possible discomfort, some lido jelly to help with that?"

Or do I ask for the specific thing-- Lidocaine gel 0.2% 10 ml vial or whatever?

Docs just hate to have to call the Pharmacy to get the order right. 'Specially at 0400.

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Specializes in ER, ICU, Infusion, peds, informatics.

yes, you would need an order for it.

honestly, i always just grab the little 30 cc tub of viscous lido that comes in our sure-med. (the stuff used in a gi cocktail.) pharmacy isn't usually involved. i guess i'd ask your pharmacy a "what if" question so you know how it needs to be ordered at 2am. and, yeah, i usually just ask the doc when getting the foley order, "he looks like he could be tough....can i use some viscous lidocaine if i have trouble advancing the foley?"

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Specializes in Utilization Management.

Thanks, I'm certainly going to try that. Patients really shouldn't have to endure painful procedures if we can help it.

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I once watched a urologist insert a Foley on a patient none of us had been able to cath. He squirted the entire tube of lubricant (the one that came with the tray) into the urethra and then easily inserted the catheter. I'd never seen that done before.

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Specializes in Utilization Management.
I once watched a urologist insert a Foley on a patient none of us had been able to cath. He squirted the entire tube of lubricant (the one that came with the tray) into the urethra and then easily inserted the catheter. I'd never seen that done before.

I have also seen that done, but many times even though the procedure is quick enough, it's still very painful for the patient. So if it's painful, guess what--it's more difficult to insert, and on we go with the vicious circle. :(

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I agree with everyone else on this thread...a Little lidocane jelly goes a long way! The lido jelly we get here has a tip that can be inserted into the meatus and you can inject a bit into the urethra before placing the catheter. The uro-retentive gentlemen will thank you for it!!!!!

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Specializes in Utilization Management.
I agree with everyone else on this thread...a Little lidocane jelly goes a long way! The lido jelly we get here has a tip that can be inserted into the meatus and you can inject a bit into the urethra before placing the catheter. The uro-retentive gentlemen will thank you for it!!!!!

EUREKA! I believe that's what I'll ask for next time.

Thanks, everyone!

the "shift up, shift down"method works.

And while we're at it, could you explain this technique? Usually I try to guide the cath up and under the pubic bone, which usually works very well, but I'm always willing to learn new techniques that will help make this procedure easier on the patient.

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Specializes in Medical.

Wow! It's policy where I work to use lignocaine gel (2%, with chlorhexidine 0.05%, 10ml, premixed in a syringe with meatus-friendly tip) with male catheterisation - never occured to me that this wasn't standard. Ouch! We have to leave the syringe in situ for a few minutes after fully (and slowly) depressing the plunger, to make sure it's had tme to act, before beginning catheterisation.

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Wow! It's policy where I work to use lignocaine gel (2%, with chlorhexidine 0.05%, 10ml, premixed in a syringe with meatus-friendly tip) with male catheterisation - never occured to me that this wasn't standard. Ouch! We have to leave the syringe in situ for a few minutes after fully (and slowly) depressing the plunger, to make sure it's had tme to act, before beginning catheterisation.

Well if I ever need to have this done I want to go to your hospital :roll

Bill

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