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!

[CoffeeRTC, BSN, RN]

Was the balloon still inflated? How much saline was in the the balloon you took out?

[amoLucia]

First off, you DID NOT intentionally harm your pt. Removal of a foley can be uncomfortable for many pts, esp for the men. And a little blood can happen.

Your technique sounded fine - that would have been the way I used to remove foleys. And I did it for years. (NOTE: I never did that NO-NO shortcut many nurses do, that is, just cutting the lumen port to drain the saline! NO-NO!)

Just know there will be many, many times that you may do a task that causes pt discomfort and at times, pain. Sometime, just turning a pt may be painful, but you just have to do the best you can to minimize the bad.

Unless you have some sadistic streak in you (I don't think you do), this is something that you'll overcome. You can only try to be as gentle as you can.

Good luck to you.

[starwarrior]

Was the balloon still inflated? How much saline was in the the balloon you took out?

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.

[starwarrior]

Thank you for replying. I can assure you I am not sadistic in any way. I spent the rest of the afternoon shedding tears on and off. I still feel terrible.

[thimba]

Woahh where was your clinical instructor/a nurse while you were doing this? Someone is supposed to be supervising you whenever you do skills! It doesn't seem like you did anything wrong, but someone else is supposed to be there to tell you to stop if you are about to harm the pt. I thought this was standard protocol for students.

[Hollybobs]

Oh please don't worry! Your technique sounds correct. I double aspirate as I worry someone previous to me may have overfilled the balloon but I tend to be over-cautious.

You know that the blood and pain could have other causes? There could have been a scab formed around the catheter tube or there could have been trauma sustained on insertion. There could have been friction caused internally or a small foreign body could have been betwixt catheter and urethra, rubbing away already. Depending on how long it had been present tissue could have grown around it or crusting could have occurred. There's probably other causes but that's off the top of my head. Maybe a UTI? And have a look at the foley catheter thread, that's really interesting.

I really sympathise with you as I HATE causing patients pain and have always watched more experienced colleagues to try to make procedures as pain-free as possible. One thing I like about being a bedside nurse is making stuff like injections hurt less.

[starwarrior]

where was your clinical instructor/a nurse while you were doing this?

The nurse was with another patient (in the next room), and my clinical instructor was with another student as they performed a task. My instructor was with me for the first few that I did. After seeing that I was doing it saftley and correctly, she gave the ok for me to do it with another student. I feel like this may have ruined the trust she has in me. I also feel like I ruined the trust the nurses have in my classmates and I.

[THELIVINGWORST, ASN, RN]

The nurse was with another patient (in the next room), and my clinical instructor was with another student as they performed a task. My instructor was with me for the first few that I did. After seeing that I was doing it saftley and correctly, she gave the ok for me to do it with another student. I feel like this may have ruined the trust she has in me. I also feel like I ruined the trust the nurses have in my classmates and I.

I honestly don't think the nurses care one bit. Pain is part of the human condition. Harm is not the same thing. Harm is when you pull the cath without deflating the balloon and the pt has extreme pain and bruising with bloody urine.

[jadelpn, LPN, EMT-B]

Do not feel badly, do not fret. If the foley was a traumatic insertion, then there could be some residual blood on the tip of the catheter, a Fr that is so large that it is stunningly weird that it is a catheter size at all can irritate coming out...all sorts of things.

Unless you have blood spurting from a member, you did just fine. The balloon only deflates down to where it started. You can't change the cath size on the way out. And for any number of men, the prostate is not their friend.

Don't cry. You did fine.

[LadyFree28, BSN, LPN, RN]

To add as the others have replied:

You didn't harm a pt; invasive procedures that are going against normal body processes can produce small amounts of trauma-you WILL see some of this as a nurse, because sometimes it is unavoidable.

As long as you intervene and provide comfort and minimize complications with critical thinking and assessment skills post procedure, pts recover from such situations.

You are fine. Woosah.

[Julius Seizure]

You didn't mess up! It sounds like you did it just as you were supposed to, and I doubt that you've damaged anyone's trust in you. You clearly care very much about the well-being of your patients. I'm sure your instructor and the nurses can see that, too.

The stuff we do at the hospital often causes discomfort. It's not because it wasn't done right. It just isn't very pleasant to have a tube stuck up your urethra!