Placing ureteral stents

[nursej22, MSN, RN]

This probably sounds like a dumb question but it came up at work the other night and it's driving me a little nuts.

A patient on our unit was found to have an obstructive stone in his lone ureter and so was going to need a stent placed. He already had a foley cath in place, but before the stone was found an order had been written to discontinue to catheter.

The nurse caring for the patient did not want to dc the foley as she thought it would be used to insert the stent. As a student, a urologist had told her that's how it done.

I had never heard this, but even if it is so, I didn't think a foley that had been in place for 3 days would be used, that most likely it would be replaced. Actually I had assumed a cystoscope would be used and then a foley placed afterward.

So how is this usually done?

Thanks in advance.

[Rose_Queen, BSN, MSN, RN]

Not only do all of our surgeons use a cystoscope, the vast majority actually use a ureteroscope to find the stone and thread a wire in place to insert the stent. Patients who come from the floor with a foley will have it pulled by the circulator just before the prep and usually a new foley will be placed by the urologist. I've never seen a urologist place a stent through a foley catheter and can't even imagine how it would be possible.

[nursej22, MSN, RN]

Thank you for your reply. My co-worker had told be about a former patient she had with a leaky foley. The surgeon had told he nicked it during stent placement and to just put a Tegaderm on it.

[4_Sq]

A foley is not used to insert a ureteric stent.

A stent is placed in the ureter over a guide wire, the stent placement and the procedure is done using xray

The stent is used to keep the ureter patent.

A stent is much stiffer and is of a much smaller diameter than a foley catheter, it is usually around 5 fr in diameter and approx 26cm long.

And Sweet_Wild_Rose is correct, a ureteroscope is used to visualize the ureter during the surgery

Stents can be removed by the Urologist in the office (if the threads are left on)

Often times the patient will be brought back to the OR for stent replacement or removal.

A stent is often placed following laser lithotripsy, and or stone basket extraction, and helps the healing process to take place following removal of a ureteric calculi

The foley catheter goes through the urethra into the bladder, & has nothing to do with the ureteric stent.

As far as a "leaky foley" goes, that foley should have been replaced.