Should urine catheterization hurt?

[swellnurse]

Do you do a lot of catheterizations? Especially in-and-out for urine culture?

When catheterizing for a urine culture, should the patient feel pain?

What is your real-world experience?

Do some patients simply experience pain for no explained reason or is there always a reason/cause? (ie, technique, underlying problem)

Is it different based on age or male/female?

[ohiobobcat]

I had a straight cath done during one of my pregnancies. I remember thinking "Oh no- they are not putting THAT in THERE!!" But I had to pee, and they didn't want to let me get up to pee. I remember it being uncomfortable, but not painful (this was 18 years ago!). I certainly enjoyed the relief from having my bladder emptied.

[Tina, RN]

When I went in for my C-section, I was catheterized. I found it to be extremely painful, and I have a pretty good tolerance for pain...

[Pangea Reunited, ASN, RN]

I had it done once, but they ended up having to sedate me. I found it very painful ...intolerable. I usually tolerate pain/discomfort without a lot of whining ...at least in public.

[nurseprnRN, BSN, RN]

It obviously varies. I had a Foley after my first delivery, when I ended up with a massive infection in the episiotomy (never have a baby in a university hospital in early summer). The whole thing hurt like hell, but what really frosted my cupcakes was after it came out a week later and I discovered I had a vee-shaped pressure ulcer in the mucus membranes on both sides of my labia/introitus due to the immense swelling crushing into the catheter. That hurt like hell every time I peed for about a week until it healed.

But was a big relief to have the thing inserted originally, since I couldn't void due to the rapidly advancing swelling, and they got out 2500cc! (Yeah, I know, nurses are supposed to have big bladders.)

[No Stars In My Eyes]

Some women have a difficult-to-locate meatus, or multiple little folds that 'pretend' to be the meatus; the excavating to locate that little booger visually can be VERY intrusive. Having someone clean, spread, and probe to locate something in your very personal area can make a person feel pretty tense. I have to laugh to myself when I hear a nurse say, "Now, just relax...." Yuh! Like that'll happen!

Use plenty of lubricant, preferably an entire lidocaine jelly tube and give it a little time to work.

Anecdotally, every time I've seen a nurse use lido jelly, they don't give it any time to work and then conclude, "oh, it doesn't make any difference." The research studies that I've read typically leave the jelly in place for 30 mins and utilize an external stricture or the patient's grasp to keep the jelly in place.

From my observations in men, it makes a huge difference.

If I ever need a Foley and I'm alert enough to know, I will demand the lido and insist it's used properly.

I actually had a doc give a patient a whiff of Amidate prior to inserting a Foley.

[xoemmylouox, ASN, RN]

I have cathed more patients that I can remember. When I was straight cathed post delivery it was wonderful.. It wasn't fun by any means, but the pain of my super overfull bladder was worse.

[NurseOnAMotorcycle, ASN, RN]

I'm another one of the c-section catheter crowd. It was weird as heck and very intrusive, but I don't remember any pain either time. I only remember the "things don't go there" feeling. That same look of shock on my female pts faces when I cath them is usually one of the measures whether or not I got the right spot on those difficult to place foleys. Then comes the pee.

[Esme12, ASN, BSN, RN]

Thanks, Esme12

That is what I've heard from other nurses who do a lot of caths...particularly peds.

But in literature (up-to-date) and in lay press articles from time-to-time there is a suggestion or down-right statement that catheterization in young kids is painful. Some parents of kids worry when they hear this and when asked say that they had catheterizations that were excruciatingly painful...so they emphatically disagreed that catheterization of their children would not be painful. I don't doubt their experience but want to have/give/share accurate information. Knowing what to say to discern how their experience may have been different (eg, cathing to empty the bladder) would be important.

BTW, I totally agree that there are kids that are more stressed by fearing what might be done to them and just react strongly with the environment (no real pain). One adult woman explained the "discomfort" as being a new sensation with anxiety that it might start hurting.

Thanks!

Kids qwill scream from beginning to end. Whether it hurts or not. They are NOT happy you are holding them still and in a very private place. If there is a UTI it can be uncomfortable. I have been cathed for both deliveries....while not pleasant....it sure hurt less than delivery!

Recently, I had emergency surgery and was very sick (to be honest I"m still recovering) and had to be cathed.....again it isn't pleasant but it wasn't painful going in or out.

I will say however....that NGT was brutal! It was very comfortable that tickle in the back of your throat you can't get rid of....then you cough and cough then you gag....it was torture....LOL Cetacaine was by best friend on a iced sponge. When they removed it....my sinus passages must have been dry because it felt like it had barbed wired on the end and drug my frontal lobe out my left nares with the NG tube!

[joyouter]

I think this depends on many issues. The size of the Foley catheter being used, The effective use of lidocaine jelly ie. to leave it in place long enough for the anesthetic action to work, the ability to locate the urethra and introduce the Foley smoothly and the reason why the catheter is being introduced. As a midwife and OB nurse, catheter insertion is necessary for mothers in labour with epidural catheters because the sensation of voiding is lost once the epidural effect starts. A full bladder will actually impede active labour and may cause residual damage to the bladder and urethra. When and obstruction is met, especially in men with enlarged prostates or in women with UTIs, (non pregnant or pregnant) the size and methodology of both catheter and skill remains tantamount to patient comfort. Patient explanation and trust is key alongside good technique with limited pain. Above all, it is worthwhile to always consider why the patient needs the Foley inserted.

[nrsang97, BSN, RN]

I had a in and out cath during labor and it hurt like hell. I only think it hurt more because of everything that was going on with being in labor at the time.

Most patients feel uncomfortable. The only ones I really see having pain are ones with excoriation and/or an infection.

[FLAlleycat]

I'm mainly asking about the small/little ones for cultures. Is that the main difference for pain? French/size?

Having worked in L&D for many years, I've done many caths, albeit on young female population! I found that the caths in those C/S kits appeared to be much more uncomfortable than the softer tubing. As a matter of fact, I quit using those kits and used the smallest cath we carried on the unit (10Fr). The kits may have changed, though, as it's been a while since I've worked in hospital setting.