Straight Caths

Published

I am new to the Emergency Department. The last three women (65+yrs old) I had to straight cath, I could not get it. I need advice. I really hate to put these patients through multiple attempts. My preceptors couldn't do it, either.

Up Vote Up Vote ×
Specializes in Critical Care, Med-Surg, Psych, Geri, LTC, Tele,.

Caths are difficult. As a woman who's had several, I hate to inflict discomfort on my pts.

That being said, the Cath experts I've worked with are very good at "digging/searching" for the wink.

I think this is key.

Up Vote Up Vote ×

Women of that age group lose the elasticity down there because of decreased estrogen levels. This makes the opening somewhat appear smaller therefore more difficulty to visualize the urethra. I was taught that it sometimes helps to gently grasp both labia and pull out a bit. This sometimes helps visualize the opening, in both older women and young females/babies.

Up Vote Up Vote ×
Specializes in ICU.

If the patients' breathing will tolerate it, put them in Trendelenburg. It is way easier to get to the urethra because it is going to be facing more upwards, and also all the belly fat is going to be pulled towards their boobs by gravity so you don't have to struggle with their bellies getting in the way.

Just watch and make sure you don't get them so far upside down that their boobs whack them in the face. Some people get embarrassed by that, not to mention it can be pretty funny and you might lose your composure and have to leave the room. True story.

Up Vote Up Vote ×

Trendelenburg can help as calivianya said. Another thing that can help is asking the patient to cough. Doing that will help the urethra "wink" at you. Just watch out for those women who have stress incontinence...that can lead to baaaaad things if you're looking too closely and things spray!

Up Vote Up Vote ×
Specializes in PACU, pre/postoperative, ortho.

There have been several threads here you can search for more pointers.

Personally, I always leave the last betadine swab which will block entrance to the lady parts; aim slightly upward above the swab (or cotton ball, whatever you use). I've never missed with this approach, even with morbidly obese or confused combative pts.

Up Vote Up Vote ×

Yes, Trenedelenberg, the wink, lots of betadine! I left the swab in as well.

Haven't done the labial pull.

The other nurses would call me in to do it. I was a one shot deal, mostly.

Find a COB to help you.

Up Vote Up Vote ×
Yes, Trenedelenberg, the wink, lots of betadine! I left the swab in as well.

Haven't done the labial pull.

The other nurses would call me in to do it. I was a one shot deal, mostly.

Find a COB to help you.

lol they used to call me the Foley Queen in my unit.

Up Vote Up Vote ×

True story--I helped another RN by putting in a foley on an elderly pt. post fall. She had unusual anatomy and took 3 attempts (and 2 RNs) to find urethra. Months later I had to put a foley in another elderly pt, post fall. Mid attempt recognized the anatomy and was like: "wait, you were here a few months ago..." I didn't recognize the face, I recognized the lady parts. Strange ER reality.

Up Vote Up Vote ×
Specializes in Psych, LTC/SNF, Rehab, Corrections.

Well, I dont wanna be gross BUT if they cough, it'll wink at you.

Beyond that, I make sure to be generous with the betadine when cleaning because I generally have to slide the cath down from the privy parts to the first hole. With all the flab I generally have to hold back, I cannot eyeball it.

Stuff sags when you get older so the point of origin will be lower.

Up Vote Up Vote ×
+ Join the Discussion