Under-inflated catheter balloon?

[Gaenari]

I have a patient with a suprapubic catheter with orders for a 20-22 fr catheter with a 5-10 mL balloon with instructions to avoid the 30 mL balloons. All we have in our facility right now is 30mL balloon sized catheters. My coworkers are saying the 30 mL balloon can be filled with 10 mL and this is the same thing as having a size 5 or 10 balloon filled with that much water.

I tried to rationalize that having a balloon under inflated wouldn’t sit in the bladder correctly and we need to order the appropriate size balloon. But I am not sure and am speaking with nurses with years more experience than myself.

Any knowledge on this issue here?

[amoLucia]

I don't have the EB research answer for you, but I did insert many a catheter when working in LTC on 11-7. (I liked SPs - so much easier than foleys!)

I always found that when a big balloon was UNDERinflated, it would tend to slip out shortly thereafter. It was like that big old balloon had extra room that the fluid was just sloshing around in.

I kind of think of it like a size 6 shoe person trying to wear a size 10 shoe. It just wasn't a good fit and the foot would just slide out.

The only reason I would ever insert such a mismatch would be just trying to keep the stoma open. It would just be a short term intervention until the day shift could get the right size obtained.

Your Central Supply Dept needs to order the right size.

[BettyGirard, BSN]

I agree with Lucia. The shape of the balloon is part of it's efficacy. I tried only putting 5-10ml in a 30ml foley and found that problematic. If you can't use a 30ml balloon (fully inflated), they need to get the smaller size. Caths are so cheap I can't imagine not stocking the right ones.

[amoLucia]

Another incident of utilizing improper supplies for pt care is the use of foley caths for routine GT replacements. Many times I've seen the use of foleys when facilities didn't purchase true Flexiflo or Bard GT replacements (are they the same manufacturer?). It was always a price thing.

HOWEVER, when one reads the foley cath's exterior paper wrapper, it CLEARLY stated FOR UROLOGICAL USE ONLY.

Nurses, its a LIABILITY THING!!!!

If a pt were to experience some negative, adverse effect with the improper make-shift GTube, YOU could be legally held responsible for any injury or damages. A smart lawyer could say "so sorry that the facility only used foleys, but it was clearly labelled for urological use only. YOU used the wrong equip. So its your fault!"

I believe the major differences is the tube's length, but most importantly, true GTs have that DISC that slides down to the ext abd wall. Without that disc, the foley tube is prone to internal migration >>> internal irritation, stomal irritation, unnecessary & freq instrumentation.

Even if you try taping the cath to the abd, it can still wiggle and irritate the stoma; migrate and cause an enterocolitis. That and with all the negative sequella. I have had pts experience torn stomas (stomae?) and NASTY diarrhea with absorbtion and 'lyte imbalances.

Soooo, getting back to the original post, always use the correct equip. And make sure you're following your facility's P&P. Also by NOT using the correct size balloon, you're just NOT FOLLOWING ORDERS. State surveyors would have a heyday with that!

[BettyGirard, BSN]

It is illegal under federal law to use a medical device inconsistent with it's labelling. Amo is right. If it says URO only, it's against the law and YOUR NECK if you use it for non-uro purposes.