Urinary Cath Insertion

[lovecardiacnursing]

Has anyone ever blown up the balloon on a catheter while it was still in the urethra? If so, what happened?

I had an incident recently where a male patient was having hematuria with clots, the clots had stopped for about 8 hours so the doc DC'd the continuous irrigation. The 3-way cath was to be pulled the next morning (20 hours later) as long as there were no complications through the night. I came back the next day and DC'd the 3-way. After 6 hours he was still unable to void and bladder scan showed he was full--called the doc and he ordered a coude to be placed. Another nurse and I put it in (or so we assumed) with ease and no c/o pain from the patient; however we didn't get any urine return. This was a huge red flag for me because to me that's the only way to know its definitely in the correct spot. The other nurse thought the tip may be clogged by the lubricant or by a clot, so she filled the balloon. We flushed the cath and still no urine. I called the doc and explained and he said he was coming in. Long story short, turns out it was at the prostate and not in the bladder (my original fear with no urine present)--and the balloon was blown up. It's still amazing to me that the patient never complained of pain, it's not like he was a stoic man either. I've never had this happen before and it's really upsetting me, so I'd love to hear any of your experiences or thoughts.

[Asystole RN]

Seen it happen many times. Most of the time the patient complains of dull pain, sometimes nothing.

[lovecardiacnursing]

@Asystole RN - did the patients bleed from the pressure of the balloon?

[RNlmk]

The 3-way catheters are usually a pretty large gauge I would think that is possibly why the pt didn't complain of pain- the urethra was already kind of stretched from the 3- way cath. I have had this happen before with difficulty inserting a cath. What I do is bladder scan the pt if they have more than 100 then you know the catheter isn't patent if it isnt draining. If you keep messing with it with no return then I would see if they can try it in ultrasound- this is what we do and it's common in older men with bph.

[nurseprnRN, BSN, RN]

There's no reason at all you can't insert a Foley all the way up to the bifurcation of the balloon port (men and women but especially men), inflate the balloon, withdraw just until you begin to feel resistance, then push back another centimeter or so. You really should do that.

[elizabell]

I've heard of it twice...

The first time, a patient came in from a nursing home because they had inflated the balloon in his urethra and that was the reason for his admission. It did a lot of damage to the urethra, the wound got infected, went septic... and sadly he actually died from the injury.

However! His was left like that for a longgggg time... not sure how long... but I don't think that much damage could have been done if the balloon was only inflated for a little while.

The second time was a patient who was admitted from the ED for renal insufficiency. The tech in the ED put in the foley wrong. When my coworker admitted him, he was c/o member pain and she noticed it wasn't draining any urine so she played around with the foley and figured out that's what the problem was. He had A LOT of pain. I took care of him later in his stay and I had to do B&O suppositories for the pain. I ended up discharging him with a leg bag and he was told to follow up with urology out patient. Not sure what the outcome was.

[SionainnRN]

I've never heard of someone actually inflating the ballon in the urethra. I personally would never inflate the balloon until there was urine in the tubing.

[dudette10, MSN, RN]

Next time, go with your gut. You had an inkling that a full bladder and no urine return didn't sound right. Would it have been possible to gently flush prior to inflating the balloon if the other nurse thought it was a clot or lubricant clog? That might have been a better sequence of events.

[nrsang97, BSN, RN]

There's no reason at all you can't insert a Foley all the way up to the bifurcation of the balloon port (men and women but especially men), inflate the balloon, withdraw just until you begin to feel resistance, then push back another centimeter or so. You really should do that.

I do this every time I insert a foley in a male. I have seen a pt with the catheter in the urethrea and he had a lot of pain. Not to mention an angry urologist.

[VICEDRN, BSN, RN]

I saw this one time with a patient and he had a lot of pain. Another time a patient did not complain of pain but he had a history of previous stroke with neuro deficits which I suspect explained why no complaints of pain.

[SaoirseRN]

There's no reason at all you can't insert a Foley all the way up to the bifurcation of the balloon port (men and women but especially men) inflate the balloon, withdraw just until you begin to feel resistance, then push back another centimeter or so. You really should do that.[/quote']

This.

[eatmysoxRN, ASN, RN]

There's no reason at all you can't insert a Foley all the way up to the bifurcation of the balloon port (men and women but especially men) inflate the balloon, withdraw just until you begin to feel resistance, then push back another centimeter or so. You really should do that.[/quote']

I was taught this way in nursing school. It seems like the safest method. Is there a reason it isn't taught as common practice across the board? Perhaps higher risk of the longer Foley touching the bed or something?

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