Urinary cath rant!

jallen326 · Feb 22, 2014

Maybe you should have your clinician set up a skills fair and brush up on all the basic nursing skills for your unit. My ED has a skills fair about two times a tear for that purpose. So far our department has 0 incidences of cauti and our er techs r trained to put in foleys as well.

xoemmylouox, ASN, RN · Feb 22, 2014

You do feel bad for the patients. Some people are hard to cath and then some nurses are just lazy or don't care. I do think it's a good idea to have the skills fair or make it known you'll help anyone who has a hard time with a cath.

blondy2061h, MSN, RN · Feb 22, 2014

I can't imagine leaving a foley bleeding or on the lady parts with no urine output and acting like I actually successfully placed it. We've all missed caths before, but I've never encountered anyone leaving it. You try again or get someone to help you.

CodeteamB · Feb 22, 2014

I feel like ranting a little bit here. I am appalled at the amount of times I come on after a nurse who put in a urinary catheter and I have to do it over. Let me go over the main reasons this happens. 1. They didn't see urine when putting it in. Duh if there is no urine, its probably not in the right spot. I cannot tell you how many catheters are in the lady parts or sitting somewhere along the urethra track after no urine output. Uh, yes actually I can tell you, how about every time? 99% of pts not in renal failure will have at least 30 mls, enough you can see it in the tubing. 2. Frank blood when inserting. I hate this one the most. If a pt is bleeding frank blood when you put in a catheter, and they never had frank blood in urine before, its probably because you inflated it in his urethra! Deflate that sucker and advance it a little! Better yet, inflate the balloon slowly and watch their face and ask about pain, it it is painful while you inflate the balloon, its probably in the wrong spot, so don't inflate when in pain, and advance it a little, some men have a very long urethra. Please visualize the urethra when putting a catheter into a female, I believe this may be the number one reason people are putting them into the lady parts. Also, if you want control of it, hold it very close to the tip, then you can guide it into the urethra much easier. Also make sure you see some urine for Christs sake! If its not there, then something is not right! Seriously, this is such a easy thing to do, its not that hard for me to come along and do it again, but dang it, think of the pts, those poor poor pts who end up with a catheter stuck in their lady partss for half a day wondering why they are soaking wet! Or the poor guys who now have a 10ml plug in their urethra's! Get it right the first time please![/quote']
This is not a problem anywhere I have worked. Sounds like a training and accountability issue which needs to be addressed with your higher ups.

SHGR, MSN, RN, CNS · Feb 22, 2014

This is not a problem anywhere I have worked. Sounds like a training and accountability issue which needs to be addressed with your higher ups.

Same here. You might even need a policy of two nurses to do a foley for a while. Patients have not had serious injuries with this going on? No one had bladder distention that then required going home with indwelling cath for a month or longer or necrosis of urethra?

nursefrances, BSN, RN · Feb 22, 2014

This is not a problem anywhere I have worked. Sounds like a training and accountability issue which needs to be addressed with your higher ups.

I agree. It sounds like there may be some nurses where you work that have an "Eh....good enough" (and walk away) attitude. To be fair they also may be so overwhelmed and feel a lack of time to do it correctly. This, of course, doesn't make it right. :no:

I have had some difficulty while inserting a foley in a few female patients but nothing that another person supporting the legs didn't solve.

Pangea Reunited, ASN, RN · Feb 22, 2014

That's very strange. I've come across one that was lady partslly inserted right before shift change, but that's the only one I've ever seen.

1fastRN · Feb 22, 2014

Once in nursing school I didn't advance a catheter far enough into a male patient and when I inflated the balloon, I knew right away! Luckily, no harm was done. But lesson learned, I always insert until I see urine, and surprisingly sometimes that means to the hub (more so on male patients for obvious reasons).

I can't imagine this happening on the unit! I've never seen one inserted in the wrong spot. I've been guilty of a "miss" on the super old female patient where all you see is a lot of skin, and sometimes obese people can be challenging as well. But no urine=no go!

We did have a nurse insert a 3-way foley with a 30cc balloon into a male patient and rupture his urethra. Poor guy. Needless to say, she didn't last long, and she was an experienced nurse!

As a side note, I always empathize with patient when inserting foleys, especially the young ones who have never experienced it before. But, I will say, it's always nice when you get a urinary retention patient and you see the relief on their face as soon as the urine starts draining. Just about the only time someone will thank you for shoving a tube up their urethra haha!

amoLucia · Feb 22, 2014

Sounds like you've got a problem where you work. In all my years, I think that maybe I've encountered a wrongly placed foley 2 (3?) times.

A couple good suggestions were offered. You really need to talk to someone in authority for such poor practice. It is a liability for the facility and the responsible nurses. And if you're seeing such widespread poor procedural practice, you should be reporting it to avoid serious pt injury. And that's a risk management problem.

ICU56 · Feb 23, 2014

Maybe Im in a more acute area than you are but I've never seen any of these things. Yes there are occasional misses, but they have never been left in the patient. They are fixed and a catheter is placed properly. As far as not going in far enough, every RN I work with goes to the hub, inflates slowly and then pulls back to ensure placement. Urine output immediately visible in the tube cant always be relied on in critical patients.

You seriously need to have a discussion with higher ups if this behavior is common enough for you to rant about it.

DedHedRN · Feb 23, 2014

Wow, thanks for opening my eyes to how bad this really is. I felt like the situation was pretty bad, but since this is my first job where so many of the RNs do not know how to insert catheters properly, I had no idea that this was not common everywhere. I think it probably comes down to hiring new grads to work in hospice care. They are off on their own case managing, and even in management, without skills far to often.

I have run into catheters placed incorrectly three times this week! I will talk to management about it.