Published May 11, 2005
In LTC nursing, when changing a catheter, do you ALWAYS get urine return??? In school, we are always told that u will get a return if u are in the right spot.
I'm asking b/c the other day, I changed a catheter and got no return. So I got the other nurse, and as it turns out, I was in the right place but there wasn't a return right away. So he tells me if you are unsure, inflate the balloon and if you tug and it comes out you're wrong. I did that on another catheter, and it stayed in there so I left it go. The dayturn nurse then had to change it cause 2 shifts had no output.
Thanks in advance!!!
Monitor output on no returns. If there's none, bladder scan. Depends on the patient, of course, but 30 ml per hour is the minimum. Hard to believe this went on for two shifts! When it was replaced, what was the output? Just curious.
Foley and straight catheter insertions have always been my most difficult skill and I am not afraid to admit it. One helpful hint is to inflate the balloon and turn the patient or ask the patient to roll, almost always you will get urine. If you leave it in place and have not noticed urine within the next 2 hours, renal ultrasound needs to be done. Good luck.
Often when I haven't got a return the pt. is a little tense. I sometimes have them take a few deep breaths and try to talk to them to take their minds off what is going on while keeping the cath in place and not inflating the balloon , often when they relax a little, I'll get a return and will inflate. If that doesn't work will then insert cath a little farther up, and then inflate the balloon(if the balloon doesn't inflate easily then I assume it is not in place and try again), pull back the cath and monitor output closely for an 1-1 1/2 hours. I can't imagine letting it go for two shifts.
actually i've cathed several pts w/o return...one way you know you're in the right orifice is when you advance it, you should hit the bladder wall. if it's in the vaginal orifice,you can advance the catheter and keep on going as you bypass the cervix and into the uterus (theoretically). or you can always bring 2 caths w/you-i've done that too, when the urethra was side by side with the vaginal opening.
when i don't get a return, i give the pt. a couple cups of juice/water, put them in a fowler's position and leave the catheter in the cath kit container, checking for urine q 15-20 minutes. sometimes you won't get a return for a couple of hours if you have an incontinent pt who peed in their attends before cath insertion.
other times i haven't gotten a return after a few hours, i did a rectal digital and found they were impacted. while disempacting them, the urine freely flowed, so passed the catheterization to the oncoming shift since obviously i wasn't going to get anything on my time (unless it was early in the shift).
i wouldn't jump to a renal ultrasound until all interventions have been tried and the bladder is obviously distended.
TiffyRN, BSN, PhD
If you are changing a foley out and the bladder was pretty empty before changing it then you might not get urine return as the bladder hadn't had a chance to fill yet. As others have said go back and check for urine output, like in an hour or two. I wouldn't wait 2 shifts without urine output before replacing the foley.
I would not inflate the balloon without a urine return. If the cath is in the urether damage could be done when the balloon is inflated. Pts with long term foleys will at times not have urine in the bladder. Unless contraindicated give fluids prior to reinsertion or bladderscan the resident to check if the bladder has urine present. Two shifts without a urine return, yipes! Was she dehydrated or have a retention problem? Do you have a bladderscan at you facility? They are very helpful and easy to use. Our cna's and nurses are trained to use the scan.
canoehead, BSN, RN
earle58 "one way you know you're in the right orifice is when you advance it, you should hit the bladder wall. if it's in the vaginal orifice,you can advance the catheter and keep on going as you bypass the cervix and into the uterus (theoretically)."
The cervix is closed and at an angle to insertion, so the catheter will hit a dead space at the end of the vagina. It is hard to find the cervix doing vaginal exams on a pregnant woman when they are not dilated to some degree so it would be almost impossible to blindly go through it with a catheter.
earle58 "one way you know you're in the right orifice is when you advance it, you should hit the bladder wall. if it's in the vaginal orifice,you can advance the catheter and keep on going as you bypass the cervix and into the uterus (theoretically)."The cervix is closed and at an angle to insertion, so the catheter will hit a dead space at the end of the vagina. It is hard to find the cervix doing vaginal exams on a pregnant woman when they are not dilated to some degree so it would be almost impossible to blindly go through it with a catheter.
that's interesting canoehead,because i have been inadvertently in the vaginal opening, and it just kept on advancing until the entire catheter was to the end. that's how i knew i was in the wrong place....haven't experienced (yet) what you're referring to.
I would not inflate the balloon without a urine return.
Me neither. How else would you know you're in the bladder? I've changed many, many foleys and have done way too many straight caths for PVR in my nursing career to know that if no urine return, the cath is usually not in far enough especially if the pt complained that he has to go but can't. Only one time was it positional and that was last week when I had to change a supra pubic catheter. He was due for his monthly cath change. I was starting to get nervous and sweat a little because I was seeing no urine return. The pt said, "once I get OOB and into my w/c, it'll start draining." Sure enough, he was right, but what really got me is as I was trying to get this catheter in and sweating it out, he says to me, "I just had it changed two days ago." I said to myself, "Oh that's nice, too bad no one documented it or reported to anyone that it was changed." I said to the pt "Oh really?" Once he was OOB and I saw 200cc of urine in the bag I told him the next time it's changed and someone like me comes along and wants to change it a day or two later, inform that person that it was already changed. Almost made me want to date and initial the foley with a permanent marker...Maybe I should have.
Almost made me want to date and initial the foley with a permanent marker...Maybe I should have.
I do date and initial the BSB. :) If I could figure out a way to do the same to the actual catheter it would be dated too. You'd be amazed at how many dated catheters I've seen that are WELL past the date to be changed. Sometimes I really think that some of the caths aren't being changed; that only the bag is. :uhoh21:
I had the same problem when I changed an S/P tube this week. It was my first try at it (I don't usually work nights) and I didn't get any urine return. I left it in and sat the patient up and sure enough... urine!!
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