Using a 30 cc baloon rectal cath for urethral drainage

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Hello,

Just wanting some info on this situation that occurred in our unit. We had rec'd a 400 lb woman from a nursing home, already trached, in resp. failure but upon arrival and shifting her over to our icu bed she was drenched in urine and the ammonia was overwhelming! We checked her cath and irrigated it but she continued to leak urine everywhere. She had a rectal cath at 30 cc inflation,very stiff, but leaking. We removed it and noticed her urethra had dilated in response to the size of the previous catheter. What is appropriate at this time? On viewing her urethra, she had been dilated abnormally so we inserted another sterile 30 cc rectal cath. Is this appropriate? Not trying to sound dumb, but should this poor lady need a GU consult? She was here last year and we never inserted a large bore/large volume urinary cath in her. Thanks for your help

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Rectal tube or foley with a thirty cc balloon? The size of the balloon has nothing to do with the size of the catheter, it is inflated in the bladder to keep the catheter from being pulled out or falling out. If the balloon was actually dilated in the urethra, then that is where the problem is. It was not placed properly to begin with and could cause many issues for the patient.

The urethra normally will not stay dilated, there needs to be some other reason for her not to have any tone there, and a GU work-up would be very appropriate.

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think about it a minute. her urethra was dilated to the size of the balloon. it wasn't dilated to the size of the catheter. that is one enlarged urethra! i would get a gu consult stat since she's been improperly catheterized for some time now. help your patient and cover yourself.

leslie

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Eliza...your post brought to mind a question regarding rectal drainage tubes. What we use is a fabricated concoction using a nasal trumpet and a urinary drainage bag which only works when the stool is very running. Otherwise it leaks. My hospital has trialed several rectal drainage catheters without success. I remember several years ago that we used a catheter made by Bardex. It was soft rubber and had a pemanent 60cc balloon which was inflated with air after insertion. It worked excellently and we rarely had any skin breakdown due to fecal incontinence. Our protocol was to deflate the balloon for 15 minutes every shift. The catheter had no negative impact on rectal tone. Does anyone know if this catheter still exists and if so, where can I get information on its purchase.

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Specializes in rehab-med/surg-ICU-ER-cath lab.

I worked in a large rehabilitation hospital for 5 years. Due to the long term problems associated with urethral catheterization more than one of our patient's urethra dilated to a size so large that a #30 FR/30 cc balloon Foley catheter just "slip out" causing incontinence. The only solution was the permanent placement of a super-pubic catheter. This resulted in total continence as the urethra was sutured closed during the procedure. We saw no increase in the incidence of infection and the abdominal stoma remained stable in size. I have only seen a rectal Foley catheter used for uncontrollable diarrhea that was contaminating a local perennial area of skin breakdown that we were trying to heal. The 30 FR/30 cc balloon Foley catheter was inserted on a very temporary basis to speed the healing time of the skin breakdown. Left in long enough the 30 cc balloon can cause a small area of intestinal necrosis in the shape of the balloon - saw this just once on a terminal patient. In this case the catheter was left in as the diarrhea could not be controlled and was causing the patient great pain. So, all things considered with a terminal diagnosis the catheter was left in to increase her comfort level.

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Supra pubic, not super.

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Specializes in rehab-med/surg-ICU-ER-cath lab.

Oh my goodness, I feel like such a looser for missing that huge one! Naturally I know it is "supra" but good old spell check got to me. Now at least the other people reading my post will be able to understand what I really meant. Thanks so much!

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Oh my goodness, I feel like such a looser for missing that huge one! Naturally I know it is "supra" but good old spell check got to me. Now at least the other people reading my post will be able to understand what I really meant. Thanks so much!

Haha, great comeback! Sorry it took so long to get back!

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Specializes in Trauma and Cardiovascular ICU.

Almost 6 years?

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