What's the trick to putting in Foleys in women?!!

Indy, LPN, LVN · Oct 5, 2005

I usually get out my penlight and look, regular clean gloves on, before setting up my sterile field. I like to know where I'm going before I try.

NurseJules · Oct 5, 2005

Hi! I'm a new RN & I would say that the biggest fear I still have is putting in Foleys in women! I always have difficulty getting them in, & end up having to toss out the first Foley & get my preceptor to help. I have only put in one! I've asked my preceptor to let me know when any patient needs to have one put in, so I can get the practice. But I'm hoping all you veteran nurses will help me out here-how do you get it in the right hole?! I'm so embarassed about this. I feel very competent in just about everything else related to my job but this! Any advice for me about how to proceed with putting the catheter in? Thanks a bunch! :)
-Christine

It always helps me to find the urethral opening before you even open the foley tray, that way you can have an idea of what it looks like and maybe find a landmark. And, if it is a more difficult person, it never hurts to get a flashlight and another set of hands!

Pediatric Critical Care Columnist · Oct 5, 2005

I once cathed a premature infant girl while she was prone. Very interesting experience... I thought it was going to be horrendous, but it was about the easiest one I've ever done.

My tip for overcoming the slipperiness is to have a couple of 2x2's in my field that I can use to hold the labia apart. I used to care for a teenaged girl who had a C-spine injury who needed to be straight cathed every four hours. Lots of practice = success almost every time.

I must also confess that I've torn my rotator cuff cathing a female patient who had severe muscle necrosis, whose legs would not move in any direction. In the end, I put as much opposing force on her legs as I could and our NP passed the catheter over my shoulder. Gong show.

Hellllllo Nurse, BSN, RN · Oct 5, 2005

With your non-dominant hand, use your thumb and place it just below the clitorous, push up slightly, and this will cause the urinary meatus to be visible, and puts a little tension on the tissue and stablizes the meatus so that it does not get pushed inward or "roll" when you insert the foley. Also, your thumb being there holds the inner labia out of the way at the same time.

On some women, when they are lying on their backs w/ legs spread for a procedure, it causes the urinary meatus to kind of sink down, just inside the lady partsl opening, and you can't see it, and it is very difficult to insert a cath that way.

The "wink" method with the betadine swab does not work if the meatus is just inside the lady partsl opening. With the tissue stablized as stated above, you can then wipe with your betadine swab, and you will plainly see the "wink". Then, drop your swab, pick up your foley, and insert. The Thumb method described above has always worked for me.

I have never not gotten a foley in any pt.

nursepotter05, RN · Oct 5, 2005

This trick works about 75% of the time. As you take your last swipe with betadine right down the middle, have the cotton really soaked, and watch for the "wink". If you do it right, the urethral opening will appear to wink at you, just keep your eye on it.

This is what I was going to suggest. I work in peds, so we in & out cath infants and I find "wink" is very helpful!

Kristen_RN · Oct 10, 2005

Here's another trick that I learned, for the older women who have "drooped", or just have a hard time opening their legs to the proper position for a cath. Have someone comin and lift their legs up in the air, and back a little bit. It makes visualization much easier.

Also never heard of NS. We use betadine as well. I've gotten really good at foleys, and the "legs in the air" trick really helps!!

Nemhain · Oct 10, 2005

A quick question, you use betadine to clean with? We only use sterile saline over here. I have never heard of betadine being used. Can you advise for reference. :wink2:

OMG! :eek: You don't use Betadine? I've never heard or seen anyone using anything else for a Foley.

jamieRN · Oct 12, 2005

I had the same fear about starting one!! My preceptor taught me a good trick to use though and it worked really well. She said instead of speading the labia with your fingers, take the back side of your hand and gently push the labia majora up. It worked pretty well and the betadine was a good trick too. It's sort of hard to explain in words the technique she showed me, but that's the best I can explain it. I got it on the first try using that though. Another instructor of mine also said to take 2 catheters in the room, and if by chance you get one in the lady parts instead of the urethra leave it there so you have a reference point and try to get the urethra with another catheter. Anyways, you'll get it. :nurse:

safewaygreenbox · Oct 12, 2005

OMG! You don't use Betadine? I've never heard or seen anyone using anything else for a Foley.

We use sterile saline too! A little research may be required here. :rolleyes:

Kay x

NorthernRose · Oct 12, 2005

Grab a package of sterile 4X4's and use them to hold the labia open...some how it gives a better grip...not as slippery as trying to hold everything open with one hand while cathing with the other.

Fraggle · Oct 12, 2005

Foleys are my favorite skill! :rotfl:

Always aim a little high and point it upwards.

If it looks big, that's not it.

If someone is really fleshy, try separating the folds starting from bottom up, not starting at the top and working down. It's like pulling open opera curtains.

If it's a hip fx and they can't separate their legs much, don't be too gentle with getting your hand down there. Make sure they are medicated first, but the more you are afraid to retract the labia the longer they are lying there waiting for it to be over in anxiety.

I've only hit a lady parts once and sometimes I spend all day foleying. That woman was really strong for 99. :rolleyes: Now, ask me how many enlarged prostates I can't get around. Actually, I'd really like some tips on that. I've held that little member as high and straight as possible and sometimes still can't get around an enlarged prostate.

student4ever · Oct 12, 2005

Aim high, and aim up! I've only been doing foleys for months now, but I've gotten really good, and done some very difficulty foleys on really old, very contractured, droopy, fat, hip fx women (not all the same person tho! :rotfl: ) However, the other day I missed one that I was SHOCKED at! It was a 24 year old college student - I thought for sure I was going for the right place - I couldn't see anywhere else it could go. I thought for sure her meatus was just right inside the top of the lady partsl opening, and it would slide right in with a little pressure. NO luck. Finally, I had to use both hands and search for it, then change my gloves. Shockingly, her meatus was ABOVE her inner labia, and my spreading it open had covered the meatus. Also, she appeared to have no privy parts - what i had THOUGHT was the privy parts, was actually her urinary meatus. Go figure. Poor thing was traumatized enough by my several attempts and having to examine carefully her private parts, and was in a lot of pain to begin with, so I didn't stick around to really figure out what was going on there, but it was the weirdest female "set up" I've ever seen.