question about foley cath

i have researched through past posts and saw noone had asked this before, so here goes. i have read and heard about how much insertion of the foley catheter hurts. i am not yet gotten outside the classroom to either perform, or even witness a catherization. i know the hardest thing i will have to learn to deal with is causing pain to my patient. do you ever get past this? knowing that catheterization is both a painful and very disliked procedure, i wonder if any of you have had patients refuse the catheter and if a patient requested to be sedated before he would consent, what would your response be? thank you very much.

here in Australia, i use lignocaine gel to numb the urethra first. then this makes insertion less painful and uncomfortable.

jessicalee wrote:here in Australia, i use lignocaine gel to numb the urethra first. then this makes insertion less painful and uncomfortable.

I've had them they aren't fun but they really aren't that painful either they make you feel like you have to pee all the time. There is a sting when it goes in. We sometimes wait for the spinal to be in (before a c/s) to put them in but usually they go in first.

My first thought would be perhaps the wrong sized cath. is being used. The average size I have used is a 16 or an 18, yet have had to 'go up a size' on occasion, d/t leakage. Then again, I have had one resident who, no matter what, would have bladder spasms, and leak around the foley.

'Cat'

Just last week I saw 2 pictures (taken by a urologist at my hospital) of men who had necrosis d/t the balloon being inflated in the urethra instead of the bladder (one died of sepsis the other isn't the same anymore) be sure that cath is up to the Y inflated and pulled back and use a cath secure or tape it in place and when patients are turned move the cath.

I think all new nurses are sensitive to those things that cause pain and while none of us wants to inflict more pain, we recognize that things still need to get done whether they hurt or not. Even very young patients come to understand these things and so long as you are honest, compassionate and matter of fact, they usually cooperate.

Regarding the foley, my personal experience has been that it's best to minimize the process. The more attention that is paid to it, the more anxiety is created. When the time comes that the foley has to be inserted, explain the procedure briefly in a quiet voice saying that it will be uncomfortable but not painful. Be sure to use more lubricant than you think is necessary and yes, lidocaine is essential, insert it quickly and then clean up.

I have had a catheter myself and as Cass said earlier, while no picnic, it wasn't the wort experience I ever had. I'm sure you will get tips along the way from others but you will eventually find your own best technique.

Good luck,

R

i was hoping for some answers to whether anyone has ever had a patient refuse catherization and what was the outcome? also, if any patient asks to be sedated prior to his being catherized, would they be accomodated? would it make any difference if he refused to consent without sedation? thank you very much. your previous responses have been very helpful,as i know these will be also.

Working in the ER, I've had several patients refuse to be cathed- it is their right to refuse- if they don't want the cath, they don't get one- just be sure they understand the reasoning for the cath, and if they still refuse, be sure they know if & how their refusal will limit their treatment. I have never seen or heard of anyone being sedated just to get a foley put in- the risks of sedation are too great for such a minor procedure.

there are lots of people who ask to be asleep or have their spinal in before caths are placed pre-op. Usually we do wait for general anesthesia cases except c-sections then they have it 1st because you want to cut as soon as you can for that. Sometimes we wait for the spinal c-sections on request but we have one surgeon who can't wait 2 minutes to start so those we have in first. We have those that are post op that want to try to go on their own "again" and it usually doesn't work so they do end up with the cath in the long run. I've never had anyone refuse and never get one when needed they refuse until they can't take a full bladder any longer.

Although it is always his or her right to do so, I've never had a patient flatly refuse the foley especially when the reason for it is explained. I've had some carry on a bit about it before but afterwards usually say, " It wasn't as bad as I thought it was going to be." As I said in my earlier post, if the foley is medically indicated, I don't offer alternatives like, "let's wait and see what happens." I don't make a big deal about it and then I insert it quickly. I've never been asked for sedation beforehand and in any facility where I've worked, O.R. patients needing a foley who didn't already have them, got them placed after anesthesia. It's one of those nice things that can be done that is both thougtful of the patient and easy for staff to do. I should have said earleir that I work in critical care so my position on this subject reflects that level of care. There's no question whether there should be a foley and the patient is too sick to object.


R

i wish to thank all of you who responded to my question concerning foley catherization. they all were very informative and i will make use of your advice as i advance in the nursing field. yes, i am indeed afraid of causing more pain to my patients. i have read where foley catheter insertion is equated with nasogastric tube insertion, and IV setup as procedures which may be painful to patients. i have experienced IV setup probably 4-5 times, and while i will agree they are far from pleasant, i have experienced things far worse. i think my aversion to foley catheter insertion is derived from the fact that it is so "psychologically traumatic" for patients, thus creating an added "mind pain" to the procedure. if i am way off base here please let me know. i read on the internet of a survey of emergency room patients, asking them to rate typical ER procedures as to how painful and traumatic they were. foley catherization was rated the second most painful and traumatic of ER interventions, behind fracture reduction. is there any reason that this procedure would be more painful when done in the emergency room? no mention is made of any other area of the hospital, i presume because the way the survey was worded. again, thank you. it is great to have the opportunity to bring what must be very minor, even trivial, problems we have, with the knowledge that all who respond have, "been there, done that, felt that". it is reassuring to me to realize that my problems are not just mine, but were faced by virtually all nurses.

I wouldn't say that catheterization is more painful in the ER- it's probably that most patients are awake in the ER when they have a foley placed, as opposed to pre-op, where they may be under general anesthesia. I have never had a foley or NG, but from what my patients have told me, NG insertion is far more painful & traumatic than a foley placement.

Having had all three, I can state from personal experience that NG tube insertion done as most Nursing Schools teach it, is barbaric. I had a wise ER MD show me the best way to anesthetize my patient's nasal, oral passages prior to insertion. 10 ml of nebulized 1% lidocaine mixed with 3 ml of NS. The patient had a hx of GI Bleeding, so you would assume that he was used to it. No, He started crying afterward, and grabbed my hand and thanked me profusely for being sooooooo gentle.As for the foley and fracture reduction, with the advent of moderate or concious sedation there is NO reason when properly used and administered that a patient should be having pain. I say that with the proviso, that nurses have to be advocates for their patients, If you think the patient isn't sedated enough or deep enough TELL the doctor to WAIT. Has your patient had enough meds?, Why do I know? ,A motorcycle accident, open fracture rt forearm, (the O.R. got that one, and a dislocated rt hip, E.R. got that one), Just enough Fentanyl, and Propofol, and it was a breeze, but the tubes went in before all, not a drop of lidocaine:firedup:

thank you for your reply. in your opinion, as far as foley catherizations are concerned, is there any difference between being catherized as an inpatient already in the hospital, and in the emergency room? when a patient in the hospital is catherized in conjunction with a procedure for which they will be anesthesized, one would expect that the insertion of the foley would occur after the patient is under. my question dealt with the other occasions when a catherization was ordered for patients, say in the emergency room, in which the patient was to be catherized and this was not prior to a planned procedure. as an example, patient taken to the ER, and after examination had taken place, the physician knew that the patient's condition would necessitate a foley. would the patient then be sedated for the insertion of the catheter? thank you very much.

When catheterization is included as part of a planned procedure, then when at all possible, the foley will be inserted after anesthesia has taken effect. When it is unplanned, like in the emergency room, then, as I have said before, sedation will most likely not be ordered just for the insertion of a foley. People are sedated in the ER for other things (like reduction of dislocated joints, as the previous poster mentioned), but I have never heard of anyone being put under sedation only for foley insertion.

I've had patients who were worried at first, only to tell me after that it wasn't as painful as they thought it would be. I imagine its not a comfortable thought to know a tube will be put up your urethra. Unfortunately, its one of those situations where most other options have been explored. Someone that can not urinate by themselves will most likely be in extreme pain unless a foley is inserted. The trick is to lubricate, educate, and be gentle with your patient. I am a new nurse, and I myself hate causing my patients pain. However, like a needle with medication sometimes has to be given, sometimes a little pain is required to make someone feel better in the long run.

well said sometimes you gotta do what you gotta do.