Foleys seem to be the bugaboo of many a nursing student and new nurse. They were for me. My instructors made it into an incredibly complicated-sounding skill, and our checkoff had about 50 steps in it. Plus it was one of those things I had few opportunities to practice. I'm not sure why, but I felt as if until I had successfully inserted a Foley, I wouldn't be a REAL nurse. I finally got my chance during my senior Capstone: two Foleys on two men, one of whom was unconscious. I felt a little better, but both times I still had an RN next to me handing me stuff. It's not that difficult, I've decided. I now deal with Foleys fairly regularly because I get postop cardiac cath patients who can't move for a while and have orders for them until they can ambulate. I have put a few into vaginas, but I'm not alone there. I've adopted the stance that it's just not that difficult. It's not rocket science. This stance helps a lot. As do a few tips gleaned from veterans:
- Someone on this blog shared this one: for women, go easy on the lube and told the tube close to the bulb. This WORKS (thanks for that tip!). Otherwise that slippery thing will slither right down into the vagina.
- Get a partner and a flashlight for women. Not a penlight. An actual flashlight. Add it to your work bag, and put your name on it with a Sharpie. Your partner can (a) help you hold the labia open, (b) train the flashlight on microscopic urethras, or (c) both a and b.
- For men, hold the penis straight up while you advance the Foley. Be confident and get a good grip on that thing.
- For people who get crazy bladder spasms, pain, or burning, these things work like magic: (1) B&O suppositories (doctors have often never heard of them so you have to be proactive and specifically ask for them. I think they're old. B&O stands for belladonna and opium! I'd feel better too). (2) Advance the tube just a little. Sometimes the bulb seems to get tugged down against the bladder wall. (3) Hook up a saline flush to the port where you draw urine out for labs, kink the tube right behind it (you don't want urine going back into the bladder), and flush the line. Unkink. Remember to subtract 10 cc's from your catheter output. This isn't an irrigation, per se, so an order isn't required, and it works a surprising amount of the time. Perhaps small bits of sediment block those little holes in the bulb or something. I think 10 cc's barely goes in to the bladder itself, but it does a bang-up job of flushing the rubber tube. Bonus: since you're not pushing a bunch of fluid into the patient's bladder, it doesn't hurt.
- I read somewhere that cleaning the perineal area with soap and water before insertion cuts down on infection rates, but now I can't find any literature to that effect. Anyone know? If it does, we should be doing it, because those infections are nasty.
- Catheter care is crazy important. It's easy to overlook because we aren't wiping those patients as much, so I'm making it a point lately to ensure my patients with Foleys are getting a soap (Dial) and water once-over on my shifts. Soap and water, it seems, go a long way toward the prevention of many evils.
- THE DRAINAGE BAG CANNOT BE HIGHER THAN THE BLADDER. In caps because I constantly see drainage bags way up in the air so the urine flows backward. I don't think nurses are placing them there, so it's a matter of patient education---particularly patients with walkers. They jump up and hook the bag around the handlebars (you'd think they wouldn't want to display it!). Yes, I'm suggesting we need to remind our patients about gravity.
Readers, share your wisdom!