[nurse2Bjrh]

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.

[jessicalee]

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

[cassioo]

Originally Posted by jessicalee

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.

[cougarnurse]

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'

[cassioo]

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.

[Ricu]

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

[nurse2Bjrh]

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.

[AmandaWIRN]

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.

[cassioo]

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.

[Ricu]

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