Foley placement

I'm a new nurse and of course my first day off orientation I place a Foley without incidence with no urine return..I checked with bladder scan approx 100 cc in bladder..pt was elderly and agitated..dementia...septic..kept pulling at the Foley..I checked Foley placement again after noting blood coming from tube..very minimal blood however flushed fine...told my preceptor was who working to check it as well and doc saw the blood in the tube...no one seemed concerned as it was shift change I passed info on...should I be worried this is going to come back on me...do u all think the Foley could have been pulled out by pt ...ummm..should I have removed it right away
Our policy is "no urine return, no inflation of balloon". If there was 100cc of urine in the bladder, if it was placed correctly you should have been able to get some kind of a return. Ask someone else to evaluate for you if you are ever unsure.

The lack of urine return and blood indicate that the balloon was inflated in the urethra, the catheter should be removed and if the patient recovers from the sepsis, they should be referred to a urologist to assess for trauma to the urethra.

If you've used sufficient lubricant you often won't get blood return immediately since the tip is covered in water soluble lubricant, although the blood returning could have been a sign that there wasn't enough lubricant. Foley's don't actually drain every drop of urine from the bladder it's not at all unusual for some urine to remain. You have to consider the position of the drainage holes in the catheter which are above the balloon which is what sits in the bottom of the bladder.

I reported it to preceptor and doc..no one seemed concerned but it worried me..was never told to remove it...should I expect to be disciplined... Nervous nellie over here

Quote from MunoRNIf you've used sufficient lubricant you often won't get blood return immediately since the tip is covered in water soluble lubricant, although the blood returning could have been a sign that there wasn't enough lubricant. Foley's don't actually drain every drop of urine from the bladder it's not at all unusual for some urine to remain. You have to consider the position of the drainage holes in the catheter which are above the balloon which is what sits in the bottom of the bladder.

Quote from mymichael2009I reported it to preceptor and doc..no one seemed concerned but it worried me..was never told to remove it...should I expect to be disciplined... Nervous nellie over here

If the person os really dehydrated, you may not get urine return right away. When I was doing CNA clinical, we put a Foley in a man and afterr about 6 hours and fluids running at 125/h, he started producing a small amount of very dark amber urine. In a man, there really isn't much chance of "missing". If they have hx of prostate CA pr BPH, it may bleed a little.

Dear Nervous Nellie, Maybe, (that is a BIG maybe) you inflated the balloon in the urethra, not in the bladder.Even IF you did do this.....it probably does not even rate an incident report. I would bet 100's if not 1000's of foley balloons have been inflated while in the urethra. Patients do not die from this, they probable don't even bleed from this. It is very painful and they will tell you it hurts, or a confused agitated patient will try to pull it out.It is not unusual for there to be a small amount of blood in a perfectly inserted foley. Many a confused agitated patient has pulled out a properly placed foley with the balloon inflated! YIKES! again, it doesn't even rate a report, it happens frequently.In the IDEAL foley world you do not inflate the balloon until you see urine coming out, then you know for sure it is in the bladder, then you inflate. HOWEVER it is not at all uncommon to be in the bladder and not see urine. There could just not be much urine in there, an old saggy baggy bladder can have urine in a pocket that the tip of the foley doesn't reach.You told your preceptor......the doc saw it.....NO ONE WAS CONCERNED for good reason.

Quote from brownbookDear Nervous Nellie, Maybe, (that is a BIG maybe) you inflated the balloon in the urethra, not in the bladder.Even IF you did do this.....it probably does not even rate an incident report. I would bet 100's if not 1000's of foley balloons have been inflated while in the urethra. Patients do not die from this, they probable don't even bleed from this. It is very painful and they will tell you it hurts, or a confused agitated patient will try to pull it out.It is not unusual for there to be a small amount of blood in a perfectly inserted foley. Many a confused agitated patient has pulled out a properly placed foley with the balloon inflated! YIKES! again, it doesn't even rate a report, it happens frequently.In the IDEAL foley world you do not inflate the balloon until you see urine coming out, then you know for sure it is in the bladder, then you inflate. HOWEVER it is not at all uncommon to be in the bladder and not see urine. There could just not be much urine in there, an old saggy baggy bladder can have urine in a pocket that the tip of the foley doesn't reach.You told your preceptor......the doc saw it.....NO ONE WAS CONCERNED for good reason.

You could have passed the catheter into a blind pouch, not the bladder. I would not inflate the balloon without seeing urine.

How do you know the Foley is in the bladder if you didn't get any urine return?I don't think you should expect to be disciplined though but you should expect more education.

Pt condition acute kidney failure..septic..1500cc with minimal in bladder via scan..asked other RN who said no urine is possible