Foley Catheters December 2005

This is the second article of a series that we hope to bring out, on subjects for new grads in the
IC ! topics that seem simple, but which actually aren"t# $ots of things in the IC will suddenly sit
up and bite your head right off if you don"t use them correctly, and the humble foley catheter is
absolutely one of them# %s with &' tubes, they ha(e to go in the right way, to the right place, stay
in for a certain amount of time, ha(e problems that you do need to thin) about, and complications
that do happen# %s always, please remember that these articles are not the final word on
anything* They are only meant to reflect the e+perience of a couple of (ery elderly IC nurses #
%lways chec) with your own resources and authorities on %&, -uestion you might ha(e# %nd
when you find errors, omissions, or anything else just wrong . let us )now/ Than)s*
0pecial than)s for an editorial re(iew go out on this one to our newest consulting 1recent!grad!
wi2ardess3, &urse 4uthie, our own oldest child# 5hat a world 6**
7! 5hat is a Foley catheter/
2! Is a Foley sterile or not/
8! 9ow do I )now if my patient should ha(e one/
:! 5hat si2e catheter should I put in my patient/
5! 5hat if my patient is late+ allergic/
;! 5hat are the lumens for/
<! 5hat is the balloon for/
=! 9ow is a Foley catheter inserted in a male/
>! In a female/
70! 5hat if it won"t go in/
77! 9ow do I )now if it"s in the right place, and I can inflate the balloon/ 0omething
INCREDIBLY important6
72! 5hat is a coud? catheter/
78! 5hat is a suprapubic catheter/
7:! 9ow do I attach the outside part of the catheter to the patient/
75! 9ow do I wor) the urine!measuring thing/
7;! 5hat if I"m gi(ing my patient $asi+/
7<! 9ow long can a Foley catheter stay in/
7=! 0hould they be routinely changed/
7>! 5hat is 1catheter care3/
20! 5hat is a Te+as @condomA catheter/
a# Bur in(ention6
27! 5hat is a 8!way Foley catheter/
22! 5hat are bladder irrigant drips all about/
28! 5hat is a Curphy drip/
2:! Can bladder irrigant drips go on a pump/
25! 5hat can I do if the catheter causes the patient pain in the urethra/
2;! 5hat if it causes bladder spasms/
a# ditropan
b# DEB suppositories
2<! 5hat if the catheter gets plugged up/
a# 5ith a clot/
b# 5ith a fungal plug/
2=! 9ow do I )eep my patient"s catheter from becoming infected/
2>! 0hould a Foley catheter e(er be clamped/
80! 5hat is a neurogenic bladder/
87! 9ow can I monitor my patients" temperature with a Foley catheter/
82! 5hat is a bladder scanner/
88! 5hat are bladder pressures all about/
Foley Catheters
1- What is a Foley catheter?
They seem simple enoughF soft tube, goes into the
bladder, drains the urine, with a little balloon towards the
end, inflated inside the bladder to )eep it from slipping
out#
httpFGGwww#medproducts#comGpicturesG50780!Foley!Dalloon!Catheter#jpg
The man* Dr# Frederic) Foley6 in(ented the catheter in the
7>80"s#
httpFGGwww#auanet#orgGmuseumGcontentGcollectionsGuropeopleGfoleyGp2#cfm
2- Is a Foley sterile or not?
,es, they absolutely are# 4emember all that about how urine is sterile/ . the whole urinary path
is sterile# Bn the inside, anyhow, and with normal urine flow, it stays that way# The )idneys ma)e
urine, it collects in the bladder, it gets drained out promptly, and nothing gets bac) in through the
urethra6 no problem# 0o what happens when you put in a tube/
3- How o I !now i" #y $atient sho%l ha&e one?
There are lots of things that a foley can tell you about your patientF
- What's her &ol%#e stat%s? Hnough to ma)e urine, anyhow/ $ots of estimations about
a patients" (olume status ! whether a patient is 1wet3 or 1dry3, start with the -uestionF 1Is
she peeing/3
In fact, there"s an old saying that the foley catheter is the 1poor!man"s I%!line3# ,ou
need to )now about your patient"s (olume status/ . there you go#
- (re her !ineys act%ally wor!in)? This is always a relati(e -uestion . we see a lot
of patients in renal failureF acute, chronic, acute!on!chronic6 someone may be (ery
1wet3 indeed, but if her )idneys don"t wor), the urine output won"t be a good indicator#
The )idneys are also dependent on the blood pressure reaching them to ma)e urine .
a hypotensi(e patient won"t ma)e much urine, e(en if her )idney function is still o)6
2
5hich raises another -uestionF ha(e you seen patients ma)e enormous amounts of
urine with a high blood pressure, and (irtually none with a lower one . maybe a
1normal3 one/ Does that say something about their renal arteries/ &arrowed, maybe/
- Is her %rine clean? 'ot bugs/ 0ediment/ Crud floating around/ % person with a
fungal urine infection is probably at serious ris) for a systemic fungal blood infection,
huh/ 1Fungemia#3 Jery bad# 5hat should we do about that/
- *he only way to acc%rately #eas%re ho%rly, and total urine output, is with a foley,
connected to a urimeter#
&ot this one#
httpFGGwww#2as)internationalmedicalsupply#comGurologicalpicsGdrainagebag#jpg
That"s the one . the plastic thing in front of
the bag measures the urine output e(ery
hour# %nd so should you*
Kust can"t do it any other way# I hear that in the pedi
ICs they weigh the wet diapers on a scale, and
subtract the weight of dry ones/ &ot really practical
with the grownups6
Bh yes . and ma)e sure the tubing leads downhill*
httpFGGwww#bardmedical#comGurologyGmetertour2Gbag#html
+- What si,e catheter sho%l I $%t in #y $atient?
I"(e ne(er -uite understood where the French catheter si2es come from . anybody )now/
0maller is smaller, and bigger is bigger, unli)e IJ catheters, in which bigger is smaller . right/ I
mean, a higher number means a smaller bore IJ catheter, but a bigger foley# 'oofy#
%nyhow . after a little loo)ing, it turns out @as if life wasn"t complicated enoughA, that the French
scale corresponds to diameter in millimiters, di(ided by three# 0ay what/ It means a si2e 8
3
French tube has an outer diameter of 7mm# %n 7= French has a diameter of ;mm# Bh* 5ell why
don"t they just call it a si+ then/ Kee2e*
sually a 7: gauge foley is the smallest we"ll put in . they drain pretty slowly, and they probably
plug more easily, being so narrow# Cost of the catheters I place are 7;"s, occasionally an 7= if the
smaller ones are lea)ing along the urethral path# Doesn"t happen often# They do get bigger . but
that stuff we lea(e to urology6
-- What i" #y $atient is late. aller)ic?
'et out the silicone ones* &ice
colors*
httpFGGwww#ec27#netGcoGpGpaul)oGimgGoimgL'C0008:0;>LC%0008;=:0#jpg
/- What are the l%#ens "or?
1$umen3 is a big IC word . it simply means 1tube3# $ots of de(ices that
we use ha(e multiple tubes in them, so they"re 1multi!lumen3 thingys6
9ere we see two, right/ Bne to drain the urine, the other for the balloon#
httpFGGwww#bardmedical#comGimagesGcloseLupLcrossLsec#jpg
0- What is the 1alloon "or?
&ot too hard to see that the inflated balloon snugs up
against the nec) of the urethra, and )eeps the tube
from just sliding out#

httpFGGwww#uroport!tbc#orgGTubeM20drainage#html
4
2- How is a Foley catheter inserte in a #ale?
9ere"s a lin)F httpFGGteach#lanecc#eduGnursings)illsGcathGcathCale#htm
% couple of thoughtsF if you ha(e any reason to thin) that the catheter isn"t going to pass
smoothly, grab one of these ahead of timeF
1ro!jets3# These are great . they"re lubricating goo mi+ed with
lidocaine# Defore e(en trying to place a foley in a patient with,
maybe, DI9 @go loo) that one upA, you inject this stuff upwards,
bac)wards, through the urethra, into the bladder# Then let it sit for a
minute# $ubes things up, numbs things up6 a wonderful tric)# I
want one*
Kust be careful# If the catheter doesn"t want to go, don"t ma)e it go*
% little steady forward pressure, along with a pre!lubed urethra, may
allow the catheter to sort of wriggle it"s way into the bladder past a
swollen prostate, but no more* ,ou may be creating a 1false tract3 .
yow* Time to call urology*
httpFGGwww#ims!limited#comGimagesG4B!KHT#jpg
3- In a "e#ale?
%nother lin)F httpFGGteach#lanecc#eduGnursings)illsGcathGcathFemale#htm
The preceptor doesn"t put catheters in females, nor does he gi(e (aginal meds# I as) my female
peers to do these tas)s for me# That"s just the way it is# 'ot -uestions not co(ered here/ %s) the
peers# I understand flashlights are in(ol(ed6
% couple of female!foley tips from our nurse consultant %myF
! For women . for ine+perienced nurses . ha(e another nurse or nursing tech help to hold the
patient"s legs so that when you insert the foley and if the patient jumps . which happens
fre-uently . they won"t close their legs on the sterile field# Btherwise . placing foley catheters in
women ta)es some practice6
! Insert the foley until you obtain urine and then go in another inch or two# Inflate the balloon
slowly and as) the patient if they feel any pain or discomfort with the inflation# If so6##deflate the
balloon and push the catheter in another inch or two and try to inflate again#
14- What i" it won't )o in?
Don"t force it* The 'reat &ursing 0uper(isor created urologists for a good reason* % foley catheter
that won"t pass is &BT a job for a medical intern, or e(en a junior# %$$ of these situations should
be referred to the urology person on call#
5
% story of geniusF unfortunately, the team docs don"t always agree to this, despite the best
arguments from nursing# % story I heard onceF a young doc, I thin) an intern at the time, was
ma)ing her way through a first rotation in the CIC6 she was one of the occasional geniuses
that go through the residency program from time to time# Iublished in Cell6 CD, IhD, this, that,
the other6 and apparently had become something of a legend in her own mind# % nurse got
stuc) trying to pass a foley in her male patient6 suggested calling urology# 'enius girl decided
that she wasn"t get let any nurse tell her what to do with something as simple as a foley
catheter6 she went in, went ahead, and inflated the balloon6 apparently it was rather the blood
bath# The patient went to the B46 turned out o) in the end# 0igh# 0adly, this is the co##on
error with "oleys# 9appens e(ery once in a while, and is totally a&oia1le5
11- How o I !now it's in the ri)ht $lace6 an I can in"late the 1alloon?
There are a couple of basic cluesF
- The catheter has gone in smoothly#
- rine starts draining through the tube#
Bnce you"re in the bladder, you"re al#ost ready to inflate the balloon# $oo) at this picture again6
0ee how far in the catheter is/ %lmost all the way to
the , . where the two lumen connectors separate .
see that/
*H(*'s how far you should insert a foley . in a
male patient, anyhow, 1e"ore you inflate the
balloon#
This is 78 important* %nd 78 simple* %nd yet, e(en
geniuses don"t grasp this*
Tells you something, right there6
For women . I"ll ha(e to chec)*
12- What is a co%9 catheter?
$ittle cur(e in the end of the catheter, a bit stiffer, lets it slip past
urethral obstructions, etc# rologists put these in for us#
httpFGGwww#allegromedical#comGimagesGproductsG0702$7;#jpg
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13- What is a s%$ra$%1ic catheter?
0ometimes, no matter what, the darned tube just won"t go into the
darned bladder, urologist or no urologist# 0o they ha(e to go in
through the abdominal wall, and drain the bladder that way#
httpFGGwww#uroport!tbc#orgGTubeM20drainage#html
1+- How o I attach the o%tsie $art o" the catheter to the $atient?
0tylin"* Do they come in colors/ Can I get one that
lights up/
5ell, again, you don"t want the catheter getting pulled
on by accident . urethral injuries are not tri(ial, and your
patient can be seriously hurt#
I always flag my patients" catheters to a leg# sually
theirs6
httpFGGwww#sslaustralia#com#auGmedicalGimagesGfoleycatheter#jpg
1-- How o I wor! the %rine-#eas%rin) thin)?
Hasy enough . read the le(el by the numbers, and empty it into the bag e(ery hour#
1/- What i" I'# )i&in) #y $atient Lasi.?
'ood thin)ing* If you"re diuresing your patient, then the hourly drainage will probably o(erflow the
hourly measuring thing6 so what should you do with the bag, whene(er you gi(e your patient a
dose of a diuretic/ %nd maybe for an hour or two after that, until they"re done dumping <00ccG
hour/
7
% -uestion for the groupF suppose you gi(e your patient a dose of lasi+, and they"re going great
guns6 and the team as)s for a % specimen# Br urine lytes/ 5hat should you do/ 0end it/
9ow about 2: hour urine collections/
10- How lon) can a Foley catheter stay in?
5e often lea(e them in as long as they seem clean# 5e don"t do routine sur(ey cultures, although
they"re fre-uently cultured anyhow when our patients spi)e fe(ers6
12- 7ho%l they 1e ro%tinely chan)e?
It loo)s li)e people with long!term catheter needs ha(e them changed e(ery month#
13- What is :catheter care;?
%n awful lot of our patients are incontinent of stool, which is something li)e 7G8 to 2G8 germulous
material, right/ 0o . suppose that stuff gets into contact with the catheter/ 5here are those
germs going to go, that normally they wouldn"t be able to/
Dac) in the $ittle Ice %ge, this was a sterile procedure . we were taught to cleanse the catheter at
the meatus with normal!saline!soa)ed gau2e sponge, then to apply to iodine goo around the
catheter where it entered# &owadays, we wash the meatus with soap and water, and the iodine
has gone the way of the woolly &urse Cammoth6
24- What is a *e.as <cono#= catheter?
0imple idea, but they don"t wor) so well# 0ome gentlemen
are not (ery well6 suited/, for this de(ice# @'uess they"re not
the ones from Te+as#A These things fall off a lot# Dut the
ad(antage is clear . there"s no direct path for infection
bac)wards up into the bladder#
@I wonder if they ma)e glow!in!the!dar) ones6 the night
nurses need all the help they can get#A
httpFGGwww#m)andrew#comGsurgT#jpg
&urse 4uthie says that she"s seen some fol)s using these for longer periods of time, and that
they use ostomy cement to ma)e them stay on# I just wonder . how sore do they get doing this/
a>8%r in&ention?
5e do ha(e the occasional brainstorm in the CIC, and a couple of our senior IC nurses
came up with the really neat idea of combining the condom cath with the o+ygen sat probe#
Drilliant* ,ou )now . for the male patient with cold fingers/ The Condosat* The problem of
)eeping it in place is easily sol(ed by coating the inside with Jiagra gel6 we"re loo)ing for
in(estors*
8
21- What is a 3-way Foley catheter?
That would be the one in the middle there#
Three ports . see Nem/ Bne for the balloon,
one to drain the urine, and the third for
irrigating the bladder with6 what/
httpFGGwww#elimedical#comGimgGbagM20andM20tubeGlate+
M20foleyM20catheter#jpg
22- What are 1laer irri)ant ri$s all
a1o%t?
0ometimes patients ha(e infections growing inside the bladder# 0ome of these can be se(ere,
and can migrate bac) up towards the )idneysF pyelonephritis# &ot )nowing enough about the ID
medicine in(ol(ed, I can tell you that we treat patients with fungal bladder infections using drip
irrigants of nystatin or %mphotericin D# The mi+es come up from pharmacy in a bag, and they"re
connected . sterilely . to the irrigant lumen of the 8!way# The mi+ is run using a standard
infusion pump, at whate(er rate the gods of pharmacy, urology, and ID decree# Bther urinary tract
infections seem to do just fine with IJ antibiotics and bladder drainage#
23- What is a @%r$hy ri$?
This is what they call a saline bladder irrigation system at my hospital# 5e use these mostly for
hematuria . did your patients" foley get yan)ed on/ 9ow"d that happen/ 0ome patients on
chemotherapy get hematuriaF 1hemorrhagic cystitis3#
This is a bit tric)y . the idea is to )eep the bladder clear of clots, because they"ll bloc) the foley
drain for sure . and what will happen to the bladder then/ 0ooner, or later/
0o the tric) is to run the saline rapidly# 4eally rapidly# 5e use really big, hea(y bags of saline, 8
liters, and there"s special tubing, really big gauge, and just run that suc)er wide open through the
infusion port of the three way, trying to )eep clots from forming# Ca)e sense/
Ceasuring the patient"s own urine output while this is going on can get really tric)y . what we do
is to use one of those scales that you hang peritoneal dialysis fluid from/ 5e hang the infusion
bag from that, and read that for the amount that"s gone in o(er an hour# Then subtract that from
the total hourly output, which has to be emptied e(ery hour# Ca)e sense/ It"s still really hard#
% point of aesthetics . we put some thought into describing our patients" hematuria by colorF
15ell, it started out li)e a merlot, but it"s come down to a sort of nice ros? by now6 no clots#3
1%h, you thin) that"s a ros?/ Dat"s a 2infandel*3 1&o way, you ignorant slob* Didn"t you watch
N0ideways"/ 0heesh*3
9
2+- Can 1laer irri)ant ri$s )o on a $%#$?
Thin) about this for a secondF if you were irrigating someone"s bladder at high speed, say a liter
or more an hour, and that fluid was on a pump6 and the foley managed to clot off6 yow* 5e do
put the therapeutic irriigants on pumps . they usually run at a fi+ed rate of something li)e
50ccGhour# 0o you ha(e to do a bit of addition and subtraction e(ery hour to get the true hourly
urine output, which is the total minus the irrigant (olume, right/
For those terrified of numbers, it"s li)e this . you ha(e a couple of columns, thusF
TimeF Irrigant In Total rine But True rine Cumulati(e rine Total
72am!7amF 50cc 52cc 2cc 2cc
7am . 2amF 50cc >50cc >00cc >02cc
m6 was the patient lying on the foley for a while/
2-- What can I o i" the catheter ca%ses the $atient $ain in the %rethra?
0ome people don"t tolerate catheters (ery well . it"s rare, since usually people usually ha(e the
most discomfort while the catheter is going in . e(en that can be minimi2ed with a good lube job#
Dut some fol)s are sensiti(e, and the catheter just hurts li)e cra2y . for them there"s a nice med
called pyridium @phena2opyridineAF oral med, which as I recall gets loaded with 800mg for the first
dose, and then gi(en 700mg po tid# Turns the urine a lo(ely orangeade color# 4ifampin do that
too/ 0omething does6
2/- What i" it ca%ses 1laer s$as#s?
Couple things you can do for this, which is pretty painfulF
a#Ditropan @o+ybutyninAF this is the stuff they ad(ertise all the time on daytime TJ6 gotta go
right now/ I suppose it wor)s . I don"t really )now# ,ou see it ordered sometimes#
b#DEB suppositoriesF Cy my6 belladonna and opium6 this I0 an old one# @%ll the ancient
nurses are grinning now#A 5e still stoc) these guys, and we count them in the narcotic
count e(ery shift# This is an ancient med, going bac) probably a couple of hundred years,
li)e DTB @deodori2ed tincture of opium, a)a laudanum, the seaman"s fa(orite drug in the
&apoleonic wars6 colchicine is e(en older, going bac) to ancient 'reece I thin)# %round
the time I graduated school#A 9a(en"t seen one actually gi(en in a while, but Cathie F# and I
always thin) of this at the same time when the issue comes up . we grin at each other and
feel li)e old wise guys #
c# Bf course, you could always ta)e the catheter out and replace it with a smaller one6
d# %nd no caffeine* @%nd maybe no chocolate/ Doesn"t seem worth it6#A
10
20- What i" the catheter )ets $l%))e %$?
%bsolutely happens . in fact, if your patient"s urine output drops off, the first thing you want to do
. after ma)ing sure it"s not )in)ed . is to gi(e it a gentle manual flush# This is a sterile procedure*
,ou ta)e one of these guys, and draw up 80cc of
sterile saline, and 'H&T$, inject it into the Foley#
5hy gently/ If your patient can"t spea), try watching
his face as you do this6
httpFGGwww#(etmed#wsu#eduGClientHDGimagesGdogLmedsGsyringes#jpg
&ow let the irrigant drain, or try gently aspirating# ,ou should get all the (olume bac) that you
instilled# 0ometimes plugs form on the drain openings, and will let you instill, but won"t let
anything bac) out# $i)e a flap (al(e#
a# 5ith a clot/
,up, could be a clot# 9as the patient had hematuria/ &o/
b# 5ith a fungal plug/
Could be a fungal plug# 9as the patient had funguria/
It could also just be a little fibrinous plug, mucoid plug ! these happen too# ,ou"d be absolutely
ama2ed at how much urine a patient may drain once you"(e irrigated his foley# In fact I"(e seen
patients admitted from outside facilities with hydronephrosis . usually both )idneys, all swollen up
. why/ 15ell, the patient hasn"t made much urine for the past couple of days6 what do you
mean, did we change the foley/3
22- How o I !ee$ #y $atients' catheter "ro# 1eco#in) in"ecte?
$oo)s li)e you can"tF
All indwelling catheters in the urinary bladder fr !re than 2 wee"s bec!e clni#ed with bacteria$
%acterial clni#atin des nt !ean the &atient has clinical bladder infectin$'
httpFGGwww#emedicine#comGmedGtopic87<;#htm
4ight . but it"s commonly said in the CIC that e(ery patient with a foley catheter becomes
uroseptic in the end6 the same article cited abo(e says that 8 times as many nursing home
patients die if they ha(e an indwelling foley, as opposed to those who don"t#
@Colleagues, please remember, the author is a registered D&F*A
23- 7ho%l a Foley catheter e&er 1e cla#$e?
The only time I e(er do this is when I"m trying to get a sterile urine spec out of the sampling port,
or for measuring a bladder pressure . more on that a bit later#
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34- What is a ne%ro)enic 1laer?
This is a bad thing# In the conte+t of foley catheters, I understand that se(ere o(erdistention of the
bladder causes the ner(ous structures to stretch, become damaged, and the patients" bladder
ne(er wor)s properly again# Foley plugged/
31- How can I #onitor #y $atient's te#$erat%re with a "oley catheter?
Cute gadget, this# 9as a little digital thermometer built into it, that
plugs into the bedside monitor console we bought# sed
mostly for continuous core temperature monitoring, when we
do the aggressi(e post!cardiac!arrest cooling protocol . the
one that apparently impro(es brain death outcomes after
ano+ic e(ents/ I"d better be pretty darned ano+ic before
they put a foley in me6
httpFGGwww#bardmedical#comGurologyGcathtourGarray#html
32- What is a 1laer scanner?
&eat de(ice, which only urology floor nurses )now how to wor)# This is a )ind of ultrasound
machine, which can tell you if your patients" bladder is empty or not# This could be pretty useful if
someone"s urine output fell off, and, say, the catheter had been (ery hard to place initially, maybe
in a (ery large person, or a person with an unusual anatomy, and would be difficult to change#
33- What are 1laer $ress%res all a1o%t?
This is pretty interesting# It turns out that there are situations in which the pressure inside the
abdomen can rise to the point where they actually threaten organ perfusion . this is called
1abdominal compartment syndrome3, ta)ing its name from the compartment syndrome that can
threaten a se(erely swollen arm or leg# Br head, in my case6 a person passes out, for whate(er
reason, and lies on his arm, on a concrete floor, for a day# Br two# The arm suffers diffuse muscle
crushing, swells se(erely, loses perfusion ! and produces all sorts of secondary problems li)e
rhabdomyolysis, renal failure6
%nyhow . really high intra!abdominal pressures can literally s-uish the organs, reduce their
perfusion, and produce injuries . patients with lots of ascites are at ris) for this# 9epatic failure
patients often become hepato!renal failure patients, and it"s possible that high intra!abdominal
pressures s-uishing the )idneys are the reason# %nyhow, you can actually measure the intra!
abdominal pressures by measuring the pressure in the bladder, and you do it through the Foley#
9ere"s howF
- First thing, you want to ma)e sure that the Foley is patent, and the bladder is empty#
12
- &e+t, you"re going to set up a regular pressure transducer set, with a stopcoc) at the end of
the stiff transducer tubing, and a blunt needle connector at the end of the stopcoc), pointing
straight along the lumen of the line#
- 5hat you do is, you clamp the Foley tubing downstream from the sampling port with
something really tight, li)e a Oelly clamp# Then you swab the port, and po)e the blunt needle into
the port# &ow you"re going to instill a fi+ed (olume . we use 700cc . of normal saline into the
bladder# Drip it in using regular gra(ity tubing screwed into the stopcoc), which is connected to
the blunt# Turn the stopcoc) such that the saline instills, and when it"s done, turn the stopcoc) so
the transducer can 1see3 through the blunt into the saline . which is partly in the bladder, partly in
the catheter# &ow you"ll get a wa(eform on your monitor, which should (ary with the patient"s
respirations# %s with all these measurements, you want to read the number at end!e+piration#
% tric)y point . ma)e sure that the tip of the blunt isn"t up against the tubing wall, but right in the
middle of the fluid column in the catheter# If the fluid doesn"t reach the blunt because there"s air in
the tubing, unclamp the foley a little until the saline . draining out of the bladder . reaches the
blunt# Then reclamp#
This ma)ing sense/ ,ou"re using the transducer to feel the pressure, through the saline, into the
bladder# &ormal bladder pressures are pretty low . the docs usually want to hear about it when
they"re abo(e 20mm of mercury# I"(e seen a patient undergo a big paracentesis for this, and start
ma)ing lots more urine afterward# Cool*
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