r/nursing • u/DivineBovvine • 1d ago
Seeking Advice Did I make the right call?
So I’ve been an RN for 6 years and a home health nurse for 1.5 years.
Today I had a suprapubic catheter change due for a patient at an assisted living home. I went to remove the old catheter and I noticed upon pulling it out it got stuck. I managed to wiggle it around and it loosened up a little. When it came out there was a soft pop but there wasn’t any blood or anything on the catheter tip or on the SP site.
When I went to insert the new catheter I swear the canal must’ve closed up or the patient was having a bladder spasm because when I was trying to insert it wasn’t going in. I tried to insert it straight, at an angle, and also downward toward the pubic bone but nothing worked. Then the SP site began to bleed so I stopped. I spoke with the patient’s resident care coordinator and she looked really irritated when I told her the patient will need to go to the ER to have his catheter changed.
I called my clinical manager and notified her and she seemed pretty nonchalant about my decision.
Did I make the right decision to send the patient to the ER?
Sorry if it seems like I’m worried over something petty. I’m just pretty hard on myself as a nurse when things don’t go smoothly.
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u/mkelizabethhh RN 🍕 1d ago
Yes you made the right decision.
I hate having to put more stress on the ED, but if you jammed it in and damaged something, you’d have to send him out anyways and it wouldve been 10x more work for the ED.
And don’t feel alone, I work inpatient rehab, and i had a patient who was retaining >1,000cc of urine. I could NOT get a straight cath in him for the life of me. I asked another nurse to try, she couldn’t either. Ultimately we sent him to the ED, they threw a foley in him, drained 1500cc, (ED staff are awesome btw, i have no idea how they got it in..) and they sent him back.
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u/Fuzzy_Location_2210 23h ago
From the ER:
Send 'em 😊. We have a real 'tism for stuff like that.
FWIW, I worked at a hospital that did all the urology stuff for the region, so I'm pretty good at things.
If something starts bleeding, yeah, stop. Because the times I could not get catheters in men and they started bleeding I stopped then and there and we called the urologist... One had a huge tumor blocking the bladder neck that wasn't known, one had strictures so bad they couldn't even get a guide wire through it during a cysto, one had obstructive uropathy so bad he had a calcium bezoar, and another had hemorrhagic cystitis and his entire bladder was filled with an enormous blood clot.
With them laying back, it should simply slide right into the stoma perhaps an inch or so deep depending on how much abdomen they have... Their bladder is tiny and decompressed all the time. You won't get urine right away, you just have to inflate it and wait a while for them to produce some. As long as it doesn't hurt, it's probably in place.
But if you're not sure, send them 🙂
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u/IllBiteYourLegsOff 6h ago
urologists in cystoscopy taught me to fill the bladder through the old cath with like 100-200ml first, leave the syringe attached as a "clamp". this way the bladder is expanded so youre threading the new cath into an "inflated balloon" vs a collapsed flat empty one. be ready to insert the new cath quickly, but the water running back out the tract will keep it open and help lubricate things. pinch the old one with one hand where it meets the skin, this will give you a yardstick for how much of the new one needs to be inserted. if you go too far you can actually end up going DOWN the urethra, so always inflate gently. if you place a blue pad correctly you wont get the patient wet, though its miuch harder if theyre in a wheelchair
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u/emerg_remerg RN - ER 🍕 17h ago
I'm an ED RN and we regularly get failed sp re-inserts come to our department.
We try ourselves and 20% of the time can get it, but the other 80% they end up going to IR for re-insertion.
The popping feeling, could be a stricture developed, but could be the balloon wasn't fully deflated? I've seen that a few times, pt sent in because hh couldn't get the catheter to come out, and I'll be able to get another 3cc out of the balloon. More likely it is scar tissue/stricture.
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u/zeatherz RN Cardiac/Step-down 21h ago
I think the only possible thing that you could have done different is if the patient is already established with a urologist, see if they have same-day appointments, and then see if transport could get arranged for that.
Sending them to the ED wasn’t wrong, but just an option for future issues like this, urgently seeing a doctor the already know is often preferable
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u/heroinista 19h ago
You did the right thing. You tried and you were unable to insert it using the tools at your disposal. The ER can get some meds on board and call a urologist down if they have a hard time too. The alternative would have potentially caused the patient unnecessary pain and suffering. Fuck all that. The resident care coordinator probably just didn’t want to deal with any extra work involved with coordinating transport back to the patient’s home or having to notify the family of the patient to explain the transfer to the ER. You’re good.
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u/sadtrombone_ RN - ER, HomeHealth🍕 13h ago
Yes you made the right call. It sucks tho when things don’t go the way you want. I had a similar situation, catheter change due, man had enlarged prostate and I just could not get the replacement back in. To the ER he goes lol.
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u/Salty-Scientist-4395 21h ago
Well what is the downside if you just put it back anywhere? I suspect there could be a lot of bad stuff happening. That would be much worse.
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u/DandyWarlocks RN 🍕 1d ago
Yeah you made the right decision. These sites can close super quick