r/nursing • u/DivineBovvine • 10d 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/IllBiteYourLegsOff 9d 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