Lord of the Foleys
A foley catheter is a piece of tubing with a balloon on the end. The balloon goes into the bladder before being inflated, allowing urine to drain into a bag. They certainly aren’t fun to have, and I imagine they’re about as uncomfortable as they sound. That said, sticking tubes into people’s privates is sure to result in awkward humor sometimes – right? Here’s two you might… well, enjoy is perhaps not the right word…
When we get trauma patients, we have to get a urine sample from them. In some hospitals, they allow the patient to try to pee before putting in a foley, though people often complain about trying to pee on command. During a med school rotation, we had an especially big weenie of a patient. He was a 6′ tall, 200lb former marine who had shrapnel in his lungs from his combat time. Yet, he screamed like a 5 year old when we took his blood.
By the time we got to the urine collecting stage, my poor ears had been robbed of their remaining shreds of innocence. None of the residents relished the idea of trying to put a catheter into this guy. Finally, one of them stepped up and explained the options. His eyes got wider and wider as he heard about the foley. I don’t think I’ve seen someone reach for a urinal so eagerly before…
Foleys also come in different sizes. After my first experience putting one into an awake patient, I’ll remember that fact forever. We had an inebriated, uncooperative patient, and it was clear that he wouldn’t be coordinated enough to give us a sample voluntarily. The resident asked me to grab a foley set and insert it while she and the ER tech held the patient down.
Foley catheters are measured in French gauge scale, where 12 fr = 4 mm, 14 fr = 4.7, 16 fr = 5.3mm, and 18 fr = 6mm. In this particular hospital, we almost exclusively used 14fr or 16 fr catheters, and they’re placed on a tray near the bed before the ambulance even arrives. But on this occasion, for some reason, the tray wasn’t ready. Once again, I had to go hunting.
Finally, I found a foley set in the supply cupboard and prepared to insert it. I managed to get about 5cm of the catheter into the patient before he opened his eyes with a yelp and tried to leap off the gurney. The resident and tech managed to hold him down, and they yelled “keep going!” in unison.
Once our adventure in insertion was complete, we continued the rest of our treatment. As we were cleaning up, a nurse wandered by and looked at the packaging for the foley.
“Why did you guys put in an 18 fr?”
The resident, tech and I looked at each other.