Placing a foley catheter in a patient with BPH or acute urinary retention can be very difficult at times. Here are some tips to increase your chance of a successful placement.
Use a Uroject lidocaine gel syringe to help anesthesize the urethra and lubricate the tract. The lidocaine gel should be slowly expressed (injected) into the urethral meatus. This helps to provide lubrication further down the urethra, as opposed to just wiping the catheter tip in the lubricant.
When using a Coude catheter, ensure that the curved tip points upward.
Apply gentle continuous pressure to help open the prostrate spincter. This will be more successful than trying to ram it through which can increase spincter contracture.
Do not inflate the balloon until you have confirmed placement with urine return.
Don't forget the ultrasound. You can calculate urinary volume (post void residual) prior to catheter placement and confirm placement with ultrasound.
If all else fails, a suprapubic catheter may need to be placed. For a great review on evaluation and treatment please see Drs. Vilke, Ufberg, Harrigan, and Chan's article in the August edition of Journal of Emergnecy Medicine entitled Evaluation and treatment of acute urinary retention.
References
Vilke GM, Ufberg JW, Harrigan RA, Chan TC. Evaluation and treatment of acute urinary retention. J Emerg Med. 2008 Aug;35(2):193-8.
