Mets Day 162 - How to remove a foley catheter by yourself

During the days that I have a Foley catheter in place, I wear a thigh drain bag.  It is held to my inner thigh by two velco straps, which inevitably loosen or slide down my leg.  That's why the StatLock is so important -- the end of the Foley is securely connected to the lock, so even if the thigh bag starts to slip down, the StatLock holds the Foley in place instead of lurching down my leg and suddenly pulling my neobladder and urethera south.  But walking with a catheter and a thigh bag is not that comfortable -- it tends to pit a bit of a hitch in my giddyup.

Anyway, I've been going to work each day.  This week has been very busy, as I'm helping get a case ready for trial, even thought I've ceded any stand-up role at trial to others on my team.  On Tuesday, I went to Norfolk for a hearing -- about a 4 hour drive each way.  I went with one of my partners, and we hired a car service, so we rode in the back of a cushy Lincoln Navigator.  Before I left, I flushed my catheter and neobladder with saline.  However, the Foley drain quickly blocked up with mucus.  During the entire drive down, or hearing, or lunch, very little urine was coming out to fill the drain bag.  I could tell my neobladder was getting fuller and fuller.  I tried to unblock it several times by repositioning the tube, sliding it up and down inside my neobladder.  I began to wonder if I might need to stop by a pharmacy for some saline and a 60 cc syringe and flush the thing out.  Finally, soon after we left on the drive back home, I felt the blockage dissipate.  The thigh drain bag rapidly filled.  For the rest of the ride home, it was like I had a hot can of soda strapped to my thigh.  It wasn't painful, just uncomfortable. 

Yesterday was an even longer work day.  I had a 90 minute presentation at one of our partner meetings, had several other meetings, and edited a number of briefs.  I felt like my brain was wading through wet concrete, especially as the day went on.  It took much longer than usual to formulate my thoughts and translate them to coherent sentences.  By the time I got home at 9 pm, I was beat.  I don't need to take Ambien, I thought.  I'll just crash.

Wrong.  There is something about having that four foot tube wrapped around your legs and hooked to the large capacity night bag attached to the bed frame that somehow keeps me from sleeping well.  Go figure.  I tossed and turned all night.  I considered taking the Ambien at 2 am, but was afraid it would grog me out until noon, and I knew I had a lot to do today.  At around 5 am, I finally started to slumber, then was jolted awake by a cold, wet patch on the bed.  The drain tube to the night bag had become disconnected from the catheter, letting urine freely flow onto the bedding.  Ugh. I'd had it with the Foley.  I knew I was supposed to leave it in for seven days after surgery.  Let's see, surgery was Friday.  Counting Friday, 1, 2, 3 ... yes, today was day 7.  Close enough. So at 5:30 am, I decided to remove my Foley catheter by myself.

A Foley catheter is held in place by an inflatable bulb inside the tip of the catheter, in the bladder.  That bulb is inflated by injecting saline into the balloon tip.  That bulb must be completely drained before the catheter can be removed.  I've never taken a Foley out by myself before, but I've watched it done lots of times, and I've also stayed at a Holiday Inn Express on occasion.  Here's how it is done:

1.  Get an empty 10 cc syringe with a small tip that fits into the secondary port of the Foley.  Hopkins helpfully put one of these in my bag of goodies after last Friday's surgery. 
2.  Release the valve on the port.
3.  The saline contained in the bulb at the end of the Foley inside the bladder will slowly fill the syringe.  Don't pull back on the syringe; let it fill by itself.
4. In theory, the bulb should be filled with 9-10 cc of saline.  But you never assume that, since trying to pull a Foley with even a partially filled bulb through a urethra is like pulling a lemon through a straw (or passing a very large kidney stone).  So after the syringe fills to 10 cc, take it off, drain it, then reconnect it, and see if any more saline comes out.  In my case, there was another 4 cc of saline in that bulb.  If you are an amateur like me, after it stops filling, very gently pull back on the syringe to see if anything else comes out (it won't). 
5.  Disconnect the syringe.  You're now ready to pull the Foley tube out of the neobladder, through the urethra, and out.  Take a couple of deep breaths.  Hope that all of the saline is really out of the bulb.  Take a couple of more deep breaths.  Grab onto the end of the Foley and notice that your hands are trembling.  More deep breaths.  Wonder if you should pull it out fast or slow.  Start to pull, whimpering quietly.  Notice that your urethra is slowly pushing the thing out on its own.  Wonder if you should wait or help it along.  More deep breaths.  Do a little of both.  Finally remove that alien probe from the orifice.  Whimper again.
6.  Sit in the hot tub for as long as you can.  This step is not optional.

So I've been at the office all day, editing more briefs and wondering why I'm doing it.  About an hour ago, I found myself staring at the screen in a torpor.  I kicked off my shoes, shut my door, shuffled over to my couch, and laid down.  Words to live by: when the going gets tough, take a nap.