Q. I am a polio quadriplegic and even though I have had normal bladder and bowel control most of my life, an incident that happened to me recently has me scared stiff. A home care RN inflated the balloon to my Foley indwelling catheter in my urethra instead of my bladder. For weeks there was pain, ghastly looking drainage and poor urination. The ER doctor told me what was wrong, and fixed it quickly. When I got home I went on the Internet and found out about penile erosion and am wondering if I have the first stages of it. Those pictures are scary to any male quad.

— Jerry

A. Jerry—you point out an important, and often overlooked, potential danger when changing an indwelling Foley catheter.

A 2010 article in Advances in Urology describes a similar situation — a 56-year-old male C5 incomplete quadriplegic came to the hospital with excessive sweating from dysreflexia after a community health professional changed his indwelling Foley. X-rays showed that the Foley balloon was inflated in his urethra, and his bladder was not draining. The article stresses the importance of making sure the end of the Foley is inserted all the way into the bladder before inflating the balloon. It also explains that some people have tight sphincters or false passages in their urethras, making a precise initial insertion even more crucial.

Rules to Live By
The article points out a red flag to share with anybody changing your Foley: If excessive length of a Foley catheter lies outside the penis (or urethral opening in women), the catheter is not correctly placed. Incorrect positioning of a Foley catheter with balloon inflated in the urethra in can cause bleeding from the urethra and urine retention, and can lead to life-threatening autonomic dysreflexia.

Diedre Bricker, MSN RN CRRN, of Craig Hospital’s SCI Nurse Advice Line, offers some good tips how caregivers should change a Foley and what to watch for to make sure they to it correctly. “In nursing school they teach you to push the Foley in to the urethra until you get urine out of the Foley,