Witnessed unsterile procedure and feeling terrible about it - page 7
by cblake4293 | 15,066 Views | 106 Comments
I am a new grad and have been working as an RN for 5 months. Everyone I work with is very experienced and I am definitely the newbie. Yesterday I witnessed an LPN with 30 yrs experience straight cath a male without using... Read More
- 0Feb 15, '13 by mariebailey, MSN, RNSince you're new to the organization, you can play dumb and act like you have this novel idea that is best practice and will decrease the rates of UTIs among cathed residents to avoid rocking the boat & becoming a target:
Just ask someone the policy b/c people may be getting sick there that shouldn't.
- 0Feb 15, '13 by SarahLeeRNI'm just going to add- don't forget that there are differences in people's intents....as a new nurse it takes a while to pick up on how some people practice nursing. Some people are genuinely trying to do the best they can and have picked up some 'short cut's' over the years-maybe wrong short cuts-but ones they have never had pointed out to them are wrong. They are not trying to practice sloppy, they just might be and not realize it. Other people just practice nursing sloppily, period.
Watch how she cares for other patients and you might have a better understanding of the person that she is. Give her the benefit of the doubt, maybe she has just picked up a bad habit.
My opinion still is that a catheter is always a foreign body entering into a bodily cavity. And a cavity highly prone to infection. Most cath kits have the sterile gloves with them....so why not use them?
All other suggestions about facility P and P are good also. However, it's not hard and doesn't take long to use sterile gloves. I think it should have been done. But I don't think the LPN should be faulted for not doing it...unless there is a pattern of shoddy practice.
Not to devalue this but at least it wasn't something crazy like a K+ push.....there is bad practice and then there is serious bad practice....:P
- 1Feb 15, '13 by joanna73 GuideHonestly, it shouldn't be a chore to find sterile gloves. If you don't have a box handy, then use a catheter kit. Sterile gloves come inside the kit, and nursing homes have those. Aside from that, you should definitely speak with the coworker first. We worked with someone who often felt the need to go to management without saying a word to the person involved. Not fun, because no one likes to feel blindsided.
- 1Feb 15, '13 by grad2012RNQuote from GrnTeaTime to reprint my handy-dandy, never-fail, no-vaginal-contamination Foley-insertion trick.
When you are prepping the woman, tuck the last betadine-soaked cotton ball into the introitus. Not deep, just enough so it blocks the vagina. Then when you are trying for insertion and you miss, the cath only hits the sterile cotton ball and you can keep trying (ask for a cough and look for the "wink" or a little urine output) because it isn't contaminated. Retrieve the cotton ball when all is secure and cleaned up.
I never went vaginal with a Foley again after learning that. Works every time.
Thanks for this great info, will do this when I start my residency position soon. GrnTea, you're awesome!
- 3Feb 15, '13 by BrandonLPNQuote from mariebaileyIt's undeniable that using sterile technique every time is best practice. That's a fact that's well established with plenty of evidence.LTC residents are already at higher risk for UTIs d/t their age & immune status; UTIs are one of the most common infections among LTC residents. If someone wants to complain a/b the cost of using sterile gloves for each straight cath, think of the potential cost savings from preventing UTIs & unnecessary antibiotic use.I think you should not stay out of it; it needs to be addressed because it affects patient care.
But not all LTC facilities are capable of supplying sterile supplies for *every* single straight cath. This is a fact, too. It's inescapable. To stubbornly insist "well, it isn't best practice, so they should change their policy!" is unproductive and childish. It sucks that there isn't adequate reimbursement to ensure best practice for every procedure, but it is what it is. There's nothing brave or noble about fighting a battle that can't be won. I mean, seriously, the OP should risk being on everyone's s*** list by trying to change a policy that anyone with a little savvy knows won't be changed anytime soon? Some new grad RN is hired and says "clean caths aren't nest practice" and suddenly management will see the light and order a truck load of sterile kits?? Come on.....
And nurses who acquiesce to this policy aren't "lazy" or "bad". What, if we're not throwing ourselves on the sword and risking our jobs to protest every policy that isn't 100% like we learned in nursing school, then we're not good nurses? Things aren't as black and white as some posters here seem to think.Last edit by BrandonLPN on Feb 15, '13
- 0Feb 15, '13 by mariebailey, MSN, RNQuote from BrandonLPNSo sterile supplies may be limited to Foley procedures. Darn shame. Gotcha. I am aware that it is well-established with plenty of evidence that asceptic technique is preferable. I think how I worded it may have led you to conclude otherwise.It's undeniable that using sterile technique every time is best practice. That's a fact that's well established with plenty of evidence. But not all LTC facilities are capable of supplying sterile supplies for *every* single straight cath. This is just a fact of life. I'm lucky to work at a government facility where we have kits for every straight cath. Because of this, it has never even occurred to me *not* to use sterile technique. But many (if not most) private facilities simply do not have the reimbursement to provide sterile supplies for a resident who might need 4 straight caths every day. Do you want this LPN to use up all the sterile gloves on multiple straight caths only to have the facility run out when a Foley needs to be inserted? I have considerable disdain toward private nursing homes, but even I know they don't make such polices because they're evil or stupid. They do it because they have to. Until reimbursement laws are changed these policies won't change either. That's why telling the OP to fight this isn't necessarily good advice.Last edit by mariebailey on Feb 15, '13 : Reason: clarification
- 0Feb 15, '13 by jadelpn GuideAt least in the hospital, and it could be in any Medicare facility, foleys are regulated strictly, and UTI's acquired from foleys.
Catheter-associated Urinary Tract Infection and the Medicare Rule Changes
So it is of one's best interest, and the interest of the patient to use sterile technique.