apparently, peri care is optional

[Art_Vandelay]

On our unit, CNAs straight cath patients. Initially this didn't bother me. However, recently I was changing my patient's foley bag and then asked if I could clean his member. He looked at me like I had lost my mind. I told him the CNA should be cleaning the member/cath when they change your foley bag to prevent infection. He said they never had/do. Thus, CNAs performing sterile procedure but failing to perform routine foley cath care. Reassuring. Am I missing something?

[wooh, BSN, RN]

Hmmm, not saying that peri care doesn't get missed. (I was a CNA and sometimes you just didn't have time to do it well, do it at all. And yes, there are some lazy aides.)

However, just because a patient said it wasn't being done, I wouldn't immediately believe it's not being done.

[ArtRN]

when people straight cath themselves they usually do it over the toilet, and it is a clean, not sterile, procedure. this can be difficult for someone else to do, so if they are hospitalized, a foley is sometimes placed.

but peri/cath care is imperative, either way.

yes, and also people straight cath themselves in their own environment - not in a hospital full of super-bugs. because of financial part of the deal, people are forced to reuse their catheter over and over, and they still don't get uti.

on the subject: depending on the protocols of the facility, cnas can be delegated to do such tasks if properly trained and based on nursing judgement (do it yourself if, say, there's an obstruction, bleeding, or prostate enlargement). here's an example of delegation rules www.msbn.state.ms.us/pdf/delegation_2009.pdf

[Art_Vandelay]

Hmmm, not saying that peri care doesn't get missed. (I was a CNA and sometimes you just didn't have time to do it well, do it at all. And yes, there are some lazy aides.)

However, just because a patient said it wasn't being done, I wouldn't immediately believe it's not being done.

Well, the patient was a&ox4 and had no reason to lie, and from the expression on his face when I asked him, he was telling the truth. He seemed somewhat embarrassed when I asked him, so I am guessing since he was young, they did cath care on shower days and that was it.

[BaltimoreHon, BSN, RN]

CNAs on our floor do straight caths and foleys. We also do trach care and G-tube feedings in addition to VS, baths, and fingersticks.

[CapeCodMermaid, RN]

C.N.A.s in my facility do NOT insert foley catheters indwelling or otherwise. They do, however, do peri care. A bit off topic but....I was the supervisor of a large skilled facility. One day I was making rounds when one of the newer C.N.A.s came running down the hall calling me. "Suzy! Suzy! Come quick! Something is wrong with Mr. Smith's member and I know you've seen more of them than anyone!!!!" so, I went into Mr. Smith's room to find him in bed, laughing so hard tears were streaming down his cheeks. The aide pointed to his member and said "See, there's something wrong with it!!!" I looked and didn't see a thing wrong with it. The aide then said "What's that EXTRA part?!?" Apparently the girl had never seen an uncircumcised man before. I told her that's how men look if they haven't been circumcised.

The resident had the best laugh and wasn't the least bit insulted. And, of course, from that day on, everyone called me the member expert.

Nope...not gonna have C.N.A.s inserting foleys.

[talaxandra]

CNAs on our floor do straight caths and foleys. We also do trach care and G-tube feedings in addition to VS, baths, and fingersticks.

Good heavens - on my (tertiary, acute) ward our LPN-equivalents don't do catheters or trache care!

[AndiSN]

C.N.A.s in my facility do NOT insert foley catheters indwelling or otherwise. They do, however, do peri care. A bit off topic but....I was the supervisor of a large skilled facility. One day I was making rounds when one of the newer C.N.A.s came running down the hall calling me. "Suzy! Suzy! Come quick! Something is wrong with Mr. Smith's member and I know you've seen more of them than anyone!!!!" so, I went into Mr. Smith's room to find him in bed, laughing so hard tears were streaming down his cheeks. The aide pointed to his member and said "See, there's something wrong with it!!!" I looked and didn't see a thing wrong with it. The aide then said "What's that EXTRA part?!?" Apparently the girl had never seen an uncircumcised man before. I told her that's how men look if they haven't been circumcised.

The resident had the best laugh and wasn't the least bit insulted. And, of course, from that day on, everyone called me the member expert.

Nope...not gonna have C.N.A.s inserting foleys.

Oh my goodness!! That poor C.N.A. That had to rank right up there on the most embarrassing days of her life.

[mindlor]

Hmmm repeatedly straight cath'ing a pt = more chances for inury/infection?

Maybe talk to the doc about ordering a foley?

The only justification i can think of for not using a foley is that perhaps the patient is highly mobile/active and is not one to be in his room much? Then again, if that is the case perhaps he should be dc to home?

[ZippyGBR, BSN, RN]

Hmmm repeatedly straight cath'ing a pt = more chances for inury/infection?

Maybe talk to the doc about ordering a foley?

The only justification i can think of for not using a foley is that perhaps the patient is highly mobile/active and is not one to be in his room much? Then again, if that is the case perhaps he should be dc to home?

utterly bizarre reasoning there to my mind

long term catheterisation creates an increased risk of UTI plus of course the issues with 'erosion' or the urethral meatus ...

[mindlor]

So what is the max hospital stay these days on avg? 5 days?

If a pt has to be straight cath'ed 5x/day it makes a lot of sense to go ahead and place a foley. We are not talking weeks or months here. A foley is also much less traumatic for the pt.

Each time a straight cath is done there is a chance for poor technique that will lead to increased risk for injury and infection. A foley is placed once and must be changed what every three days? In either situation great care should be taken with cleaning.

To me a foley is a no brainer for a pt that has been straight cath'ed frequently.....

[canigraduate]

No need to get all upset, it sounds like an education issue for your CNAs. Just send out an email or put a notice in their mailbox, or however you communicate with them, reminding them that peri-care is required post-cath.

Unless you trained the CNAs personally and you know they were taught correctly, they may be just doing things the way they were trained.

If that doesn't work, approach the individual CNAs and remind them. If that still doesn't work, then the appropriate disciplinary technique should be used.

[leslie :-D]

A foley is placed once and must be changed what every three days?

a foley changed q3d????

never heard of it.

once a foley is placed, it stays there til malfunction or discharge/death.

w/long term pt, it'd be q28d.

leslie