Foley sterile field

[AJPV]

I'm practicing for a school checkoff doing a foley. Sterile technique is the biggest thing we're focusing on. There is a tray that sits in the top part of the box that the cath comes in. The tray contains the cotton balls & iodine. The catheter sits below the tray in the box itself. I realize that I have to don the sterile gloves, then test the cath balloon & apply lube to the cath (which is below the tray), then when everything is ready, I can finally prep & use the cotton balls (which is when I will contaminate my non-dominant hand).

My question relates to the fact the the catheter is initially inaccessible due to the tray being over the top of it. After donning the sterile gloves, is it okay to remove the tray from the top of the box and set it on the bed between the pt's knees (on the sheet and not on top of the sterile drape due to the size of the drape not accomodating the box and tray side by side)? I have to somehow get the tray out of the way to access the cath so I can test the ballon and lube the tip - BEFORE I use the cotton balls and thus contaminate my non-dominant hand. But if I move the tray and set it down on the sheets (not on the sterile drape) does that make the cotton balls contained in the tray officially "contaminated" because the tray is not sitting on top of the sterile drape?

Any tips would be great - thanks!

[cherrybreeze, ADN, RN]

Adri_RN said:

I have never heard of this ...can you please explain further? Thanks ?

It was a joke, Adi.

thehipcrip said:

Something no one mentioned here is the use of Lidocaine 2% gel to make insertion less uncomfortable. Apply a liberal amount of lidocaine gel to the patient's meatus and leave it to start working while prepping your insertion tray. You can also mix the Lidocaine gel in with the Surgilube. It doesn't necessarily make the insertion more comfortable but does eliminate irritation/discomfort shortly after.

Question -- why do hospitals/clinics all seem to use the insertion trays with the cotton balls and tongs instead of the prepackaged antiseptic swabs? For women, it's so much easier to ensure the swabs get into the labial folds than using those clumsy tongs and drippy cotton balls.

Lido jets cannot be used without an order, and very few of our docs would order them for a routine foley insertion. Having a cath placed isn't comfortable, of course, but you can still feel it even with gel. It's not worth the risk of a reaction. I've only ever had an order to use lido in particular, specific circumstances.

klone said:

I insert foleys into female patients daily, sometimes more than once a shift. In OB, pretty much everyone who gets an epidural, gets a foley.

First, it's no longer EBP to test inflate the catheter.

Second, the kits we use have the cotton balls and plastic tongs. I don't use the tongs. The first cotton ball gets swiped down her urethra/vulva, then I use it with my non-sterile hand between my finger and her labia to keep her labia separated. It's hard to describe without a visual.

If you have an obese patient, don't be shy to ask for another nurse to help you hold labial folds out of the way.

Thanks for mentioning this, klone, I was going to say it to (surprised more people didn't?). I was taught that recently, too, that we are not to test the balloon anymore.

[supervisorhatchet]

Just practice.....When I was in school, we got a cath kit to play with. We took that kit home, and I found one of my daughter's dolls that had a hole big enough, and me and a partner quizzed each on other, watched each other until we were comfortable doing it. The more you do it, the easier it will be.

[DookieMeisterRN]

We've also been taught it's no longer EBP to test the balloon and we are encouraged to wash thoroughly with soap, water and washcloth before the procedure. Which I hope would be standard practice anyway, duh. Our kits have changed too and we don't have cotton balls w/ tongs anymore but the 3 pack of betadine swabs.

I also set up the sterile field on a separate table. It has saved getting contaminated from unruly patients many times!