Frustrated Foley Catheter Insertions

Published

The long intro to this question is... I am an LVN student at a school in SoCal. My problem is that our clinical instructors are at odds ends with one another because of egos, some of them are from "out" of the country, and are ham-strung by a D.O.N. that is obstinate to allow anything other than by how "Christensen" Foundations and Adult Health Nursing says to do procedures. The book in my opinion is completely worthless in terms of it's content. I know that that comment might infuriate some readers, but there are so many typos, mistakes, and contradictions - one has to wonder if this went through a final edit before it was published. Now compound that with a "language" barrier because a good portion of our instructors have the "god" complex despite not having worked in a facility for the past 5 years, and this becomes a recipe for impending disaster.

The question is as follows: Due to our school's budgetary restraints (despite raping us for the low-low price of $30K) the lab does not have "STERILE" urinary bags to attach to our foley catheters. Now when we are tested, one instructor loves to use the "VRE in the urine" scenario. We tell her that we are "pretending" that the bags are new and that they have the "caps" on the port end still attached...making the scenario STERILE. However, she says that we need to attach bag to the foley before insertion -without pulling the bag from it's "STERILE" pack (the pack that the bag comes in). Now how the #%$@#$ are we supposed to do that?! She says that this is how the book (Christnesen) explains it, but we don't think this woman has read the book, and her command of English is deplorable. Yet she still manages to fail a great majority of the classes going through. Is there an answer for this....having the foley kit and urinary bag being in separate "container" kits at the beginning...and what would be the procedure to maintain a completely sterile field? :banghead:

Because despite our best attempts at mastering and "maneuvering" past this issue....she and the D.O.N. still maintain that the bag should not be hung before it is connected. Yet, in connecting it before hand....we need to open the kit glove up with the sterile gloves and somehow attach the two without mussing things up. :no::no: :confused::confused:

PLEASE HELP!!! By the way...in asking nurses at our clinical sites, they have commented that they don't understand why there is such a fuss over a procedure that should not be complicated the way that this school has....:no:

Up Vote Up Vote ×
Specializes in LTC, Cardiac Step-Down.

Ugh, what a mess. I love it when they try to make "learning opportunities" out of the cheap stuff they have in the lab.

Ask her to demonstrate for you. Not only will this solve the language barrier problem but it'll show her how silly it is to expect this of you.

Up Vote Up Vote ×

Boy, that really is a mess. I am with PepperAnne. Ask your instructor to demonstrate it for you.

Up Vote Up Vote ×
Specializes in med/surg, telemetry, IV therapy, mgmt.

there is nothing wrong with your instructor's directions. i was a practicing rn for many years and we connected the foley drainage bag to the foley catheter before opening the catheter insertion kit being cautious to keep those two ends sterile. we opened the corner of the package that the bag came in so we could connect the drainage tubing to the end of the foley or we just removed the entire bag from its package completely and either placed it on the sterile field or laid it off to the side but it still remained on the bed. we did not hang the foley drainage bag until we established that the catheter was in place and urine was being collected in the bag. you have to keep principles of aseptic technique in mind. that can often be accomplished as long as you open the correct part of the packages that these pieces of equipment come in. the most important part that must be kept sterile is the tip of the foley catheter that is going to be inserted into the patient. you might want to review these principles of aseptic technique which support your instructor's directions to keep the foley drainage bag on top of the bed during the catheter insertion because it keeps that item within your line of vision. a cardinal principle of sterile technique is that anything below your waist is to be considered contaminated because you can't see it and you don't know what it is touching or may come along and touch it.

  • principles of aseptic technique (http://nursingcrib.com/principles-of-aseptic-technique/)
    • only sterile items are used within sterile field.
    • sterile objects become unsterile when touched by unsterile objects.
    • sterile items that are out of vision or below the waist level of the nurse are considered unsterile.
    • sterile objects can become unsterile by prolong exposure to airborne microorganisms.
    • fluids flow in the direction of gravity.
    • moisture that passes through a sterile object draws microorganism from unsterile surfaces above or below to the surface by capillary reaction.
    • the edges of a sterile field are considered unsterile.
    • the skin cannot be sterilized and is unsterile.
    • conscientiousness, alertness and honesty are essential qualities in maintaining surgical asepsis.

also see http://www.lhsc.on.ca/resptherapy/students/orient/sterile.htm - principles of sterile technique

for the or

many roads lead to the same destination. learn the principles of aseptic technique first to understand why your instructors have you doing things certain ways before jumping to criticizing them. you can link in and view videos of catheter insertions on post #20 of this sticky thread: https://allnurses.com/nursing-student-assistance/any-good-iv-127657.html - any good iv therapy or nursing procedure web sites in nursing student assistant forum where i am sure you will find some slight differences in those technique as well. keep in mind that as long as aseptic technique is being followed it is all good.

Up Vote Up Vote ×

Thank you for your reply on this. And believe me I will bring this to her attention. However, we discussed exactly what you presented here - and the problem wasn't "leaving the bag in the line of site." She contradicted herself in regards to the "sterile field" when we asked if the bag could be placed on it when removed from its container. She snapped at one of the students in our group emphatically stating that by taking it out of the container and placing it on the field we contaminated the field. Her bone with me is that I stated that as long as the TIP of the connecting portion of the collection bag remains COVERED and that it is not removed UNTIL PROPER PLACEMENT is achieved then it is still STERILE and your ASEPTIC TECHNIQUE is still maintained. If I can't remove the bag from its container to connect it before hand because I'm not supposed to connect the bag before I insert the foley, and I'm not supposed to do it after I achieve urine flow because the urine has VRE in it...then when am I supposed to do it?

Ok, to up-date the folks who recommended asking her to demonstrate the technique...we've asked on 2 separate occasions - and she's blown us off both times with 1.) I shouldn't have to teach you clinical skills that you should have learned from the trainers in the lab during your TERM 1 time. Then the No. 2.) excuse of I'm too busy to come to the skills lab to do a demonstration for a SIMPLE technique that we should already know. However, we've discussed this issue with our other clinical instructors, and they don't understand what her deal is with foley insertions. Because when we stated our dilemma and our solutions, they said that they were all valid, and presented with no violation of the sterile field or aseptic technique. Oh, and one of the other instructors even commented that without connecting the bag, your hand that was used to secure the labia or member should be able to kink the line long enough for you to take your dominant hand to remove the "STERILE" cap and thus facilitating connection without violating the aseptic technique. (That is if the bag is hanged on the bed frame properly - and the line is secured to the bedding without the cap being removed).

So, in as much as I appreciate "Daytonite's" advice about how this instructor has presented "nothing wrong with her technique". This instructor 1st critiqued a skill that NO ONE has seen her do, and 2nd she seems very wary of even presenting it (even on a mannequin). Which makes us wonder if she knows what she is doing as a nurse, because her attitude as an instructor leaves a good many things to be desired. We are in a dilemma here. By the way "Daytonite" thank you for the guide on "sterile technique" for the OR. Unfortunately, our instructor seems to have problems handling basic skills needed for a SNF.

Up Vote Up Vote ×
Specializes in med/surg, telemetry, IV therapy, mgmt.

first, has anyone gone back to the trainers in the lab and relayed to them what this instructor is saying about what she says they should have taught you with regards to this procedure? seems to me that perhaps there is a communication breakdown among the instructors and what is to be taught--at least that is what she is implying. if so, why is she bringing you students into an instructor's problem, is what i would be asking the dean of nursing. if the trainers failed to teach your class a procedure the correct way (according to this instructor) then it needs to be investigated and reported to the dean of your nursing program.

second, forget attitudes. with regard to getting the procedure done with this instructor, this is all about power tripping and getting a passing grade. this instructor is not about to let you win this argument without a fight. it sounds like you have to do it her way or fail. can't you accept that? arguing with her is only going to aggravate her more. she's an authoritarian. you have no power over her and the more you oppose her the more she will fight back because she has an upper hand and has no intention of sharing it. you are wasting your energy trying to prove you have any influence over her. it's an argument you will never win. you kowtow to and butt kiss people like this until they are out of your hair. put your efforts into getting through the course and moving on.

Up Vote Up Vote ×

Daytonite, as much as I appreciate your advice regarding the "proper" way to do things. It sounds like you feel as though we the students have not gone through the proper channels regarding this matter. Furthermore, as "little" as we "STUDENT NURSES" know, there are those of us who do know that to get through this course requires a great deal of humility on our part as to our conduct with our instructors and how we approach them. However, this instructor has a rep of having "complaints" lodged with our DON. The DON has in every instance just MOVED the instructor or transferred students to different clinical sites. The reason why I posed this question was not to get advice about how to deal with the problems of this instructor, but more importantly to get advice and information regarding how we can approach the procedure to either indicate that "we are completely our of our gourd" in our approach to the procedure -or- IF she fails us in the lab because of her own obstinance, then we may have something to go to our clinical director and DON with. The big thing with this program is "chain of command", and we (as a group) are covering our basis. We have gone to her. She has shown us nothing but woe-full disdain. So our next stop is the clinical director and then the DON.

Regardless of how "pointless" you may feel this is, WE are in the middle of a "******* contest" that we did not start. Nor are we going to simply just lay down and let this instructor act as though we are morons. We have come this far - passing the same procedure with other instructors. Now, assuming that the other instructors are incompetent, that is a possibility. But they are all currently working RNs at area hospitals - so I'm not going to go there by impugning their credentials and expertise. In regards to "accepting" that we aren't going to "win" this fight. That's the problem - and maybe you need to understand that not all students look to be "right" in an argument. From your replies, it sounds like you may feel for this instructor - and maybe you might run your clinical classes the same way. But that becomes a problem, because nurses like our instructor are instructors because they cannot work well with others nurses, and thus end up directing their energies at abusing those people that are trying to learn. Again, I don't know what your issue seems to be with my posting. But frustrated students who pay instructor's salaries should not be "knocked down" just because instructors feel like they can. At the same time, if an instructor is asked, WITH RESPECT, to assist or to teach - their "EGO" should be checked at the door. As nursing students we are supposedly taught "THERAPEUTIC COMMUNICATION". Funny how it is applied only to our patients and we get graded poorly if observed not showing that to patients. Yet, in regards to us, SOME instructors tend to think that we are nothing more that cannon fodder for the ol' excuse of "You've got bad attitudes". Sorry, was a teacher before this, and even in my meager existence as a middle-school teacher, we could not use the excuse that the kid was a "bad egg". Nursing instructors are no exception - especially if the students that they get don't have disciplinary actions or complaints against them from other instructors or the DON. I chose this profession to make more of a difference in people's lives, and if I can't count on an instructor to show some integrity then I'm willing to fight for what I believe is a cardinal principle of nursing. Regardless of if she fails me and gets off on the "orgasm" of victory - I want to know that what I'm doing is right. Because KARMA is a b*ch - when I have documented actual problems with how this instructor has approached our class. That's something our previous instructors taught us - DOCUMENT EVERYTHING. So again thanks for the links, but in regards to everything else and the tone or your posts....you can keep it.

To everyone else who's kept on the sidelines of all this, and gave some awesome advice THANK YOU!!!!

Up Vote Up Vote ×
Specializes in med/surg, telemetry, IV therapy, mgmt.

Oh, hey, whoa! I'm on your side here. I "got" your frustrations and just made some suggestions based on my experience. Truly, its good advice not to openly argue with this instructor anymore. How in the sam hill you interpreted my posts as having a "tone" to them which I am taking as you thinking that I am giving you a superior attitude is beyond my comprehension. You are totally wrong, wrong, wrong. I'm with you here and trying to help you out. You don't have to take anyone's advice, but when you post on an open forum like this you are going to get advice. You may agree or disagree with it, but please be respectful. I really did take a lot of time and trouble to respond to this thread because I was sincerely trying to be of help.

Up Vote Up Vote ×
+ Join the Discussion