Our OB clinical has left a bit to be desired all around...but that's not the point.
Today I was standing at the nurses station (my instructor was with me) bored outta my mind (it's VERY slow on this unit) when one of the nurses comes up and says "I have an in and out cath, do you have someone who would like to do it?" So I get volunteered--which is fine. I prefer to be busy. I don't know the patient or anything about the patient, just that I need to go do the cath and get a sterile speciman too.
Instructor asks me have I done it before (yes), am I comfortable doing it (yes), so off I go. I explain to the patient what I am going to do and she is fine with it (she works at the hospital). I put on my non-sterile gloves to see what I have to work with down there, can I visualize the meatus, etc. Pt was having a hard time getting in a good position for me, but I *thought* I saw the meatus--sure looked like it to me.
Changed gloves. Got my kit ready. I opened the kit on a chair got out one of the sterile drape thingys and put it on the bed between the pt's legs because there wasn't room for the whole kit because of the way she was positioned. Had my gloves on, put my supplies on the drape (except for the speciman cup which I didn't need *right there*) and started to work. I'll spare the details, but let's just say that what looked like the meatus was a dead-end or something because the cath wasn't going in that hole. The IV pump starts beeping.
So I tell the patient I'm going to dump that kit and try again after we get the IV pump to stop beeping (she needed a new bag of fluids). Right then, in walks the nurse *and the doctor*. I am clearing off my stuff and tell her I didn't get the cath done. She says "Ok, we are going to do a speculum exam, please go get a bag of LR".
Fine. I go get the fluid and take it back. She meets me at the door and grabs it.
I go back to the nurses station, my patients water breaks so I go check on her, help get her linens changed, check the FHR, etc. All is fine. Go back to the nurses station (the nurse wouldn't let me back in the other room for the cath because they are doing the speculum exam--privacy and all).
The nurse from the other patient walks by the desk with a urine speciman and says "thanks Dr. _____ for getting that urine". Then says to me "Next time, don't put your catheter on the chair". Well, I didn't have the catheter on the chair--just the outside plastic wrapper, the outside packaging, and the darn speciman cup.
Well, my instructor gives me 500 kinds of grief about it. "I thought you knew how to do a cath" "Don't you know the kit should be between the patient's legs" etc etc. Like she thought I was a total dope.
I don't know how I could have handled things any differently. She made me feel like I was the only person ever to have not gotten a cath in on the first try. I hate days like this...it makes me so nervous about the next clinical.
May 29, '03
Oooh good grief! Every womans' anatomy is different!! For crying out loud thier are some experienced Rns out thier who cant find the meatus right away! And you dont HAVE to have the Cath kit between the pts legs anyway!! You can have it somewhere else as long as you can see it (but between the legs is easiest on a female). Your instructor needs to get over it. Sheesh we had a student in our clinical rotation that put a rectal Suppository in the patients Vagina (hehehe, I thought it was funny though, but hello, like you cant tell the difference!) but anyway, sometimes thiers not much you can do, well except maybe get frustrated by the situation! I've heard of and participated in a cath that took 3-4 nurses (she had a broken hip and a hard to find meatus), one to hold each side , one with a light and the other one to put the cath in
May 29, '03
i am more concerned that you have an instructor that you can't talk to and explain why and how you were doing something rather than your inability to get the specimen. it isn't often that i see 2 nurses do a cath in the same manner but sterile technique is always followed and the end result is that the specimen was obtained. for the instructor to just stand outside the room and take your word that you know what you're doing (no offense intended) isn't smart, imo. i could tell someone i know how to do open heart surgery but that doesn't mean that i could actually perform it. :chuckle
May 29, '03
oh, and sorry about your crappy day. just keep in mind that this too shall pass.
May 29, '03
Not everyone can get a catheter first go just as not everyone can get a vein first go and somethimes the most obvious are teh worst. I have evern had bad experiences with male catheterisations and had to call the urology registra out of bed at 2 AM - who had difficulties - sometimes --it just happens
May 29, '03
Thanks for the support all...
I'm not sure why the instructor didn't just go in there with me. There wouldn't have been a problem then. This is the first semester I have had her, and I guess she figures that we wuldn't have gotten to her class without knowing how to cath someone. It just really upset me that the situation went the way it did and I didn't really have a chance to defend anything I did.
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