How common is it to be in this situation? In clinical only a few people had a chance to insert (I think 2 or 3 out of 8 in my group). Not only have I never inserted a foley, but I've never inserted or D/C'd an NG tube, among other skills. The only thing I have done is a dressing change, meds obviously, D/C of a foley, D/C of IV, and trach suctioning.
I'm kinda worried about what my preceptor will think when I tell her than "this will be my first time doing ......______"
This is very common. I would not worry about it. I would mention it to my preceptor and maybe in report to the other nurses one day. I'm sure they would be willing to let you get the experience. Good luck!
It's very common, but It really shouldn't be. Where do you live? It sounds like the US, since I haven't heard the classification GPN. Well the same mambly pambly, throw medicine through the window and let's have a love in thing is going on here too in our nursing programs (Canada). Why do the idiots always take over, and do everything opposite to common sense?
In my program, we spent year 3 in community health ONLY. But, in year 4, with NO SKILLS TRAINING, and no training in medical elements like lab values, and disease processes, (nothing but community nursing and social program planning) for all of year 3, we were suddenly thrown into med/surg floors. Many of the fish that were thrown in the pond that day sank to the bottom - some to never return again.
I have to say, that nursing needs to return to the old ways and dump this "new curriculum" ASAP.
It is a shame the way the programs (some at least) are run.. like someone else stated in another post somewhere - they teach so much about CARING but not enough about skill.
Anyway, I talked to another nurse at orientation today who just got her LPN license and she is in the same boat as me.. only she is working in ER not Medsurg.
Well, as a nurse, I guess I could try helping rather than just complaining, but just once more, NURSING NEEDS TO BECOME MORE MEDICAL AND SKILLS FOCUSED! Oh that feels better. Nurses kept saying that doctors would respect them more if they were degree trained. This hasn't happened though. Doctors will respect nurses more, when nurses know what the hell doctors are talking about :)
Now that that's out of my system, I'll give you come catheter tips. Take in mind these tips are from my perspective, which is at times a little warped.
For male catheterizations - the only thing you really have to worry about is coiling. Check the chart for any past history of prostate enlargement or urethral stricture. If these conditions exist, you'll either just have to be more careful, or get someone who does them more frequently. Obviously you're going to use sterile technique during the process, so we won't get into that, just make sure that you place the collection basin, in my case a white plastic box, somewhere between the patient's legs. Pull up on the member and keep it straight - this will help prevent the dreaded coil. Also, you can feel the catheter sliding through the urethra past your fingers. Men have long urethras - you may be almost the length of the catheter before you see the urine start to flow.
Women. Oh yes, then there's women. Well, women are dreaded, by other women and men alike, because each one is different. The important thing here is to make sure that you clean the area thoroughly, because it might be a bit of an exploratory adventure. Always take 2 catheters! I'm a pro, and rarely miss when it comes to catheters ( I use what's called the force, but that's for advanced nurses), and I sometimes miss. So if the patient cannot feel the insert, and you're not getting urine flow, you're probably in the wrong spot.
LEAVE IT THERE. Leaving it there will provide a signpost that says go further north. I use the shematic UVA (a deadly form of ultraviolet radiation - no a natural fear of women is healthy:) U-urethra, V-lady parts, A-orifice. These are the three entry points from top to bottom. Do not laugh, the female anatomy can be quite a bit different in each case.
Now, it is very important that you separate the labia as widely as you can. Get the female patient to spread her legs apart as far as possible for you. Keep your now, no longer sterile hand separating the labia - I mean I would use a lot of pressure. Now, look for the clear hole - the lady parts is more of an irregular hole. The urethra is always fairly small and rounded. Remember the schematic! Do not go for the first hole that you see! Always look for one further north first. If you are absolutely certain there is nothing further north, then go ahead.
Now, where you really can't see much of anything, you might try using the force. You know the shematic, so start upper most and feel your way down to the first possible opening with the tip of the catheter.
When inserting catheters, male or female, make sure that you have a grasp which allows you to keep the head of the catheter straight - you don't want to hold the catheter too far up that it becomes too hard to guide.
Well, that's all I can think of for now - I think its a skill you will pick up quickly and remember, if you take an extra catheter along, (maybe some extra sterile gloves as well), you can make mistakes along the way and still get it. I hope that helps.
Oh, I almost forgot to mention foreskin - that's maybe because I myself am circumscribed. OKay, so with men, who have foreskin I recommend that you not pull back and retract the foreskin. What!? You say.. Have you gone mad!? ARe you a real nurse!? You heard what I said young one, wherever possible, have the PATIENT DO THIS. He's more familiar with his anatomy than you are, why not have him do it? That's not a sterile part of the procedure, it's really only the head of the member you will be swabbing with betadine, so why not let him do it? This will be less embarrassing for you and him both and most times more effective.
If your patient is confused and you do have to retract the foreskin, start about midway to the top and pull it down like a sheath until the head "pops" out, then hold it down and in position while you insert with your other hand (which is still sterile right
This has been an addendum to my help with catheter insertions package. I hope you will put it to good use.
I graduated from a PN program in december and did about 8-10 foley or straight catheters...mostly straight caths. I did both male and female. However, I never did insert a NG tube...I think only a couple of students were able to do that. I think most of them inserted atleast one catheter. We all had to check off on these skills in the lab but weren't mandatory to graduate. I would say inserting an NG tube and taking one out and inserting an IV (which we checked off on in the lab but weren't able to do in clinical) were probably the only skills I didn't do in clinical. It's a shame that not everyone gets the same experience in clinical, but I guess that always can't be helped. You'll do fine. I would inform your preceptor and maybe some of the other nurses on the floor and i'm sure they would be willing to give you the experience when the opportunity arises. If you're not sure about the procedures, look them up in a med book before doing them.
To a good preceptor it shouldn't matter. A good preceptor won't judge but be supportive and teach you. Good luck in finding a good preceptor. No one comes out of nursing school and expert in tasks. Good luck to you.
Tweety- I already got set up with a preceptor. She is a wonderful nurse with tons of experience... although, recently while working as a tech I overheard her mention how she doesn't enjoy precepting... AND someone told me that she recently made a new LPN cry a few times because of wanting to just get the job done and not focus on letting her know what was going on.
grannynurse FNP student
1,016 Posts
But accurate and strict I & O is.
Grannynurse:balloons: