Have I Been Doing It Wrong?

[All4NursingRN]

That's why it's always good practice to review the basics.

So tell me if I've been wrong or if this is adequate practice.

Regarding foleys, I usually....

1. Wash hands, apply clean gloves, and open my kit.

2. I then open the catheter package just enough to attach the urinary bag while leaving about 90% of the catheter in the package until I'm ready to insert.

3. Open up my sterile gloves package and carefully place it aside without manipulating it too much.

4. I then with my clean gloves still on.... open my betadine and pour over my cotton swabs and also open and squeeze out my lube.

5. With clean gloves still on, I pick up the soaked cotton swabs and clean from front to back or up to down using one swab per swipe.

6. I then change into my sterile gloves for insertion, snaking the foley out of the package carefully, lubing the tip, and then inserting.

Is it acceptable to leave my clean gloves on while I clean the area? Was I still sterile? I have just always thought that the clean gloves should be used to clean the ''dirty'' perineal area and not the sterile gloves. I've looked up the procedure but most sites are somewhat vague about the minor details.

Sorry I know I should know better but sometimes a nurse needs to be sure! Trying to keep my practice up to standard.

[Clovery]

I don't insert foleys very frequently, but I think you are supposed to put on the sterile gloves before you start manipulating anything in the sterile kit. And definitely before you clean the patient with the betadine.

Here's a checklist I found http://www.mc.vanderbilt.edu/documents/7north/files/Urinary%20Cath%20insertion%20%20comp%20checklist.pdf

[DisneyNurseGal, BSN, RN]

In my hospital with do general peri-care first, then once the peri-care done, [sterile] outer package is opened, sterile draping over area, then sterile gloves. The way I remember it, is that our foley kits have the sterile gloves stacked inside. I do everything and work my through the things that are stacked in the kit, when I get to the sterile gloves, I know it is time to put them on!

[JBudd, MSN]

Don't touch anything in sterile kit unless you are wearing sterile gloves. You have broken the sterility of the field by using only clean gloves to open the betadine etc.

Do some pericare if needed first, but once you have the kit open you go straight to sterile gloves. Prepare everything while both hands are sterile, open the betadine, lube the tip, check the balloon (although some are saying to skip that step, I won't because I've found nonworking balloons before). Non-dominant hand becomes the "clean hand", and dominant stays sterile. Clean hand opens the labia, other uses the plastic forceps to pick up the betadine cotton and clean without actually touching skin (or use the hand to wipe with if are really good at not touching anything but the cotton). Keep the clean hand in place so the urethra remains uncovered, use the sterile hand to pick up the foley and insert it. Once you get urine back, both hand can then be "clean", let go of things and inflate the balloon.

[Mr. Murse]

I agree with what the above poster said. Keep in mind everything inside the kit is already sterile. If you have handled the betadine and other things in the kit then you have already compromised the sterile field.

So basically, sounds like you've been contaminating the sterile field very early on by handling the supplies with "clean" gloves. Probably didn't hurt anyone, but you just upped the chances of a few different infections. If the patient needs more cleaning than the kit provides, do it before hand, before you even open the kit and get started.

[All4NursingRN]

Thanks everyone, will change my routine to maintain sterility!