inserting foley, some tips please

[PRETTYODD]

What is best way to preserve sterile field in foley ?

[Anne*LPN*]

I work in a nursing home, so sterile procedures are known to be "as sterile as possible". In a NH your field is much smaller and quite often is threatend by combative, confused geriatrics. In my workplace I set my field up on the bed after the pts legs are open and knees are bent, that way everything is easily in my reach. The best way to keep the foley sterile is to get a good look at the pt when cleaning so you aren't 'poking around' and contaminating the foley. In men, obviously this is much easier :) In women it can be tricky so take your time to know exactly where you are going and the foley can stay sterile the entire procedure.

[mskate]

Men are pretty much a straight shot. For women - especially bigger women or old ladies - get a second person and a flashlight!!! :) - Its pretty much impossible to maintain a sterile field holding the foley in one hand, trying to keep flesh out the way with the other and hoping the lighting is perfect - often times while fighting to keep legs open.

[merlee]

I have a home care patient who is large, and she insisted on being on a bedpan for the procedure. Works like a charm. Still need someone to hold the flashlight!

[CBsMommy]

practice, practice, practice!

And an a helper in the room

[canesdukegirl, BSN, RN]

I work in the OR and have to do foleys every single day of my tired life! Obese pts are difficult, male or female. I remember one time I had a male pt so obese that I had to end up cathing him like a woman.

Here is what I do: Get a second pair of sterile gloves. Open your kit on a prep table or mayo stand. Pull the trash can close to you. Before you position your patient, don the extra pair of sterile gloves that you pulled. You will now start putting your foley together. Take your betadine and cover the cotton balls, put your foceps in the tray with the cotton balls. Take the plastic covering off the foley itself, test the balloon. Keep the syringe on the foley. Squirt a bit of lube in the corner of the sterile box containing the bag. Dip the foley in it. Put the prep tray with the cotton balls back on top of the box, and put your sterile gloves right on top. You have just made your prep SO much easier. Now you can position your patient. Don the gloves that come in the kit. Put the prep tray on the bed carefully as to not contaminate your gloves. Keep the sterile box on your prep table. Prep your pt, and now you can hold the flesh open while only needing to grab the sterile box and place it on top of the contaminated prep tray. You have your foley all prepared, so now you just have to make the shot! Bartholin glands can sometimes fool you when looking for the urethra in a female, but when you prep with betadine, you can see much more clearly, and just shoot for the middle!

I hope this helps some. An assistant to hold is golden...

[MAISY, RN-ER, BSN, RN]

Foley tips

In elderly women, angle upwards-everything droops with age.

Always use a light.

Ask people to bear down to pee.

Trendelenberg (if the patient can tolerate it) works for heavy or fleshy patients.

Push down on the male fat pad when placing foley.

Hold member firmly and straight up.

If you can get help, make sure you do....

Bring an extra catheter and gloves to the room with you so you don't have to leave.

Get larger sterile gloves to put over regular gloves-you can remove them after insertion and have a clean fresh pair on.

Just some that I use.

[leslie :-D]

like canesdukegirl, i prep/connect everything on a bedside table.

when swiping w/betadine tips, i make sure i can see the urethra.

always (always!) explain what you're doing along the way...pts need to feel prepared as well.

i also found that the others who suggest bedpan or trendelenberg, are spot on.

even supporting the buttocks with pillows, helps elevate the pelvic region upward.

if there is no urine s/p insertion, then remove pillows/bedpan, lower fob...

so urine can drain to gravity.

for obese and combative pts, assistance is a must.

for pts that have contracted lower extremities, pt sidelying is almost always the way to go.

i just want to add, that i've had pts that i truly got no urine return from.

and the question is almost inevitably, "are you sure you weren't in the lady parts?"

uh....no.

you can always know when you're in the bladder...

because you can only advance the catheter so far, before you hit the bladder wall.

but in the lady parts, you can keep on advancing it, w/o any obstruction.

anyways, sometimes you just have to give the pt a drink, keep catheter in, and come back and wait for the urine to come.

naturally, that would only apply to oriented or comatose pts.:)

maisy, what's a "male fat pad"?

agree up holding member upright...

and still, you often need to twist and turn to ease the catheter in.

plus, prostate glands are often enlarged and get in the way of access.

males are not always easy to cath, for sure.

leslie

[canesdukegirl, BSN, RN]

I agree with Leslie-the prostate is your enemy when cathing a male pt. A trick that an excellent GI surgeon taught me when I knew that I was in the male bladder but didn't get any urine back was to take my pinkie finger and press against the base of the member right above the testicles. I never had heard of this trick before, but it worked! Of course make sure the bag is low so that gravity is your friend.

L-I think the male fat pad is the base of the pubis. Just guessing.

I think that cathing a female is so much easier than a male any day of the week!

[Nurseinprocess]

Four hands!!!!

[MAISY, RN-ER, BSN, RN]

Oh Leslie....

In the heavy males whose member performs the disappearing shaft-you must push down on fat to make it pop up! Thus the male fat pad:) sort of like a mons but not:D

Maisy

[leslie :-D]

Oh Leslie....

In the heavy males whose member performs the disappearing shaft-you must push down on fat to make it pop up! Thus the male fat pad:) sort of like a mons but not:D

Maisy

ah....good to know.

i've never done that.

rather, i pull and stretch the member upwards (in obese men).

i'll have to try the pad push and see how that works out.

leslie