Inserting Indwelling Catheter with No Foley Kit

[1luvJesus]

Hello! I am new to allnurses and am looking for some insight. Where I work doesn't supply Foley kits, just the supplies for the catheters. So the other RNs use the sterile gloves as their sterile field. They open the gloves, then drop the catheter onto the field (which is really hard because it barely fits), but the thing that concerns me is they open the betadine and lay the handles of the swabs on the edge of their sterile field. I've asked the other RNs about it and people don't ever give me a clear answer. What is a way to do this without breaking the sterile field?? I've thought about opening betadine swabs and placing the package in a clean urine cup near the field but not touching it so I can just grab the swabs... Hoping for suggestions. Having someone there to hand me the swabs isn't an option. It's just a few nurses on a busy floor and they just tell you to do it yourself.

[kp2016]

What do you use for sterile dressings? If you have a basic sterile dressing pack I would open that as a sterile field.

[Nurse Trini]

A glove? Yeah, I'm with kp. If I had to make do, I'd use a 4x4 or something flat. In my last job, we had sterile drapes that were our goto thing for expanding a sterile field (they were about 2 feet square).

Of course, when I switched to working in the school, I thought my foley days were over, but I was wrong. I do insist on the kits though.

[JKL33]

Ideas:

1) You could do the urine cup idea but you would want to squeeze the bottom of the swab-stick package to "scoot" them upward towards the very top of the package or else you'll have difficulty getting them out with only one hand while not touching the outside of the package at all.

2) Get sterile towel (paper w/ impermeable backing). Use it for your sterile field. Open the betadine swab package and place it carefully into the clean urine cup off the sterile field in a way that the protruding sticks are not contaminated. Put on one sterile glove. Use sterile-glove hand to touch only the protruding swab sticks and pull them out of the package and place them onto your sterile field; you can use your non-sterile hand to hold the package while you are pulling them out. Put on other sterile glove and proceed. *I don't think this will work if you don't have any sterile, impermeable paper towels; you can't use the inside of the glove package in this same way because I don't think it is impermeable to liquids.

[K+MgSO4, BSN]

Do a cost analysis of how much these work arounds are costing compared to the cost of a foley pack. Including nursing time hunting for supplies and your CAUTI rates including increased LOS, IV antibiotics, IVs needing to be inserted etc.

My infection control team would have a field day with this situation....

[amoLucia]

On 1/11/2020 at 6:24 PM, K+MgSO4 said:

My infection control team would have a field day with this situation....

This was my first thought as I started to read others' attempts. Yikes!

[Hoosier_RN, MSN]

On 1/11/2020 at 6:24 PM, K+MgSO4 said:

Do a cost analysis of how much these work arounds are costing compared to the cost of a foley pack. Including nursing time hunting for supplies and your CAUTI rates including increased LOS, IV antibiotics, IVs needing to be inserted etc.

My infection control team would have a field day with this situation....

This sounds like a LTC situation to me. They generally don't care about time cost, only supply costs ?

[CKPM2RN, ASN, EMT-P]

On 1/11/2020 at 4:02 PM, Hoosier_RN said:

This sounds like a LTC situation to me. They generally don't care about time cost, only supply costs ?

I was thinking that as well. I learned to jerry-rig, hay-wire, and McGyver everything while I worked LTC/SNF. I must have done alright because I never caused an infection and actually healed a bunch of ulcers.

I would suggest that the OP take a moment to really look at the supplies and the solution will come. As for the problem of getting the betadine swabs out without contaminating your field? I sometimes would nudge the opened packet to the edge of the sterile field, closed side out, so the CNA could pick it up and hold it for me. The CNA had a hold of the very bottom of the packet and although not ideal, it worked. Trying to get them out in my limited sterile field by myself often had the entire packet end up on the floor or somewhere.

[JKL33]

55 minutes ago, CKPM2RN said:

I sometimes would nudge the opened packet to the edge of the sterile field, closed side out, so the CNA could pick it up and hold it for me.

If I read this OP question right, though, there are two problems: The betadine package isn't sterile, and there is no assistant to help. If either one of these things were different the whole question would be moot.

[CKPM2RN, ASN, EMT-P]

On 1/13/2020 at 11:40 AM, JKL33 said:

If I read this OP question right, though, there are two problems: The betadine package isn't sterile, and there is no assistant to help. If either one of these things were different the whole question would be moot.

You are absolutely right, I was just relating a real-world problem I dealt with while working 38:1 at a SNF with no supplies and no help. The betadine package came in the kit so it started out sterile and the package became un-sterile, true. One does what one can in impossible situations.

[kp2016]

10 minutes ago, CKPM2RN said:

One does what one can in impossible situations.

I feel like this is the real life answer so many things I read on here.

[CritterLover, BSN, RN]

On 1/11/2020 at 9:58 AM, Nurse Trini said:

A glove? Yeah, I'm with kp. If I had to make do, I'd use a 4x4 or something flat. In my last job, we had sterile drapes that were our goto thing for expanding a sterile field (they were about 2 feet square).

Of course, when I switched to working in the school, I thought my foley days were over, but I was wrong. I do insist on the kits though.

I think she means the wrapping the gloves come in -- not the glove itself. I was taught to do that a long time ago -- open up the gloves, completely open up the paper they are wrapped in, flip one glove to the other side, and then dump my other supplies onto the packaging from the gloves. It isn't a waterproof sterile field, but if everything you are using is dry it works quite well.

I think the kits aren't very cost effective in low use areas/facilities because so many supplies inside can expire, and once one thing expires it basically renders the whole thing useless. I mean you can open it up and salvage what you can, but most won't.

OP, I've always treated straight caths as a sterile/dirty procedure -- one hand is sterile while the other is dirty. Before you put on your sterile gloves, carefully open the betadine package and prop it so that the ends are in the air. After you've set everything up and put on your sterile gloves, grab the betadine package with your "dirty" hand, pull the swabs out with your sterile hand. Lay the swabs on the sterile side of the plastic (waterproof) packaging from the gloves.