Most Dreaded Procedures

I work Med/Surg and there are certain procedures that I dread performing and last night I had one that I dread: Inserting a foley catheter in an uncircumcised 81-year-old man. I have so much trouble with the foreskin getting impossibly slippery with the lubricant and I can't get a grip! The sterility of the procedure is impossible to maintain with the foreskin in the way... (I need a screaming smilie!) And of course, there's usually an enlarged prostate to contend with. Does anyone have any tips to help me with this in the future since I invariably am inserting foleys in uncircumcised 80 year olds?

What other procedures do you dread? NG tube insertion? Trach care/suctioning? Peritoneal Dialysis? Wound Care? Starting IV's? Giving injections? Inquiring minds want to know.

[Cascadians]

That IS hard, especially if the elder has been ill a while and has not kept himself sufficiently clean. Can't even describe what we've seen going on a new job and pulling that back, ack!

This helps but takes time:

Clean entire area thoroughly, dry.

Shave area, rinse, dry.

Apply protective skin barrier wipe, allow to dry until tacky

Tape foreskin with gentle tape way back away but still enough flexibility

Then it's easier to start cath procedure; also have somebody help you.

[ERNurse752, RN]

That's a good tip for catheters...

I hate trach care!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

I don't mind OG insertion on a vented pt, but I really hate trying to anchor an NG on a conscious person...

I rather enjoy giving IM injections (especially on PIA pts, hehe), and starting IV's. :)

[Bossbutterfly]

I dread Poop rounds... Inevitably there is always one pt who hasnt had a BM in 5 days and most likely requires dynamite or some other sort of agressive action manual or other to get transit happening... In any way, guaranteed sh*t hitting the fan..... On the bed, floor, shoes..etc...

[Cascadians]

Trachs -- tuck long paper towel around and under trach like a bib

Have soft paper towels detached and stacked for quick pick-up and wipe

Have all supplies prepped and ready

Especially that water container for cleaning / clearing suction cath!

Wear face shield -- splatter guard

Keep waste container right there handy

Gird your stomach ...

[Huganurse]

The procedure I hate to do the most is: Digital Removal of Fecal Impaction.

[disher]

Was the problem retraction or a tight foreskin?

Retraction sometimes need more manipulation at the base of the penis.

Also to keep the lubricant on the catheter.

-use the extra drape (the one with hole cut in it)

-squeeze lubricant onto the folded drape

-pick up the catheter in one hand

-pick up the drape

-place the catheter into the lubricated area of the drape and slide the drape down several inches of the catheter to give the catheter even lubrication.You won't have blobs of lubricant dropping onto the head of the penis making it to slippery to hold on to. :)

[ceecel.dee, MSN, RN]

I hate inserting NG's! It seems like a punishment to an already suffering pt.

[Cascadians]

ok, we 2 caregivers (husband + wife who always work as a team, 30 years of cg in july) are infamous for our quick effective painless enema technique, which greatly relieves the patient and saves a huge amount of time & mess for the beleaguered nurse/s !

here you go, this production method we've devised has worked every time:

spectacular enemas:

when indicated:

if pt is sitting on commode, straining, nothing happening after 10 minutes, stand him/her up and there's bulge or stool stuck:

time for compassion and expediting

place interapad in strategic floor spot

place commode over it with bucket on floor

bucket has 1/2 cup water with shaving cream in it to facilitate quick clean-up afterwards and odor control

get order from dr for fleet (or whatever is necessary in your state),

get fleet, fill to top with water, put lubrication on entire tip

heat in microwave exactly 9 seconds, no more

open window

tell patient you are going to give an enema to relieve their obstruction, make them feel better and speed up the relief of their discomfort. explain this involves a pressure sensation in their rectum which will be released as their stool evacuates.

with triple-gloved lubed hand, visually and manually locate anus and digitally gently determine slope of rectum

expel any air from enema bottle

insert carefully and gently and squirt @ 1/3 bottle, remove slowly and wait 2 minutes

first boulders of stool will come out

repeat squirting

more comes out

etc

after @ three squirts, volcanic emptying will occur

clean exposed peri area with warm water and peri spray, dry

give pt 10 minutes to finish expelling backed-up stool

can save pt's life (and prevent colostomy) with this method

safe and sensible: pt sitting up, continually supervised, small amounts of fleet at a time, works like a charm, goodbye hemorrhoids, toxins, misery, difficulty breathing, etc. no fainting either :-) saves a lot of time.

re get fleet, fill to top with water:

fleets come with air in top part of bottle. they're too salty as is and cause the colon to contract too quickly to really be effective enough. also a lot of liquid stays in bottle after it crumples from squeezing, so more is needed. so we unscrew the top, fill up space with water, screw top back on, take orange tip off, slather with ky or whatever lub is available, heat for 9 seconds, expel air, ready to squirt.

oh, also, while and after squirting, hold bucket with other hand close to pt's bottom to avoid splatter.

many pts on narcotics, and those not moving around much, experience constipation.

when doing home visits, yep, encounter lots of "haven't had a bm for a week."

we carry a commode and above supplies in our van.

[dawngloves, BSN, RN]

K exelate enemas! Never stayed in no matter how tight you tape those butt cheeks together.

[l.rae]

RN PA, In the ER where I work we use coude tip catheters often in this situation. Thi tip is just a little rigid and angled. When inserting on a male, point the peins to the nose in fact you can hold all the way onto the ab. I keep my thumb at the base where the scrotum meets the shaft and fell for the catheter threadint through, Sometimes some gentle pressure there will keep it from curling. I AGREE WITH HUGANURSE....Digital impactions are the WORST!

[semstr]

I hate giving injections! any kind of them.

As for putting a foley in a uncircumsized old man (i ahrdly see the circumsized here) I alway take a sterile 8x8 gauze to put around the penis, so I can hold it better.

take care, Renee