Female Catheterization and UTI

[meatballgirl]

Hi there:

I'm actually a nursing student and I have a question regarding Female Cath and UTI for real-life practicing nurses in hospitals and acute care situations. Last night, in school, we did female catherization. It was ridiculous because the dummy we practiced on had a lady parts the size of a cantaloupe and there was no urethral meatus to look for. It was the dummy that gave birth but is broken.

I've asked my RN buddies and many have said they've never been able to successfully cath a female. My instructor was super strict and made me so nervous about the sterile technique that I messed up on putting on gloves! But it was just nerves. I tried to ask her whether it was really THAT severe... that touching the cuff of the glove by accident would give my patient a UTI. After all, I would have scrubbed my hands before putting on gloves. And she screamed at me for asking a question.

I've seen nurses cath people in hospitals. They are not all that delicate or ginger about everything. They just do it. Yes, they do the sterile technique thing, but I wonder if patients develop UTI not just from the cath process but from having BM in bed and not getting cleaned properly or just from having the Foley in there for a month.

Nurses? What is the real deal out there in the hospitals? Is one tiny touch on my glove or something like that really going to "kill" my patient? My instructor had me soooooo scared.

Thanks,

Meatballgirl

[sauconyrunner]

Well, if you break sterile technique yes, it's a problem. Especially if you have trouble with the gloves in a situation where the patient is not moving etc. Once you get a patient who is moving around, and you are trying to see- and the meatus of a real female may often more resemble a cantaloupe than what you might think it would look it...maintaining sterile technique is going to be harder, so if you can not do it on a dummy...going to be much harder on a real person...

People get UTI's in the hospital for a variety of reasons. But one of them is having a catheter in for some time, germs easily can enter the urinary badder by simply crawling on the catheter...Proteus mirabilis is one that can actually kind of change shape to move up the catheter more easily. Obviously any person sitting in feces is at higher risk for the same problem... I am the person at my hospital who investigates hospital acquired UTI...clearly if the UTI is e.coli it is an issue of possible not being cleaned properly, and a nice passageway into the bladder. If it is a different organism not normally found in feces, then it is probably the introduction of bacteria from the catheter either by allowing the bacteria to travel there, or by introduction on the catheter when first being put in. Have you had microbiology yet? You seem to not understand the amount of bugs that proliferate and can crawl right up a foley.

So to answer your question: Is a break in sterile technique a big deal when putting in a catheter? Yup. If sterile technique were not tthat important, would hospitals bother? It costs a lot more to get a sterile kit than to work with unsterile equipment.

It might seem like a small detail to you, but when you think about all the small details that go into a procedure with sterile technique... which one is it ok to break? Which one would you want your nurse to break and decide "it wasn't a big deal"?

I would like to add that placing a catheter in a female is not that difficult, I am surprised at the amount of people you know who say they have not been able to do this. I don't know anyone who says they can't....now some days and some patients, yes, bit not never...

[MySonIsAdorable]

It is certainly important to maintain sterile technique you know those nurses who for instance say "do as I say not as I do" yeah they are out there. BUT that doesn't mean you have to be one of them. My favorite nursing instructor says "If you make a habit of doing things right then you wont have to be worried when someone is watching you." Get as many sterile gloves as you can and practice putting them on its not the easiest thing to do but certainly isn't hard after practice my best tip could be to have your hands completely dry if possible.

I am sure you have read about HAI's, Nosocomial infections...these things are real and the hospital or LTC facility isn't going to get paid by the insurance if its their fault the infection is there. They keep track of who, when, how many times you have possibly caused this and there can be consequences.

These infection control procedures are not just to protect the nurse and other healthcare workers its to protect the patients from harm as well. So do you part in preventing HAI's by following the guidelines, they are all there and are all important for a reason.

Good luck, I know the models are sometimes hard to work on, just don't attempt one alone and if you break sterile field go back & start over don't feel bad if you have to waste a cath. I saw a nurse drop one on the floor and then wash it off with some tap water once, and use it! I also have seen a nurse insert into the lady parts and then go ahead and use the same cath for the urinary meatus. I was in school and so we were told to let our instructors handle stuff like that but in the real world you need to do your #1 job which is being a patient advocate, after all that's why there are strict rules for us to follow and why we go through so much to be a nurse because its important to one's safety and well being. Good luck & sorry for the lecture.

[monkeybug]

Sterile technique is essential, but I do think nursing instructors go a bit nuts on things. You don't absolutely, positively have to do it their way, you just have to maintain sterile technique. I've watched some of the instructors teaching in our unit, and I try not to stand their shaking my head. You don't have to make the outer container your little garbage bag. You don't have to use that stupid fenestrated drape in a female foley kit. One day you will be doing this without someone breathing down your neck, and you will find your own way. That said, it can be very, very difficult to cath a woman sometimes. Not everyone looks like the text book. In fact, most people don't. I had a precepting student with me last year, and she was going to do a straight cath on a pregnant patient. She was freaked out about it, but I did a little cheerleading and we went in the room. And she couldn't find the meatus. So I gloved up, got a new kit, turned on the exam lights, and I couldn't find it either! So we covered the patient, apologized and walked out of the room, with me pointing out that experience doesn't always mean much! :) I got a colleague, we went back in, and my nurse coworker just stood and stared, shrugged, and poked where it should have been, and voila, it went in. And she admitted later that she couldn't see a dang thing, she was just giving it a try.

I got a UTI after I had my baby from the Foley. I know the nurse who put it in, and I've worked with her many times, so I know how good her technique is. I think cath care while the Foley is in is essential, and I think it falls by the wayside. I don't blame anyone for my UTI, it is just a risk of having a Foley. Your job as the nurse is to do your absolute best to maintain sterility at all times in the way that works best for you. And never, ever, be too shy to ask someone to come in and hold for you, especially if you have a huge patient! That can really help you clean the area well and stay sterile, if you can completely visualize the urethra.

[monkeybug]

Oh, one more good tip. If you put the Foley in the lady parts, leave it there, go get a new one and start over. If you leave it there, you will not put the second one in the lady parts. And don't ever, ever, ever send a patient to surgery with a Foley if you don't have at least a drop of urine in the tube. Nothing ticks an obstetrician off more than to make the initial incision for a cesarean only to see the bladder come inflating out like a crazy balloon because the dang floor nurse put it in the lady parts and just assumed all was well. I was circulating that c-section, and after I reminded everyone in the room that had to stand around waiting while I replaced the Foley that I was NOT the one that placed it, a couple of nurse managers (mine and theirs) got an irate phone call from me, followed by one from the doctor. You might possibly not see urine if they are really dehydrated or just voided, so that's why you need to tug on it. If it's in the lady parts a gentle tug will pull it out.

[sauconyrunner]

Oh, one more good tip. If you put the Foley in the lady parts, leave it there, go get a new one and start over. If you leave it there, you will not put the second one in the lady parts. And don't ever, ever, ever send a patient to surgery with a Foley if you don't have at least a drop of urine in the tube. Nothing ticks an obstetrician off more than to make the initial incision for a cesarean only to see the bladder come inflating out like a crazy balloon because the dang floor nurse put it in the lady parts and just assumed all was well. I was circulating that c-section, and after I reminded everyone in the room that had to stand around waiting while I replaced the Foley that I was NOT the one that placed it, a couple of nurse managers (mine and theirs) got an irate phone call from me, followed by one from the doctor. You might possibly not see urine if they are really dehydrated or just voided, so that's why you need to tug on it. If it's in the lady parts a gentle tug will pull it out.

good tips. and a pregnant lady going for a C section should not be so dehydrated that there is no urine, though I guess it could happen...

[bubblejet50]

I got a uti when I was in labor and they straight cath'ed me. (i waited for the epidural until I was 6cm) my first attempt at cath'ing a female was a labor patient and if you take your time (dont spend an hour down there tho!) and find what you are looking for its not hard. Just when you find your landmarks go quickly. Its guna hurt if they do not have an epidural and pain equals squirming. This can cause you to miss also.

[nursel56]

As a general rule, initiating a discussion about the necessity of a component of a procedure while attempting to demonstrate that procedure for your instructor is not going to result in anything good from the student's point of view.

It's true that there are many ways of approaching a task depending on the nurse's preference, you still need to do it their way when you are a student. It takes practice to keep sterile technique, so perhaps she was evaluating that along with the rest of it.

I remember when I was fairly new one day my arm brushed the corner of a sterile field prior to the removal of a sebaceous cyst, my supervisor flipped out, rolled her eyes and huffed off to get another kit. I felt like such an idiot but it certainly improved my contamination awareness.