Kirstie

I recently changed a supra pubic catheter for the first time----I didn't realize once you pulled the catheter out, the site would continue to drain urine.......needless to say, the patient was a bit wet by the time I got the other catheter in......ooops!!! .......how do you keep a sterile field, if you can't clean the site with betadine and put sterile drape around before inserting new catheter..........because you have to quickly take one out and quickly put the other one in before it voids everywhere? right? The patient plugs the end of his catheter, does not wear a bag...if I opened it up and let the urine drain out, would I have more time to properly insert new catheter? or wouldn't that matter? Kirstie

That's why you go from LPN to RN........more responsibility, more money, ect...........so therefore you are more responsible if something goes wrong because you delegate........you can only delegate to someone you "know" will be able to do the job................if not, do not delegate to them even if they are the only one left..............NOT ME......NOT ME...........NOT ME.....wasn't that in a Family Circus cartoon in the Sunday paper.......apparently at your hospital there are a lot of "not me's" running around!!!!!!!!!!!!!!!!!!!!!!!!!! QUOTE=jkaee]Just my opinion.... When I worked Med Surg (12 hr nights) it was not unusual for me to have anywhere from 10-12 pts, with the ability to accept admits, so I don't think the pt. load is really an issue, as that's the standard ratio in most places I have heard about (whether or not that's acceptable standard of practice is debatable, but not an issue in this case). Also, working in LTC and subacute care, I have been in situations where I'm the only RN in the building, acting as supervisor, and working as a floor nurse on top of that. There is NO way that I can supervise every LPN and every resident. I count on my LPN's to give competent care and to let me know when there's a problem. If they don't tell me, I'm sure as h*** not going to be held responsible JUST because I'm the RN. LPN's are held to their own standards to act as competent responsible nurses. It is not the RN's job to "babysit" LPN's or any staff for that manner. To give an example, I worked with an LPN that "forgot" to tell the RN super if there was a problem with a low blood sugar. In this instance, the pts BS was 40. She did not tell me this when she checked it. I found out about it as I was getting report from all the nurses towards the end of the shift. When I asked her why she didn't call me, she said she just gave him some juice and didn't think it was a big deal. I assessed the resident, who thankfully responded and had normal levels, and talked with the DON. She was subsequently disciplined, although that was not the first time this had been addressed with her. Now, if the resident died from hypoglycemia, or wasn't rechecked, would that be on my head? I had my own wing to give meds to and work on, and if the LPN didn't report it, how was I to know that there was a problem? That's 145 residents that I'm responsible for.....and it's ALL LEGAL staffing ratios, so I can't "refuse" anything, if I do, it could be considered patient abandonment, and I could be reported to the state. It most certainly wouldn't be on my liscence, because the LPN is responsible to call an RN for any changes in pt. status. If she doesn't, or she neglects a resident in any way, that's not on me. I can't supervise a 145 bed facility plus staff every single second of my shift. LPN's, CNA's, techs, etc all have the responsibility to report to an RN for problems. It's their job, and they should be held to it. I think the appropriate action was taken in this situation. The patient died from NEGLECT on the part of the LPN. She had her own assignment, and she was responsible for providing competent care. She didn't, simply put. On the floor for 4 hours??!! Unacceptable conduct! The RN had nothing to do with that. Like I said.....we are NOT babysitters! Sorry for the rant!

Exactly...........RNs oversee LPNs........period!!!!!!!...that's how it is.....you have more schooling, ect......you are in charge when it is beneficial to you and not, when it is not?????????????????????

A feeding tube?????? Are you able to do this with one person....because I need someone to transfer the fluid from 60 cc syringe to the catheter syrine?

When adminstering mitomycin intravesically to patients; I draw it up in a 60-cc syringe and then I have someone else assist to pour the solution into a catheter syringe after I catheterize the patient and allow it to gradually drain into the bladder; is there a better way to do this; safer and so that I didn't have to utilize another person to help? Anyone! With the BCG administration, there is a nice little bottle with adapters so that you don't have to mess with syringes; is there anything like that for mitomycin tx?

I was taught you never inflate the balloon unless you see urine come from the catheter to ensure you are in the bladder, right?

The patient would feel this if this happened, so you should know right away and be able to deflate it and move it in further, right?

The reasoning behind instilling the sterile water before pulling the foley is so you will know you are in the bladder because if the patient has a catheter in place for long-term there will be little or no urine when the foley is replaced, so you will not be "sure" you are in the bladder before you inflate the balloon - that is the reasoning I got anyway and was wondering if anyone else has done this In my A & P book, there is an external and internal sphincter

If a patient has a foley catheter in long-term and you need to change it; how do you know you are in the bladder? Will urine still come out? I was told to put sterile water in the foley before I pull it in to ensure that I am in the bladder because I will have return of the sterile water I put into the bladder, since the urine will be nil to little. Thanks for your help.

I am a new graduate LPN and just started working at a clinic; I have been assigned to work with the Urologist, but I do not have a lot of experience with this field. First, when you change a foley catheter, do you need to instill sterile water into the foley 1st before pulling it, so that there will be return since they have the catheter in all the time and there would be very little or no urine in the bladder to determine if you are in the bladder or not? We were not taught this, but I have heard about from around the clinic. Second, there are two sphincters, right? How do you know you are past both of them if urine will come when you get past the external one? Or will it? Is it possible to inflate the balloon while in between the two sphincters? Any advice would be of great importance.