Sterile technique/Foley question

[Libby1987]

I swear I've done a search but maybe I've missed it.

I have a question re changing a foley when the supplies come in separate pkgs ie we have the insertion tray, the catheter and the bag in their own separate pkgs, not the all in one kits where you can put on your sterile gloves and then handle all of the supplies inside the tray maintaining sterile tech.

(And all of the videos I can find do not include removal of the old catheter or using supplies in separate pkgs and the threads I've found here involve using a single complete kit)

I was training a new hire in setting up for a catheter change which got me talking to one of our other seasoned nurses and found that we aren't setting up and using the same process.

Can you tell me how you set up your field incl the process for laying out the catheter. ie do you put the catheter in the tray or connect to the bag before insertion. And how do you handle the catheter and packaging while maintaining sterile tech?

Thank you.

[Wayne876]

Im a nursing student, but my hospital uses instruments from different packaging from time to time when kits run out. The package normally comes sterile from within another wrapping of sorts. What the nurses there do is set up a sterile field on the patients bed, then pull the tray relatively close but not into the sterile field. They then open the unsterile package with non sterile gloves, apply sterile gloves, remove the sterile material from that area and quickly bring it to their base sterile field and continue working from there, its literally a BAM-BAM scenario. And i believe that is in accordance to the facility's policy. I hope this helps! Maybe check with your nurse manager or nurses from another unit....

Also, in school, were taught to connect to bag in the sterile field first before insertion. Just in case the patient has had urine retention for a long period of time and the urine starts rushing out on insertion. Be sure to note if the bag is closed all the way before starting the procedure. Everything that comes inside the packaging is sterile so as long as you don't bring any materials that aren't sterile into the field, you can manipulate the catheter and materials any way necessary for you to get the procedure done. Let me know if you need more detail on the whole procedure of inserting a cath using sterile technique.

[kidzcare]

Have another nurse or aide with you to open the package while you take out the sterile items while wearing your sterile gloves. My part time job is in a rehab/LTC facility and if I need to cath a woman, I usually have someone with me to help with positioning

[Libby1987]

This is home health so no chance of having help and there is no policy addressing the specific aspect in question.

The main aspect that we differ on is how we get the catheter out of the pkg and where we put it. This is how I've worked it out..

with clean gloves

take drainage bag out of pkg

remove catheter from outer pkg

slide back inner sleeve to expose cath open end

remove end cap from drainage tubing and connect to cath (which is still in it's inner sleeve)

position patient with towel or chux

remove existing catheter and dispose (double bag policy)

with new clean gloves

open tray and remove sterile gloves...

here's where we differ:

other nurse then dons sterile gloves and sets up sterile field, I've got that part but then she puts the catheter in the tray (that has been laying in its inner sleeve on a clean paper towel and unattached to the bag). I'm stuck on how she handles the catheter from it's sleeve while wearing the sterile gloves.

What I do:

with clean gloves grab edge of sterile drape (folded inside of the tray, not wrapped around, our trays don't come like that)

lay out next to patient for supra pubic or under hips for urinary

pick up catheter holding onto sleeve and drainage tubing and slip off sleeve and drop onto sterile drape without touching anything

bring tray to distal end of drape

put on sterile gloves

reach into tray and pull out betadine sticks and lube etc and start procedure

That's what I've worked out when I had to start using these separate pkgs versus the complete trays which I set up traditionally.

Neither are absolute perfect tech IMO but I don't have an incidence of UTI's in patients with no hx but I don't want to confuse our new nurses (who btw aren't coming with solid sterile tech despite varied experience so I have to teach them)

How would you do it under the same circumstances?