sterile technique q for foley insertion

[allthesmallthings]

Hi, there. The meat of my question is: after skin has been disinfected and air-dried, is it considered sterile?

I admit, I struggle with Foley catheter insertion in women - particularly obese / CVA / poorly able to open their legs and position themselves women. I work in home health, so I don't necessarily have another person available to help me position these women. So it can be a bit of a struggle to get the Foley in while maintaining sterility. ? I used to think that if my Foley catheter touched the (betadined and air-dried) skin of the labia while I'm trying to get it in, then I have to call it contaminated and re-start with a new Foley.

Then I started thinking about if that's really true. For example, of course doctors  contact skin in surgery, scalpel-ing through betadined skin. And when I get the Foley right in that darn little urethra, I've passed at least the edges of the catheter on the (betadined) edges of the urethral meatus, of course. My dad, who's a retired infectious diseases doctor, says that disinfected and air dried skin is sterile. 

So - that Foley catheter that touches the disinfected labia is still considered sterile? Right? Right? ? 

(For that matter, is it still sterile technique for sterile gloves or sterile materials to touch disinfected and air-dried skin while performing PICC dressing change, or portacath accessing?)

 

Thanks!

[Hannahbanana, BSN, MSN]

You’re correct. Betadined surfaces are considered OK and not contaminating for purposes of Foley insertion or incisions. 
You could try the side-lying position for obese or otherwise hard to visualize field— check it out online. 

[Rose_Queen, BSN, MSN, RN]

On 6/30/2021 at 11:01 AM, allthesmallthings said:

after skin has been disinfected and air-dried, is it considered sterile?

Technically, skin is never sterilized. The purpose of skin antiseptics such as betadine is to reduce the organisms a set logarithmic amount. (If you want to know how much, the FDA requires certain log reductions based on area for the antiseptic to be approved but I don't have a handy link for that.) But yes, as long as you aren't entering unprepared areas (please don't do what I've seen done where nurses inserting the foley hit the wrong spot and then, instead of leaving it as a marker and getting a new one, pull it out and aim for the meatus again with that same catheter ?), it is OK for the foley to touch the prepped skin.

[allthesmallthings]

1 hour ago, Hannahbanana said:

You’re correct. Betadined surfaces are considered OK and not contaminating for purposes of Foley insertion or incisions. 
You could try the side-lying position for obese or otherwise hard to visualize field— check it out online. 

Wonderful. Succinct, Ms. Banana.

1 hour ago, Rose_Queen said:

Technically, skin is never sterilized. The purpose of skin antiseptics such as betadine is to reduce the organisms a set logarithmic amount. (If you want to know how much, the FDA requires certain log reductions based on area for the antiseptic to be approved but I don't have a handy link for that.) But yes, as long as you aren't entering unprepared areas (please don't do what I've seen done where nurses inserting the foley hit the wrong spot and then, instead of leaving it as a marker and getting a new one, pull it out and aim for the meatus again with that same catheter ?), it is OK for the foley to touch the prepped skin.

Sounds good. Wow, someone who uses the word log!  

[Hannahbanana, BSN, MSN]

14 hours ago, allthesmallthings said:

please don't do what I've seen done where nurses inserting the foley hit the wrong spot and then, instead of leaving it as a marker and getting a new one, pull it out and aim for the meatus again with that same catheter ?)

I used to teach students to aim high — in a lot of women, the privy parts can resemble a urethra, especially to naive students who haven’t seen a lot of them — and if you discover that’s not it, you can slide posteriorly over the prepped area until the next likely candidate, which is probably what you’re after. You’ll hit that before you get lost in a lady parts and have to start over with a new cath. 

[allthesmallthings]

On 8/12/2021 at 9:24 AM, Hannahbanana said:

I used to teach students to aim high — in a lot of women, the privy parts can resemble a urethra, especially to naive students who haven’t seen a lot of them — and if you discover that’s not it, you can slide posteriorly over the prepped area until the next likely candidate, which is probably what you’re after. You’ll hit that before you get lost in a lady parts and have to start over with a new cath. 

?  Thank you

[vampiregirl, BSN, RN]

Head lamps are super helpful for lighting in home health/ hospice:)

[allthesmallthings]

I was about to laugh...but then I thought, Its So TRUE. Not funny....but TRUEEEEE.  I want a headlamp!

[vampiregirl, BSN, RN]

20 minutes ago, allthesmallthings said:

I was about to laugh...but then I thought, Its So TRUE. Not funny....but TRUEEEEE.  I want a headlamp!

Oh, I'm I've been laughed at - by patients and family members! But sometimes that lightens the mood and builds rapport, especially if it is a smooth catheter insertion.

Catheter insertion can be uncomfortable both physically and as well as from a dignity standpoint for the patient. And is an infection control high concern for nurses. If my goofy headlamp benefits both the patient and the nurse, I'm good with that!