Straight cath in MD's office

[delphine22]

This might sound like a strange question, but when a nurse (let's be honest, a medical assistant) performs a straight cath for a urine sample in an MD's office, are they expected to use the same sterile technique I've been taught to insert a Foley in the hospital?

Saw a male family member straight cath'd in the office (not a urology office) and was horrified that the person used clean (not sterile) gloves and even used her gloves to wipe off excess lube from the catheter before insertion. She moved so fast I wasn't able to stop her, or I would have literally ripped it out of her hands before she put it in my family member.

Thankfully there was no UTI. But before I mention to the MD at next appt that he might need to inservice his staff on proper sterile technique, am I overreacting, or should I expect it to be just as strictly sterile as it is in the hospital?

[CrunchRN, ADN, RN]

In the Ob/Gyn office we always used sterile technique. How else do you ensure a good sample? In home care I know they use clean technique, but that is different........

[Anna S, RN]

I don't think you're overreacting. Sterile technique should always be used.

[bugya90, ASN, BSN, LVN, RN]

I'm a nurse in a family practice clinic. Our medical assistants are not allowed to cath as it is out of their scope. Only licensed nurses can and we use sterile technique. You need to inform that persons supervisor. Depending on the clinic her supervisor may be the charge nurse or the MD she is working under.

[delphine22]

In the Ob/Gyn office we always used sterile technique. How else do you ensure a good sample? In home care I know they use clean technique, but that is different........

The sample was for a tox screen (it was a pain management office), not a UA or culture, so that might make a difference. But to me, I'm more concerned about my family member's risk than the integrity of the sample!

[jonorato]

I'm a nursing student who spent her first 5 yrs as a CMA in a top 10 nationally ranked urology office. :)

We ALWAYS used sterile technique. I do not think it's out of line at all to ask for an inservice. People get lazy or trained wrong. I shudder to think of the lecture that I would've gotten if my surgeon, lead nurse, or boss saw me do that...which I wouldn't do.

@bugya90 straight cathing is most certainly not out of our scope. We are taught sterile technique. I have performed more straight caths, placed more indwelling foleys, suprapubic catheter changes, performed CBIs, etc then I care to admit to. We assist with minor surgical procedures that require sterile technique all the time. During vasectomies I was right in there with the surgeon acting like a scrub tech. I can't tell you how many different types of "sterile"/clean (i call them clean b/c they're done in the office). I've even gone to the OR to help with difficult prostate biopsies b/c the OR nurses weren't trained on them & the surgeon requested it.

CMAs can do A LOT of clinical interventions. (sorry if I sound defensive or full of myself...I had my nursing program tell me I had to get my CNA 1 b/c "how much clinical experience can you say you really have as a CMA?" I was completely offended. I would've been more receptive to something along the lines of, "there are a couple of skills you need to learn that are different from your CMA skills"...bedpans & linens. I am just really proud of all that I've learned as a CMA over the years.)

Now that being said, it is up to the discretion of the physician as to what they are willing or want to let CMA's to do since we operate under their license. (a physician must be present in the office in order for us to even take vital signs)

[bugya90, ASN, BSN, LVN, RN]

It is out of their allowed duties per our facility policy (large multi hospital organization with over 100 outpatient clinics in the system). Our CMAs are not allowed to do any sterile procedures or give injections to anyone under 12. CMAs don't really have a "scope" per say as they're not regulated by an agency like the BON or AMA. Scope may have been the wrong choice of words on my part.

[Nurse Sasha]

I think you would be justified in discussing this with the physician at the next visit. This is not acceptable care in my opinion, certainly advocate for your family member as well as the other patients who are subjected to this sub standard practice!