As a student nurse (many years ago) in a bachelor's program the opportunities for writing case studies, care plans and memorizing side effects of medications far outweighed the opportunities to practice basic nursing skills. Always remember to first consult the nursing clinical policy and procedure book at the facility where you are learning however, These steps are fairly basic ... good for many facilities. Read, Practice on a doll or manikin (If you have one) then "Go for it"
Go to the patient's chart and review the physicians order. Even if the nurse who told you about this order gets a bit "cool" towards you, remember that they are human too. Remember, you worked hard for your license, so protect it! Now, write out the laboratory slip, place it in the outside pocket of the lab bag then write with magic marker on the specimen cup the pertinent information. That way you don't have to worry about contaminating your pen if you write on the cup after you collect the specimen!
!) Gather your supplies. Double check your supplies. There is nothing more frustrating or intimidating than to get halfway into something and then have to stop just to go back to you chart and get something small like a Q Tip!
Enter your patent's room politely by knocking and calling out a greeting including your name as a way of announcing yourself. Explain the procedure to your patient and provide patient privacy by closing curtain over windows and pull privacy curtain itself around bed.
Place your supplies on the overhead table, open your garbage bag and set it on the end of the bed or on the floor depending on the facilities policy. Now tell your patient that you are going to wash your hands, this is very important; this lets your patient know that you know the best way to prevent the spread of any infection is to...What? Right, go wash your hands.
Scrub your hands for 15-20 seconds with soap and water, letting the water stay running the tire time. The CDC says this is enough time to kill bacteria on your hands; besides you can use this time to go over the steps of the procedure you are about to perform.
When you come back to the patient's bedside you will begin to set up your sterile field, remember to open all items away from you, do not tear open items, and pull apart on the edge or on the dotted line. Even though you did the correct patient right steps at the nurses’ station, do it again. Double check your paperwork; starting with R's, right patient, right MD order, right site, right date, right time, right type
Verbalize every step as you are performing each step/this is a good to keep your patient calm as well as to keep your hands steady! And the more often you speak the steps out loud the easier it will be to continually perform the correct steps in the correct manner every time
The correct steps, the ones that will rarely vary from one facility to the next are as follows after you have washed your hands: Open sterile catheter kit, Remove sterile field maintaining aseptic technique and place in between the patients legs which are opened but patient is still draped for privacy, only the specific part of the body necessary for the procedure should be visible to you. Do not touch the bed, the sheets, the patient, if you do you will contaminate it all and have to get new sterile gloves, wash your hands, do everything all over again so be careful!
Remove catheter from plastic sleeve and drop onto sterile field, Don sterile gloves correctly, Open betadine packet or Chloroseptic packet, place swabs on sterile field next to catheter, open lubricating jelly packet, place end of catheter into packet of lubricating jelly, Decide now which hand will be clean and which hand will remain as sterile as possible. If you are right handed you may find that being on the patient’s right side of the bed with the overhead table facing the head of the bed will work well for you. Regardless of whether catheterizing male or female the next step is the same. With both hands, both still as sterile as possible at this time pick up the cath box with all items inside by the inside. Not as hard as it sounds, place both hands, palms down, into the box, spread your fingers, no you have a grip on the inside of the catheter box and you can lift it up and set it between your patient's legs.
Instruct your patient as you are doing all of this that you have now made him/her your assistant. Their job is to keep from touching or moving or knocking over that catheter box. This is also the time to start speaking your steps to your patient. It lets your patient know what is about to happen so they stay calm, and the more times you say the steps out loud the more likely you will be to actually perform the steps in correct order every time.
With your unsterile or dirty hand pick up the penis of the male patient and hold it at 90 degree angle or spread the labia of the female patient so you can see the meatus. Remember, male or female, the unsterile hand does not move from this point on, its' job is to keep the meatus visible and keep it from preventing contamination of the catheter as it is being inserted as that would make the UA results false.
With your sterile or cleanest hand each into the catheter box, for the swabs. I cannot hold the packet with my left hand; keep the labia open and meatus visible and swab the meatus of male or female without contaminating. I have to use one swab at a time, being careful not to touch anything but the tips of the cleaning swabs, and dropping the dirty swab into the garbage bag.
I swab down with one swab down either side of the meatus, then the last one right down and directly over the meatus. Remember to drop the dirty swab onto the sterile drape you placed in front of the patient and not behind the cath box, that would mean you crossed over your sterile field and contaminated it remember Ghostbusters "Crossing the streams...I thought you said crossing the streams was bad Russ..."
Still with cleanest, sterile, gloved hand reach into your cath box and take out the catheter, curled into a ball with the end inside the open specimen cup. This is a bit awkward as well; remember you only need 10 ml for a UA, only 30 ml for a C and S.
For a male you may need to insert the catheter to the hub before any urine is obtained, for a female you should see urine flow when you 2-3 inches inside the meatus
Once you have enough for the specimen in your specimen cup you can empty your patient’s bladder the rest of the way or withdraw the catheter. Withdraw the catheter, warning patient first. Try saying "OK, count to three, one, and two and then on three withdraw the catheter.
Reassure your patient; set aside the specimen cup with the top securely closed... spilling the catheter cup in front of your patient is bad! Now pick up and put up. Tidy your patient first, betadine and Chloroseptic are both chemicals, do not let this stuff remain on your patient’s skin or their skin may be burned!
Again, provide privacy, ask patient if door can stay open and let the patient know that UA may come back in 24 hours; if a culture is done it takes 72 hours to know the results and the physician may or may not start the patient on an antibiotic right away This is also the best time to instruct your patient on the signs of a urinary infection, ways to manage or prevent infection, starting with hand washing and how the infection may be treated according to the physicians orders
barbara bethard
barbara bethard
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