Urinary Catheter

There is not a live patient for this skill demonstration. You will need to use the side of the modular skills trainer that is created as female genitalia. Position it with the female genitalia side of the box on top. Place it on a separate surface or away from your sterile field area. Use a stuffed animal in a blanket as well to make a patient to talk to and provide privacy with the blanket. Enter your female patient's room after knocking. Perform hand hygiene (can be hand sanitizer). Provide privacy by closing the room door and bedside curtain. Introduce yourself and explain the procedure. Position the patient to a supine position with their legs bent at the knees with the knees pointing outward and the feet spread apart. If your stuffed animal does not have legs that can do this, please motion and describe this step. Their legs need to be uncovered from the waist down. Remember to tell the patient about each step before you do it. Apply clean gloves. Stand on the side of the patient's bed that you are dominant handed. Clean the perineal area with no-rinse soap and dry (Use the washcloth and towel. You do not need to have actual soap and water). Remember to follow the correct hygiene care directions and clean and dry the patient's perineal area in an anterior to posterior direction using a different part of the cloth or a new cloth for each swipe. With these gloves still on, carefully examine the patient's perineal area, open their labia, and look for and identify urinary meatus. Remove and discard gloves. Perform hand hygiene (can be hand sanitizer). Open the outer wrapping of the catheterization kit. Fold this outer wrapping open to make a small trash bag and place it near the patient's hip, but away from the sterile field. Place the inner wrapped catheter kit tray on a clean, dry, accessible surface such as a bedside table or, if possible, between the patient's open legs. Be sure to give yourself room to open the sterile flaps without touching the patient. Open the inner sterile wrap covering the tray that contains the catheterization supplies using sterile technique. Fold back each flap of sterile covering one at a time with the last flap open towards the patient. Do not touch anywhere inside the sterile field. If needed, put your hands under the sterile wrap and pull gently to help it stay open. Pick up the sterile gloves that are on top of the kit, only touching a small area to pick it up and set it on a clean, dry surface near the patient, or open it carefully on top of the supplies. Be sure that you do not touch anything in the kit while doing this, or your kit is no longer sterile. Also, do not turn your back to your sterile field. Carefully open the sterile gloves and apply them as you learned in the Hand-washing and Sterile Gloving video. Pick up the bottom flat drape and gently shake it to open, only touching two connecting corners. Pick up the corners of one side of the drape on the not-shiny side with your thumbs and first fingers with your palms facing you. Keep holding the drape. Turn your hands in towards the drape. This covers your sterile gloved hands inside the drape. Ask the patient to lift their hips and carefully slide the drape under their buttocks, again making sure that your sterile gloves remain sterile. Pick up and shake gently to open the fenestrated drape. Place this drape with the opening in the drape over the patient's perineum, keeping gloves and the working surface of the drape sterile. Do not touch the patient. Be sure that both drapes have the shiny side down as this is the waterproof side that will keep the area clean. Arrange remaining supplies on the sterile field, maintaining the sterility of gloves. Open the lubricant package and place the lubricant on the tray. Open the alcohol swabs and place them on the sterile tray. Take the lid off and attach the prefilled syringe to the indwelling catheter balloon inflation hub. Pull out the top portion of the catheter from the box. Open the plastic piece on the foley catheter part and place the catheter tip into the lubricant and lube the catheter. Place the sterile urine container on the sterile drape with the lid loosely on top. Explain to the patient that you are going to touch her perineal area and clean her, and that it will probably be cold. Remind her that it is a sterile procedure, so you need her to stay still. With your non-dominant hand, go into the patient's labia and spread them open. Visualize the meatus. This hand will stay here. With your dominant hand, use the alcohol swabs one at a time to clean the patient's meatus. Go in an anteroposterior direction using one cleansing swab for each wipe downward. The first swab cleans the side of the meatus away from you. The second swab cleans the side closest to you. The last swab goes right down the middle over the meatus. Be sure that you are looking at this area for the wink, which is when the betadine covers the meatus and then pops open. This helps you know where the meatus is and where to insert the foley catheter tubing. We use alcohol swabs, as the betadine stains the supply box. When you are done with each swab, place it inside your clear outer wrapping bag without touching the bag with your sterile gloves. Be very careful not to bring the dirty swab over your sterile field to dispose. Grasp the catheter firmly five to seven point five centimeters (two to three inches) from the lubricated tip with your dominant hand. Ask the patient to take a slow, deep breath and exhale slowly. Insert the catheter as the patient exhales. Maintain sterility and continue to insert the catheter quickly. Look at the catheter tubing for urine to appear. Advance the catheter another five centimeters (two inches) after you see urine. This whole time, the non-dominant hand has continued to hold the labia open. With your non-dominant hand, hold the catheter to stabilize at the opening of the meatus. Use your dominant hand to carefully inflate the balloon with the fluid filled syringe on the balloon port of the catheter. Push the entire syringe of fluid in without it leaking or coming off too soon. Take the syringe off the balloon port when it is empty. If you do not take the syringe off, it will fill back up, which means that your balloon will not be fully inflated. Note that the balloon port has it printed as to how much the balloon will hold. Pull back on the Foley catheter tubing gently until you feel resistance and then stop. Break the fenestrated drape and use it to clean the patient's perineal area around the catheter. Remove all excess betadine or lube that remains. Remove all the supplies except the foley catheter and bag, including the sterile field, and put it in the trash. Attach the catheter to the patient's leg with a securement device. Just explain. Hang the catheter bag on the patient's bed below the patient. Remove gloves and perform hand hygiene (Can be hand sanitizer for the video only). Return the patient to a comfortable position. Instruct the patient on positioning and moving with the catheter in place.

Now that the catheter is in, do you have any discomfort?

No discomfort. I'm feeling good.

Alright. I'm gonna go ahead and document now.

Okay.

Thank you.