General principles
There are a lot of preparation steps before you actually insert the catheter
The catheter must remain sterile at all times› The hand holding the catheter
must also remain sterile Usually your dominant hand
In order to spread the labia, you must “contaminate” one of your hands› Usually your non-dominant
hand› Make sure everything is
prepared before you do this!!!
Foley bag (ok if it gets un-sterilized)
Catheter (must stay sterile!!!)
Foley kit—important items
Sterile gloves Iodine prep:
› Could be iodine-soaked sticks OR
› Prep solution, cotton balls, forceps
Lubrication› In a syringe OR› In a package
Foley catheter with bag attached
10mL syringe with saline to inflate balloon
Sterile sheets
Foley insertion--Prep
1. Put on sterile gloves2. Place drapes to ensure a sterile
pathway from foley kit to patient
Source: Southern Adventist School of Nursing, “Southern Nursing Skills—Foley Catheter.” https://www.youtube.com/watch?v=gcVzgOVdpU0
Drape
Foley kit
Sterile pathway
Foley insertion--Prep
3. Get everything ready› You have to do this
because in the next step, you will un-sterilize one of your hands
› Attach 10mL syringe to foley and test balloon
› Pour iodine onto cotton balls (if needed)
› Pour lube into tray
Source: Southern Adventist School of Nursing, “Southern Nursing Skills—Foley Catheter.” https://www.youtube.com/watch?v=gcVzgOVdpU0
Foley insertion--Prep
4. Use your non-dominant hand to spread the labia minora.
› This hand is now un-sterile!
› Keep your hand there until foley is placed
› Make sure you can distinguish the urethra from the vagina
› Sometimes you have to use a lot of force—especially if a patient has a lot of extra tissue
Source: UpToDate, “Surgical Female Urogenital Anatomy.” http://www.uptodate.com/ contents/ surgical-female-urogenital-anatomy?source=search_result&search=f emale+perineum+anatomy&selectedTitle=1~150
Identify the clitoris and then look
posteriorly. Don’t confuse urethra with
vagina.
Foley insertion--Prep
5. Prep the urethra with iodine sponge sticks or cotton balls› Prep three times› Anterior to
posterior› Discard used cotton
AWAY from sterile field
Source: Southern Adventist School of Nursing, “Southern Nursing Skills—Foley Catheter.” https://www.youtube.com/watch?v=gcVzgOVdpU0
Foley insertion
6. Insert the foley› Don’t put it in
the vagina› Insert until you
can see urine in the tubing (usually 4-5cm)
7. Fill the balloon› This can be
done with your un-sterile hand
Source: Southern Adventist School of Nursing, “Southern Nursing Skills—Foley Catheter.” https://www.youtube.com/watch?v=gcVzgOVdpU0
Sterile hand Un-sterile hand
Secure the foley
Secure the foley, usually with a statlock
Source: Bard Medical
Attach to patient’s thigh. Catheter should have some slack.
The stat-lock has two grooves. One is larger and one is smaller. Make sure the larger tube goes in the larger groove.
General Principles of Skin Prep
Goals:› Minimize number of skin microbes› Remove dirt/oil
Two mechanisms of action:› Mechanical (rubbing skin to remove
contaminants)› Chemical (antiseptic)
Types of Antiseptics
Provodine-Iodine› Very irritating—needs to be removed after procedure› Possible allergies› Rapid effect, lasts only ~30 minutes
Chlorhexidine› Less rapid effect, but longer-lasting (3-4 hours)› Usually in a solution with alcohol› Generally, it shouldn’t be used in the vagina (irritation,
possible desquamation). These effects are likely due to high alcohol content.
Alcohol› Flammable› Very irritating in the vagina
General Principles of Skin Prep
Start at the surgical site and move outwards in a circular motion
Do not go back Include an area
that is larger than the surgical site
Abdominal skin prep pattern for laparoscopy, where surgical site is the umbilicus
General principles of skin prep
Skin prep pattern for c-section, where surgical site is a Pfannensteil incision
Chlorhexidine abdominal prep
General Principles of Skin Prep—Contaminated Areas
Prep surrounding area first and contaminated area last
Contaminated areas:› Mouth› Nose› Vagina› Rectum/anus› Stomas
Skin prep for vaginal surgery
Prep kit will include:› Two provodine-iodine
“scrub” kits Each has two sponges
Sponge stick for the vagina
Sponge or stick for the surrounding skin
› One provodine-iodine “paint” kit Includes two sponges
Sponge stick for the vagina
Sponge or stick for the surrounding skin
Scrub
Paint
The sponges might also come in bags like this that say “scrub” or “paint”
How to prep the vagina
1. Put a scrub sponge stick in the vagina2. Use different sponge to scrub the
surrounding skin1. Start with urethra2. Move to pubis/thighs3. Perineum4. Rectum LAST5. Discard sponge after touching the rectum
3. Thoroughly scrub inside of vagina with sponge stick, then discard
How to prep the vagina
2. Different sponge used to prep urethra, pubis, thighs, perineum, rectum last. Then discard this sponge.
How to prep the vagina
Twirl sponge stick around
3. Sponge stick used to scrub inside vagina, then discard sponge.