Proper Procedure for Catheter Insertion Spokane Community College

November 13, 2013

Proper Procedure for Foley Catheter Insertion

Prevention of nosocomial infections should be a top priority in every nurse’s plan of care; one way of doing this is to be sure that aseptic technique is being used when necessary. This paper will discuss the proper procedure for the insertion of straight and indwelling catheters and whether or not staff are correctly following it. To do this I will discuss the procedure set by Deaconess/Valley Medical Center and The Center for Disease Control (CDC) and compare them to the procedure that I watched the staff nurse perform during my capstone rotation.
For my capstone experience I spent 55 hours on the Labor and Delivery Unit at Valley Hospital. The role of the nurses on this unit was to provide care for ante partum, laboring, and post partum moms by using the nursing process of assessing, implementing, planning, and evaluating. During my time there all of the patients that were seen on the unit were females varying in age from 20 to 40 of varying race, religion, and socioeconomic status.
The policy/procedure that I chose to observe was “Male and Female Bladder Catheter Indwelling and Straight” (Nursing and Infection Control, 2011). The purpose of the policy is “to outline the nursing responsibility for insertion of urethral catheter: indwelling and straight” (Nursing and Infection Control, 2011) ensuring that all nurses are using the appropriate practice and maintaining patient safety and preventing unnecessary infection. There were a few reasons I wanted to use this procedure, one was because the majority of moms on the unit either had an indwelling catheter placed after they were given an epidural or spinal or were straight cathed following an epidural, and also because a lot of nosocomial infections are caused by the improper placement of catheters.
Once I decided on the policy/procedure I wanted to observe I went on the hunt to find it. I asked one of nurses where they were located and she informed me that they could all be found on the computer, so I sat down and started looking on the website. After awhile of looking and still no luck I asked one of the nurses I was working with on the unit where on the website the policies and procedures were located and she didn’t know. Another nurse on the floor, which was who I observed perform the task, was sitting at the computer next to me and I asked her where to locate the policies and procedures and she walked myself and the other nurse through finding what I needed. The information wasn’t difficult to find once I was shown how to get there and I’m sure I would have found it eventually on my own, but being unfamiliar with the system definitely delayed the process.
The hospital website has all of the documents available for the staff to print when they are needed, but I do not believe they were distributed to them. Both the nurses that helped me locate the policy, the one I observed perform the task and the one who was unfamiliar with where the policies could be found, had never looked at that specific outline on catheter insertion. Based on that I am assuming that when they started working at the facility the policies were available but were not necessarily distributed to them directly.
When comparing the policy from the CDC with that of Deaconess and Valley Medical Center the key points that were listed by the CDC were all mentioned in the policy written by the hospital. The CDC (2009) states that hand hygiene must be performed before and after the procedure, only people who are trained should perform this task, sterile gloves, sponges, drapes, and a single-use lubricant package should be used, and the catheter should be secured after the procedure. The hospital policy goes more into detail by discussing how the patient should be positioned, how to cover the patient, how to prepare equipment and where to place it during the procedure, how to clean the male and female areas, how to insert the catheter and how far, and what to document on the patient record. In my opinion the outline from the CDC leaves the nurse to make adjustments based on personal preference, which could make the patient susceptible to infection, but with the hospital policy the outline gives detail for both for men and women and helps ensure that aseptic technique is being used every step of the way.
After observing the RN insert an indwelling catheter on a women and looking over the policy the only thing I saw that she deviated from was securing the catheter to the patient’s leg. After we left the room I sat down and talked with the nurse about the procedure and asked her why she didn’t use a stat lock to secure the catheter and she said, “the catheter is going to be in for such a short amount of time that it really isn’t necessary” (E. Jones, personal communication, October 21, 2013). She then explained to me that the catheters are only left in until the moms are ready to push and since this mom was almost fully dilated when she got her epidural it wouldn’t be in for an extended period of time.
Once I am an RN it will be my responsibility to ensure that patients are safe by following the proper procedures and by making sure that other nurses are following procedure. If I were to witness unsafe practice the initial response that I would take would be to tackle the person doing it…just kidding! The first thing I would do would be to respectfully confront the person and recommend that they look over the policy so they can make the proper adjustments in their future practice. If that was unsuccessful I would go and talk to the next person up, either a charge nurse or unit manager, and let them know the situation and that an attempt was already made to correct the issue.
When evidence based nursing practice is implemented at the bedside patients can be sure that they are receiving the best care and nurses can be sure that they are doing everything they can ensure that their patients are cared for. When using the most current practices, hospitals can care for their patients in not only a safe manner, but also a timely manner, which is good for everyone across the board. It also helps prevent patients from returning to the hospital with issues that were not properly resolved before they left or returning with new problems that might have developed during their stay. However, the challenge to implementing evidence based nursing practice is that in order for it to work people have to stay up to date on what the newest practices are. People learn how to perform tasks a certain way and they tend not to deviate from that, even if it’s not the safest or most efficient way.

References
Agarwal, Rajender K. Gould, Carolyn V. Kuntz, Gretchen. Pegues, David A. Umscheid, Craig A (2009). Guideline for Prevention of Catheter-Associated Urinary Tract Infections 2009. Atlanta, GA: Centers for Disease Control and Prevention.
Nursing and Infection Control (2011). Male and Female Bladder Catheter Indwelling and Straight (C-3). Deaconess Medical Center.