Foley Catheter;Skin Prep for Vaginal SurgeryGynecology Mini-Lectures for Students

Foley Catheter InsertionMini-lecture for Students

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--Prep1. 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

DrapeFoley kit

Sterile pathway

Foley insertion--Prep3. 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--Prep4. 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--Prep5. 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 insertion6. 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.

Skin Prep for Vaginal SurgeryMini-lecture for Students

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 vagina1. 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

1. Place sponge stick in the vagina

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.

Of note If abdominal surgery is also being

performed, the abdomen is prepped separately from the vagina, usually afterwards› This avoids contaminating the abdomen

with possible splashes from the vaginal prep