2. Mini-lecture for Students

3.  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!!!)

4.  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

5. 1. Put on sterile gloves 2. 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

6. 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

7. 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

8. 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=gcVzgOV dpU0

9. 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

10.  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.

11. Mini-lecture for Students

12.  Goals: › Minimize number of skin microbes › Remove dirt/oil  Two mechanisms of action: › Mechanical (rubbing skin to remove contaminants) › Chemical (antiseptic)

13.  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

14.  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

15. Skin prep pattern for c-section, where surgical site is a Pfannensteil incision Chlorhexidine abdominal prep

16.  Prep surrounding area first and contaminated area last  Contaminated areas: › Mouth › Nose › Vagina › Rectum/anus › Stomas

17.  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”

18. 1. Put a scrub sponge stick in the vagina 2. Use different sponge to scrub the surrounding skin 1. Start with urethra 2. Move to pubis/thighs 3. Perineum 4. Rectum LAST 5. Discard sponge after touching the rectum 3. Thoroughly scrub inside of vagina with sponge stick, then discard

19. 1. Place sponge stick in the vagina

20. 2. Different sponge used to prep urethra, pubis, thighs, perineum, rectum last. Then discard this sponge.

21. Twirl sponge stick around 3. Sponge stick used to scrub inside vagina, then discard sponge.

22.  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