ALRIGHT, CATHETERS.
WE ARE DOING CATHETERS THIS WEEK.
WE HAVE HAD OUR TUBE THEME HERE GOING
AND SO THIS IS OUR LAST WEEK OF TUBES IF YOU WILL.
AND WE ARE GOING TO DO CATHETERS.
IT'S ACTUALLY THE EASIEST SKILL TO TEST ON.
IT WILL ONLY TAKE US, LIKE, 20 MINUTES FOR THE DAY.
SO JUST COME EARLY, BE PREPARED,
DO YOUR THING AND GO. IT'S REALLY FAST.
BECAUSE WHAT WE ARE GOING TO DO IS I AM JUST GOING TO SEND YOU TO A BED.
YOU DON'T GET A PRE-PICK, I AM GOING TO PUT YOU AT BEDS.
AND YOU DON'T KNOW IF YOU ARE GOING TO GET A MALE OR A FEMALE.
ALL YOU ARE GOING TO CATHETERIZE IS ONE. THAT'S IT.
YOU ARE JUST GOING TO CATHETERIZE SOMEBODY.
WHATEVER IT IS I GIVE YOU. AND THAT'S IT.
AND THEN YOU HAVE A PASS/FAIL STATION TO GO OVER CONTINUOUS BLADDER IRRIGATION.
SO IT'S NOT PARTICULARLY PAINFUL,
IT'S ACTUALLY QUITE EASY.
IT'S A REVIEW OF SOME ANATOMY AND STERILE TECHNIQUE
AND THEN OF COURSE SOME CATHETER CARE.
THE REALITY OF CATHETER CARE IS IT'S HARD ON PEOPLE.
AND IT'S NOT BECAUSE IT'S HARD, IT'S BECAUSE NO PERSON IS ALIKE.
SO I HAVE LOST OF STORIES TO TELL YOU.
HOPEFULLY, THEY WILL STICK IN YOUR MIND,
AND YOU WILL BE ABLE TO DO CRITICAL THINK AND PROBLEM SOLVE
WHEN YOU GET INTO SOME PRECARIOUS SITUATIONS,
PUTTING YOUR FOLEY CATHETERS.
WHAT I AM GOING TO DO TODAY IS I WILL START
AND I WILL PUT A CATHETER IN A MALE AND DC THE CATHETER.
THAT'S WHAT YOU ARE GOING TO DO.
CATHETERIZE. DC.
THEN I WILL GO OVER AND I WILL DO THE FEMALE, SAME THING.
AND THEN WE WILL DO THE CONTINUOUS BLADDER IRRIGATION.
PUT MY STORY STRAIGHT HERE.
ALRIGHT. WE'LL JUST START FROM THE TOP. FOLEY CATHETER.
YOU CHECKED YOUR DOCTOR'S ORDER.
YOU HAVE TO HAVE AN ORDER TO PUT IN A FOLEY CATHETER.
THERE ARE ACTUALLY TWO KINDS OF CATHETERS THAT WE WOULD PUT INTO A CLIENT.
ONE IS A FOLEY CATHETER OR AN INDWELLING CATHETER,
AND THAT'S THE CATHETER THAT GOES IN AND HAS THE BALLOON THAT WE HAVE TALKED ABOUT.
SO YOU ARE FAMILIAR WITH THAT.
THERE IS ALSO WHAT'S CALLED A STRAIGHT CATHETER,
AND IT DOESN'T HAVE A BALLOON.
IT'S A RED RUBBER CATHETER. AND IF YOU JUST PUT THE CATHETER IN,
DRAIN OFF THE URINE TO GET A URINE SPECIMEN
OR TO DRAIN THE BLADDER, TAKE IT STRAIGHT OUT.
THERE IS NO BALLOON TO FILL. IT'S JUST TO GET THE URINE OFF.
SO YOU WANT TO BE CLEAR AS TO WHAT KIND OF CATHETER YOU ARE PUTTING IN YOUR CLIENT AND WHY
SO THAT YOU GET THE RIGHT THING.
YOU WILL HAVE YOUR DOCTOR'S ORDER AND TYPICALLY,
THE DOCTOR DOESN'T SAY WHAT FRENCH TO PUT IN.
NOW CATHETERS ARE IN FRENCHES, NOT GAUGES,
SO YOU PICK THE FRENCH.
AGAIN, WE TYPICALLY GO WITH THE 14-16
AREA OF FRENCH SIZES.
AND YOUR FRENCHES ARE ON YOUR KIT.
YEAH, LET'S SEE WHERE IT IS. RIGHT HERE.
SO FIND WHERE YOUR FRENCH IS AND THEY SHOULD HAVE 16 OR 14,
IS WHAT I ORDERED FOR YOU.
ALONG WITH PICKING MY FRENCH,
I ALSO WANT TO BE AWARE OF THE BALLOON SIZE.
THE BALLOON COMES IN TWO DIFFERENT SIZES.
IT COMES IN A 5 CC BALLOON THAT ACTUALLY STRETCHES TO 10,
AND IT COMES IN A 30 CC BALLOON.
WE TYPICALLY USE LARGER BALLOONS FOR PEOPLE THAT HAVE CHRONIC CATHETERIZATION.
SOMEONE THAT'S INCONTINENT. A STROKE CLIENT...
A PARAPLEGIC.
SOMEBODY THAT'S IN KIND OF -- CHRONIC CATHETER.
IT'S JUST GOING TO STAY AND STAY IN.
WHAT HAPPENS IS THEIR URETHRA GETS STRETCHED,
JUST FROM MOVEMENT AND TRAUMA OF THE CATHETER.
AND SO THE 5 CC BALLOON WILL PULL ON THROUGH SOMETIMES OR THEY WILL LEAK AROUND IT.
SO WE OFTEN PUT A BIGGER BALLOON IN,
SO THAT IT DOESN'T FALL OUT AND IT DOESN'T LEAK.
WHAT YOU NEED TO MAKE SURE AND DO IS WHEN YOU WRITE ORDERS
THAT YOU WRITE 16, 5 CC OR SOMETHING LIKE THAT
SO THAT INSURANCE WILL PAY FOR THE RIGHT CATHETER.
IT IS REALLY CRITICAL IN HOME CARE.
IF YOU PUT IN A 16 FRENCH CATHETER
AND THEN THE CLIENT'S LEAKING AROUND AND YOU ARE HAVING TROUBLE
AND YOU WANT TO GET A BIGGER CATHETER SO THEY DON'T LEAK AROUND,
YOU HAVE TO ORDER THAT CATHETER OR INSURANCE WON'T PAY FOR IT.
SO ALWAYS CALL AND GET CHANGES FOR SIZES IN HOME CARE
SO THAT YOU WILL GET REIMBURSED. THEY WILL GET REIMBURSED.
ALRIGHT. SO I HAVE MY DOCTOR'S ORDER.
I NEED AN INDWELLING FOLEY CATHETER.
IT'S JUST AN AVERAGE FOLEY CATHETER FOR SURGERY
OR FOR SOMEONE THAT'S NOT GOING TO BE ABLE TO GET UP
AND URINATE FREQUENTLY. SO I AM GOING TO PUT IN A 16, 5.
I AM GOING TO GET MY KIT AND MY GATHERING UP OF EQUIPMENT.
AND I JUST LOVE WHEN THERE'S KITS, COS IT'S ALL THERE.
THERE IS JUST NO THINKING ABOUT IT. YOU JUST HAVE TO GET IT.
NOW, I DO WANT TO QUALIFY THAT JUST A LITTLE BIT.
THERE IS TWO KINDS OF KITS.
THERE IS ONE WITH THE CATHETER AND ONE WITHOUT.
WHAT A BUMMER TO PULL THE WRONG KIT
AND BE ALL INTO THE THING AND IT'S LIKE, "OH, SHIT."
YOU KNOW, AND YOU DON'T HAVE YOUR SUPPLIES.
ON THE OTHER HAND, THERE ARE TIMES WHERE
WE HAVE TO GET A CATHETER ON THE SIDE
AND PUT IT WITH THE CATHETER BAG.
AND THAT'S FOR SOMEONE AGAIN THAT HAS A CHRONIC CATHETER
AND THEY HAVE GOTTEN A UNIQUE SIZE.
TYPICALLY, YOUR KITS ARE 16 FRENCH AND 14 FRENCH.
THEY DON'T USUALLY PUT ALL THE UNIQUE SIZES.
THE 18S, THE 20S, THE 22S, THE 24S.
SO YOU HAVE TO GET YOUR CATHETER SEPARATE
AND THEN YOUR KIT WITHOUT A CATHETER
AND THEN PUT THE TWO TOGETHER.
SO, ALWAYS LOOK AND SEE WHAT YOU GOT AND IF IT'S WHAT YOU WANT WHEN YOU ARE GATHERING.
THIS HAS EVERYTHING I WANT TODAY.
BUT SOME THINGS I NEED IN ADDITION TO THIS ARE.
I NEED TO PREPARE TO CLEAN THE PERINEUM
BECAUSE IT'S JUST MUCH MORE PLEASANT.
THINGS ARE CLINGING IN THAT DEPARTMENT.
I ALWAYS BRING A PAIR OF SPARE STERILE GLOVES BECAUSE THINGS HAPPEN.
A CHUX, JUST IN CASE I NEED IT.
AND I NEED TAPE TO SECURE THE CATHETER.
WHEN I WAS DOING CLINICAL AND I WAS GOING WITH STUDENTS,
ONE OF THE HARDEST THINGS ABOUT PUTTING IN CATHETERS,
ESPECIALLY WITH FEMALES, WAS FINDING THE SPOT.
AND SO WHAT I ALWAYS HAD THE STUDENTS DO
WAS BRING A PAIR OF STERILE APPLICATORS.
AND SO THEY WOULD THE CLEANING AND DO THEIR STUFF
AND THEN I WOULD POINT TO THE RIGHT PLACE.
BECAUSE YOU CAN'T TELL AND EVERYBODY IS STERILE
AND I JUST CAN'T STICK MY FINGER IN.
SO IF YOU WILL BRING SOME APPLICATORS THAT WILL HELP,
JUST AS A POINTER FOR YOUR INSTRUCTORS TO GO.
ALRIGHT.
THE OTHER THING I WOULD ENCOURAGE YOU TO DO
WITH YOUR FIRST ONE IS JUST TO BRING A SPARE KIT.
YOU JUST NEVER KNOW WHEN YOU ARE GOING TO CONTAMINATE
AND YOU JUST GOT TO HAVE A SPARE KIT AROUND.
SO IT'S KIND OF A GOOD LUCK CHARM IF YOU WILL.
ALRIGHT. YOU NEED TO GET SOME TAPE READY SO YOU CAN SECURE IT.
SO I AM GOING TO GET THREE PIECES OF TAPE...
AND I WILL SHOW YOU THE TAPE WAY
AND I WILL SHOW YOU HOW TO DO A PRE-MANUFACTURE.
ALRIGHT. THE OTHER THING I NEED IS A DRAPE FOR PRIVACY.
AND I NEED TO CONSIDER LIGHTING.
AND LIGHTING IS A WHOLE ANOTHER BALL GAME WITH MALE AND FEMALE.
SO MY MALE HERE, HE'S EASY TO SEE.
AND SO IF I NEED LIGHTING, I CAN JUST PULL THIS DOWN
AND I CAN SEE JUST FINE.
ALRIGHT. SO I HAVE WASHED MY HANDS.
I AM GOING TO IDENTIFY MY CLIENT MR. SAM SPADE
AND I HAVE CERTAINLY PROVIDED PRIVACY.
AND I WANT TO EXPLAIN TO MY CLIENT THAT
"WE ARE GOING TO PUT IN A FOLEY CATHETER
TO DRAIN SOME URINE FROM YOUR BLADDER.
IT'S GOING TO STAY IN SO YOU WON'T NEED TO GET UP AND GO TO THE BATHROOM.
SO NO NEED TO MOVE AROUND
SO THAT YOUR LUNGS DON'T GET CONGESTED
AND YOU DON'T GET SORES, BUT IT WILL BE EASIER FOR YOU."
ALRIGHT.
FIRST THING I WANT TO DO IS GET HIM COVERED UP
AND THEN...CLEAN THE PERINEUM.
I DON'T NEED HIM TO BE PARTICULARLY TOO HIGH.
ALRIGHT. I DON'T DO ANY SPECIAL DRAPE ON MALES
BECAUSE YOU DON'T REALLY NEED TO.
I AM GOING TO JUST KIND OF SHOW YOU HOW I AM GOING TO DRAPE HIM,
BUT I WILL PROBABLY UNCOVER HIM SO YOU CAN SEE.
NOW, ON A MALE, YOU CAN CLEAN HIM WITH
THEIR LEGS TOGETHER OR APART, IT DOESN'T REALLY MATTER.
BUT I LIKE TO SPREAD THEIR LEGS JUST A LITTLE BIT,
BECAUSE I LIKE TO PUT MY KIT BETWEEN THEIR LEGS.
EVEN THOUGH THEY ARE NOT A FEMALE,
I JUST WORK STRAIGHTFORWARD AND IT'S EASIER.
IF I COULDN'T DO THAT, I WOULD PROBABLY PUT IT ON MY TABLE
AND GET IT REAL CLOSE LIKE THIS. I MEAN, REALLY CLOSE.
BUT I LIKE TO WORK RIGHT SMACK IN THE MIDDLE,
IF THEY CAN SPREAD THEIR LEGS A LITTLE BIT.
SO, I AM GOING TO GET HIM COVERED
AND I WOULD HAVE MY BASIN.
AND ALL YOU HAVE TO SAY HERE IS "I WOULD CLEAN HIM."
THEY ARE ALREADY CLEAN. I JUST WANT YOU TO, KIND OF, HAVE THAT THOUGHT IN YOUR MIND.
SO YOU WOULD EXPOSE HIM AND THEN CLEAN.
ALWAYS TOUCH THE THIGH FIRST BEFORE YOU GO GRAB THE PERINEUM
AND THEN CLEAN FROM THE ANUS BACK
AND PUT THEM IN THE HAMPER.
ALRIGHT.
I WOULD JUST PUT THIS BACK LIKE THIS.
BUT IS IT BLOCKING VIEW? CAN YOU GUYS SEE ALRIGHT HERE?
OKAY.
SO HE'S NICE AND CLEANED UP, MY LIGHT'S GOOD, I CAN SEE FINE.
"CAN YOU JUST SPREAD YOUR LEGS A LITTLE BIT.
THAT WILL HELP ME SO I CAN PUT MY TRAY BETWEEN YOUR LEGS.
AND...
WHAT I SET UP IN BETWEEN YOUR LEGS IS STERILE,
SO IF YOU CAN HOLD STILL I WILL REALLY APPRECIATE IT
BECAUSE I SURE DON'T WANT TO CONTAMINATE THIS."
THE RULE OF CATHETERS TO ME IS,
IT'S BETTER TO MISS AND BE STERILE
THAN TO HIT AND BE CONTAMINATED.
RIGHT?
BECAUSE THE HIGHEST INCIDENCE OF URINARY TRACK INFECTION
IS USUALLY RELATED TO CATHETERS.
SO YOU JUST GOT TO BE VERY DILIGENT ABOUT OUR CARE HERE.
ALRIGHT. YOU HAVE YOUR NICE, LITTLE TRASH BAG,
WHICH HARDLY I EVER USE, BUT IT'S THERE IN CASE I NEED IT.
AND THEN I AM GOING TO OPEN UP MY KIT.
AND I THINK YOUR PAPER SAYS
OPEN THE LAST FLAP TOWARDS 'EM OR WHATEVER.
WHO CARES. WHATEVER. JUST DON'T CONTAMINATE IT.
SO I AM GOING TO OPEN UP MY KIT.
TRY TO GET THAT FAIRLY CLOSE TO HIM.
OPEN UP HERE.
I AM GOING TO PULL THIS DOWN OVER HERE.
THIS ISN'T WORKING TO GREAT.
OKAY. ON TOP IS A DRAPE.
SO YOU WANT TO GET YOUR DRAPE -- YOU KNOW HOW TO DO A DRAPE.
AND ON THE MALE, I JUST KIND OF DROP IT DOWN
AND IF THEY CAN LIFT THEIR BUTTOCKS,
I GO UNDERNEATH A LITTLE BIT...
AND JUST SLIDE IT UNDER.
COS I JUST WANT THE PATH OF THE CATHETER TO REMAIN STERILE.
ALRIGHT. THE ONE SIZE THAT ALL GLOVES...
PUT YOUR GLOVES ON.
OKAY.
IN YOUR KITS IS A FENESTRATED DRAPE.
I HARDLY EVER USE THEM.
IF I WAS EVER GOING TO USE THEM, I WOULD USE THEM ON THE MALE,
BECAUSE IT'S EASY TO GET IT ON.
ON A FEMALE, I NEVER USE USE IT AND I'LL SHOW YOU WHY.
IN YOUR KIT YOU HAVE TWO TRAYS
AND YOU WANT TO SEPARATE THEM
AND PUT YOUR FIRST TRAY FORWARD.
IT'S NOT HARD TO SEE HERE SO...
STAND UP OR MOVE IF YOU CAN'T SEE.
OKAY. IN YOUR KIT YOU HAVE BETADINE.
AND WE ARE GOING TO USE THE BETADINE WHEN YOU TEST,
BUT DON'T USE IT TO PRACTICE
IT WILL ANNIHILATE YOUR KITS AND IT WILL GET ALL OVER THE PLACE,
BUT WE WILL REALLY USE IT TO PRACTICE AND I WILL REALLY USE IT FOR A DEMO.
SO WHAT I WANT TO DO IS GET MY KIT ALL PREPPED HERE.
SO I AM GOING TO OPEN UP MY BETADINE.
IN YOUR TRAY ARE TONGS
WHICH YOU ARE GOING TO NEED,
BUT I SEPARATE THEM OFF TO THE SIDE.
AND WHAT I DO IS I PLUCK MY COTTON BALLS --
YOU DON'T LIFT IT UP.
I AM JUST LIFTING IT SO THAT YOU CAN SEE.
SEPARATE ALL YOUR COTTON BALLS,
BECAUSE IF YOU DON'T, WHEN YOU POUR THE BETADINE ON,
THEY ALL STICK TOGETHER AND WHEN YOU GO TO PLUCK THEM,
THEY ALL COME UP IN THIS BIG, OLD WAD THAT'S A MESS.
SO IF YOU SEPARATE THEM OUT, IT HELPS. YOU KEEP FORGETTING.
YOU PUT BETADINE ON ALL OF THEM.
OUR GOAL IS REALLY TO ONLY USE THREE,
BUT...THERE'S THAT.
OKAY. IN YOUR KIT YOU HAVE A COUPLE OF THINGS.
YOU HAVE GOT A SPECIMEN CONTAINER.
BUT WE DON'T NEED A SPECIMEN, SO YOU CAN JUST SET THAT ASIDE.
YOU HAVE GOT K-Y JELLY
AND YOU HAVE GOT WATER TO FILL YOUR BALLOON.
SO IT'S IMPORTANT THAT YOU KNOW WHICH IS WHICH.
A LOT OF THESE KITS HAVE TWO SYRINGES.
SO THAT'S WHY THEY STARTED SWITCHING THEM,
SO THAT YOU CAN TELL THE DIFFERENCE
COS WE WERE FILLING BALLOONS WITH K-Y AND -- THAT'S STUPID.
ALRIGHT. WHAT YOU WANT TO DO BEFORE YOU GET STARTED
IS YOU WANT TO CHECK AND MAKE SURE YOUR BALLOON WORKS.
AND THIS IS WHERE YOU WANT TO BE REALLY CAREFUL.
THE CATHETER NEEDS TO REMAIN STERILE, SO YOU WANT TO PROTECT THAT.
ALL I REALLY HAVE TO DO HERE IS PULL THAT LITTLE TAB OFF,
CONNECT TO MY BALLOON...
AND THEN FILL IT ALL THE WAY
AND MAKE SURE THAT THERE IS NO LEAKING.
I AM NOT SEEING ANYTHING LEAKING ON THERE.
AND MAKE SURE THAT IT IS NICE AND SYMMETRICAL.
AND THEN LEAVE THE SYRINGE ATTACHED...
BUT LET ALL THE WATER BACK OUT.
ALRIGHT. I AM GOING TO SET THAT IN MY BOX CAREFULLY.
AND YOU WANT TO MAKE SURE THAT YOU ARE VERY CAREFUL AND IT'S STABLE
BECAUSE THEY WILL GO SHOOTING OUT AND YOU WILL CONTAMINATE
YOUR CATHETER AT THIS POINT SO BE REALLY CAREFUL.
AND I AM GOING TO GO AHEAD AND LUBRICATE THIS.
AND THE WAY I DO IT IS JUST SQUEEZE IT OUT INTO THE TRAY...
AND THEN PUT THE LUBRICANT ON TWO OR THREE INCHES.
I TRY NOT BE TOO OVER ZEALOUS,
BUT YOU DO WANT TO LUBRICATE IT WELL.
I JUST FOUND THAT IF THINGS ARE KIND OF SLIPPERY DOWN THERE
AND I DON'T LIKE TO BE TOO SLIPPERY.
I JUST SET MY CATHETER IN THE BOX.
IT DOESN'T MATTER IF A LITTLE K-Y GETS ON IT BECAUSE IT'S ALL STERILE,
BUT THAT WAY I KNOW IT'S NOT CONTAMINATED.
ALRIGHT. AT THIS POINT WHAT WE NEED TO DO
IS JUST CLEAN AND PUT IT IN.
SO, AGAIN, I AM GOING TO SET MY HAND ON THE THIGH BEFORE I JUST GO GRAB IT
AND SAY, "OKAY, I AM GOING TO GRAB YOUR PEANUTS HERE SO THAT I CAN CLEAN.
SO, I AM GOING TO LIFT UP,
GRAB SOME BETADINE ON A SWAB
AND SAY, "A LITTLE BIT COLD."
AND GO FROM MEATUS,
DOWN AND DROP.
YOU COULD CROSS OVER AND THROW IN THERE, BUT I DON'T LIKE CROSSING OVER MY HEELS.
AND THREE.
ALWAYS STARTING FROM WHAT YOU WANT TO BE CLEANEST AND DOWN.
NOW, THEORETICALLY, MY LEFT HAND IS CONTAMINATED.
SO I HAVE TO BE VERY CAREFUL ABOUT THAT
COS I DON'T WANT TO CONTAMINATE WHERE I AM GOING TO PUT THE CATHETER.
AT THIS POINT, I GRAB THE CATHETER.
I HAVE TO DRAG OVER ALL THE STUFF.
AND SAY, "YOU ARE GOING TO FEEL A LITTLE PRESSURE."
NOW, ON THE MALE, WHAT WE WANT TO DO
IS TAKE THE PENIS AND MAKE IT A 90 DEGREE ANGLE.
STRAIGHT OUT FROM THE BODY AND THEN PUT A LITTLE TRACTION ON IT.
PULL SO THAT IT STRAIGHTENS OUT. YOU GOT TO STRAIGHTEN IT OUT,
OTHERWISE YOU MAY HAVE DIFFICULTY GETTING AROUND THE PROSTATE GLAND.
SO GET THAT CATHETER NICE AND STRAIGHTENED OUT AND THEN LOW PRESSURE.
SO I AM GOING TO PUT THIS IN
AND JUST KEEP GOING UNTIL I SEE YOUR --
USUALLY ON THE MALE, ABOUT EIGHT INCHES OR SO.
HOWEVER, ON MANY OF THEM, I GO ALL THE WAY TO THE BIFURCATION,
WHICH IS VERY DIFFERENT FROM THE FEMALE.
BUT YOU CAN GO ALL THE WAY IN BEFORE YOU EVER HIT URINE.
ONCE YOU SEE URINE COMING THEN YOU GO ANOTHER INCH OR TWO
BECAUSE REMEMBER WHERE THE BALLOON WAS.
THE TIP OF THE CATHETER IS RIGHT HERE.
THAT'S WHERE THE LITTLE HOLES ARE, WHERE THE URINE WOULD HIT.
BUT THE BALLOON IS RIGHT BELOW THAT.
WE GOT TO CLEAR THE BALLOON OUT OF THE MEATUS --
OUT OF THE URETHRA. SORRY, THAT'S MEATUS.
URETHRA. SO THAT WE DON'T INJURE THAT URETHRA.
ALRIGHT. ONCE WE HAVE GOTTEN URINE BACK,
WE ARE GOING TO FILL UP OUR BALLOON...
AND THEN PULL BACK A LITTLE BIT
TO MAKE SURE IT'S NOT GOING TO FALL OUT.
OKAY. THEN YOU CAN RELEASE AND AT THIS POINT,
NOTHING IS REALLY STILL.
OKAY.
TO GET THIS OFF. YOU GOT A CATHETER THERE NOW,
SO WE ARE GOING TO JUST HAVE TO RIP.
CLEAN SOME OF THE BETADINE OFF.
IT CLEANS BETTER WITH A WASHCLOTH.
TAKE THE BETADINE OFF.
TAKE THE BETADINE OFF MY HANDS.
THEN YOU WANT TO GET YOUR BAG
AND HOOK IT TO THE BED SO THAT IT DRAINS.
YOU WANT TO BE KEEPING TRACK OF I & O.
THEN YOU WANT TO TAKE YOUR CATHETER IN PLACE.
AND ON THE MALE YOU CAN TAPE IT TO THE THIGH
OR YOU CAN TAPE IT TO THE ABDOMEN,
WHICHEVER WORKS THE BEST.
WHEN I TAKE MY FOLEY CATHETERS,
I TAKE THEM RIGHT BELOW THE ARM OF THE BALLOON,
COS THAT STABILIZES IT.
YOU DON'T WANT TO TAPE ON THIS PART
BECAUSE YOU CAN COMPRESS IT AND THEN IT WON'T DRAIN.
AND IF YOU TAKE ON THE BOTTOM PART, THE GRAVITY CATHETER PART,
IT'S SO HEAVY THAT IT PULLS OFF OF THE TAPE.
SO, I DON'T DO THAT.
I ALSO PUT IT ON THE TOP OF THE LEG, INSTEAD OF INSIDE THE LEG
BECAUSE THEN WHEN THEY ARE LAYING ON YOUR SIDE,
THEY DON'T HAVE THAT CATHETER
PRESSING BETWEEN 'EM, GIVING THEM PRESSURE SOURCE.
SO I PUT IT UP ON THE TOP OF THE THIGH
AND I DOUBLE BACK IT, JUST LIKE I DID THE IV TUBING ON THE BACK
AND THEN TAKE ANOTHER PIECE OF TAPE ON EACH SIDE TO STABILIZE
AND HOLD THAT TAPE IN PLACE.
ALRIGHT.
ONCE ALL THAT'S SET,
GET ALL YOUR SUPPLIES OUT OF HERE.
FOR TESTING PURPOSES, NEVER IN REAL LIFE,
WHEN YOU NEED TO DC OUR CATHETERS,
YOU ARE GOING TO USE THE SAME SYRINGE THAT YOU PUT IT IN.
I'LL JUST SET THAT OVER TO THE SIDE.
GET RID OF ALL YOUR SUPPLIES.
THROW THEM AWAY.
MAKE SURE HE'S COMFORTABLE.
OKAY. GET DOWN.
AND AT THIS POINT, YOU WANT TO WASH YOUR HANDS, DOCUMENT
AND ALSO, DEPENDING ON HOW LONG IT TAKES YOU TO CLEAN UP,
YOU WANT TO SEE HOW MUCH URINE YOU GOT OUT
FROM WHEN YOU CATHETERIZED THEN.
THERE IS SOME DIFFERENT SCHOOLS OF THOUGHT ABOUT OUTPUT,
AFTER CATHETER GETS PUT IN.
ONE OF THE SCHOOLS OF THOUGHT IS THAT WHEN PUT A CATHETER IN,
IF THEY HAVE MORE THAN 1000 CC OF DRAINAGE,
YOU NEED TO CLAMP THE CATHETER,
SO THAT THEY DON'T BECOME SHOCKY.
THEY DON'T LOSE TOO MUCH FLUID AND HAVE BLADDER SPASMS
AND BE SHOCKY FROM FLUID VOLUME LOSS.
SO YOU JUST CLAMP THE CATHETER FOR 15 MINUTES TO HALF AN HOUR,
LET THEIR BODY KIND OF RECOUP
AND THEN UNCLAMP IT AND RELEASE THE REST.
FIND OUT WHAT YOUR HOSPITAL POLICY IS.
THE OTHER SCHOOL OF THOUGHT, AND MORE RECENT RESEARCH THAT I HAVE READ
IS THAT THAT'S NONSENSE AND IT'S NOT TRUE,
AND THEY DON'T GO SHOCKY COS THEIR BLADDER'S EMPTY.
SO, YOU KNOW, THERE IS THESE FUNNY LITTLE TALES THAT GO THROUGH
THAT NONE OF US REALLY HAVE SUPPORT FOR.
AND YOU WILL HEAR ABOUT THEM AND GO, "OH, OKAY." YOU KNOW?
SO, YOU CAN ALSO JUST LET THE URINE COME OUT
AND THEY HAVE 1200 OUT, AND THERE YOU GO, WATCH 'ME.
SO EITHER WAY, WE HAVE HAD ENOUGH DONE.
GO WITH IT.
ALRIGHT. IF IT WERE THAT EASY IN REAL LIFE.
BUT THERE ARE A FEW PROBLEMS THAT YOU MAY RUN INTO WITH THE MALE
AND...HERE'S A COUPLE.
JUST A COUPLE.
OKAY. WHEN I WAS IN HOME CARE,
I WENT OUT WITH THE NURSE, WHO HAD BEEN A NURSE FOR QUITE A WHILE.
AND THIS OTHER NURSE HAD BEEN A NURSE FOR A LONG TIME.
LIKE 25 YEARS. AND SHE WAS BRAGGING ABOUT BEING
A HOME CARE NURSE AND HAVING THESE PATIENTS FOREVER.
AND SHE NEW HER PATIENTS SO WELL COS SHE LOVED HER PATIENTS.
SO I FOLLOWED HER AROUND AND IT HAPPENED TO BE CATHETER CHANGE DAY.
AND SO WHAT THAT MEANS IS EVERY 30 DAYS,
IF SOMEONE HAS A CHRONIC CATHETER,
THE CATHETER COMES OUT AND A NEW CATHETER GOES IN.
SO WE WENT TO SEE THIS OLDER GENTLEMAN OUT IN THE STICKS.
I MEAN, HE LIVED LIKE AN HOUR OUTSIDE OF THE CITY PROPER.
AND UP, YOU KNOW, DIRT ROAD, ROCKS, THE WHOLE THING.
SO WE FOUND THIS MAN,
TOOK HIS CATHETER OUT AND SHE PUT HIS CATHETER BACK IN
AND NO URINE CAME OUT.
SHE SAYS, "WELL, I HAVE BEEN PUTTING HIS CATHETER IN FOR YEARS,
I KNOW EXACTLY WHERE IT IS."
AND SHE STOPPED, WHEREVER SHE STOPPED AND SHE FILLED THE BALLOON.
AND RIGHT WHEN SHE FILLED THE BALLOON, THE MAN GOES, "ARGH!" AND HE YELLS OUT.
WELL, I AM JUST WATCHING THIS WHOLE THING GOING,
"THAT'S NOT HOW THEY THOUGHT ME TO DO IT."
AND SHE WAS LIKE, "OH! OH! OKAY."
SO THEN I LOOKED DOWN AT THE CATHETER, THERE'S STILL NO URINE,
BUT BLOOD'S TRICKLING DOWN INSIDE THE CATHETER.
THE MAN IS IN EXCRUCIATING PAIN.
SO SHE DECIDES WHAT SHE NEEDS TO DO IS MOVE THE CATHETER UP A LITTLE BIT.
SO SHE UNDOES THE BALLOON AND TRIES TO MOVE THE CATHETER.
HOWEVER, THE MAN'S GONE INTO URINARY SPASM BECAUSE OF THE PAIN
AND THE CATHETER WON'T MOVE IN OR OUT. IT IS STUCK.
WITHOUT THE BALLOON FULL, IT WON'T GO.
WELL, WE STAYED THERE FOR 15-20 MINUTES AND THIS THING IS NOT BUDGING.
AND HE'S IN MISERABLE PAIN AND WE HAVE GOT THIS LITTLE TRICKLE OF BLOOD
THAT'S COMING DOWN INTO THE CATHETER.
THE LONG AND SHORT OF IT IS,
SHE ENDED UP HAVING TO SEND HIM TO THE EMERGENCY ROOM.
SO THEY HAD TO HAVE AN AMBULANCE COME OUT.
IT'S A RIDE 60 MINUTES OUT.
AND THEN TAKE HIM 60 MINUTES IN TO THE EMERGENCY ROOM.
THEY FINALLY GOT HIM IN THE EMERGENCY ROOM, HE LAID ON THE TABLE,
POOP, THE CATHETER FELL OUT ON THE FLOOR.
HE FINALLY RELAXED AND THE THING FELL OUT.
SO THEY ENDED UP PUTTING ANOTHER ONE IN AND, YOU KNOW, ALL IS WELL.
MORAL OF THE STORY.
DON'T THROW THE BALLOON UNTIL YOU SEE SOME URINE COME OUT OF THAT THING.
HOW WAS SHE TO KNOW? YOU KNOW, YOU GOT TO SEE SOME URINE.
ALRIGHT. MY CATHETER STORY. I WENT -- HOME CARE.
HOME CARE IS THE MOST UNIQUE SETTING OF ALL SETTINGS IN THE WHOLE WORLD,
COS THERE'S NO ONE THERE TO HELP YOU AND YOU GOT A PROBLEM, YOU SOLVE ON YOUR OWN.
AND IT WAS CATHETER CHANGE DAY FOR THIS MAN.
AND I GO IN TO CHANGE HIS CATHETER
AND HE IS SITTING IN A RECLINER CHAIR
AND HE CAN'T REALLY GET UP AND WALK.
I AM THINKING, "WELL, ALRIGHT.
I CAN DO IT IN A CHAIR, WHATEVER."
SO I PUT MY SUPPLIES ON THE FLOOR, WHICH, URGH, HORRIBLE.
AND I AM ON MY KNEES TO DO THIS CATHETER. I TAKE THE CATHETER OUT.
AND I LIKE WHEN THERE ARE REDOES
BECAUSE USUALLY THE HOLE'S PRETTY STRETCHED, PRETTY RED.
SEE IF WE ARE GOOD. AND SO I COULD SEE --
I THOUGHT WHERE IT CAME OUT AND I KNEW IT CAME OUT SO IT HAD TO GO IN.
BUT I COULDN'T SEE ANYTHING.
I MEAN, LIKE, THERE'S JUST SCROTUM.
AND THERE IS LIKE NOTHING THERE.
AND I THOUGHT, "WOW!
THIS IS A PROBLEM."
WELL, IT CAME OUT OF THERE. IT'S GOT TO GO IN THERE.
I SAW THE LITTLE WRINKLY PLACE WHERE I THOUGHT IT CAME OUT OF.
AND SO I KIND OF HAD MY FINGERS THERE AND I WAS KIND OF CLEANING AND THE GUY DIDN'T SAY MUCH.
HE HAD A STROKE OR SOMETHING, I DON'T KNOW.
ANYWAYS. SO I CLEAN HIM.
KIND OF POKING A LITTLE.
"THIS AIN'T GOING ANYWHERE.
THAT'S A PROBLEM."
SO I PUT MY STUFF DOWN AND I WENT, "OH, MY GOD."
DO YOU KNOW WHAT I DID?
UNCIRCUMCISED MALE. - OH.
- OH. NOW LET'S TALK A LITTLE BIT HERE.
TWO PROBLEMS THAT -- A LITTLE NAIVE. A LITTLE, WHATEVER.
OKAY. SO HE'S UNCIRCUMCISED, SO THERE'S EXTRA SKIN HERE
AND IT'S BLENDED IN WITH SCROTAL SKIN.
AND MALES CAN RETRACT INTO THEIR SCROTUM.
I DIDN'T EVEN KNOW THAT.
AND SO THERE WAS LIKE THERE WAS NO PENIS THERE
AND THERE WAS NO HEAD THERE.
SO WHEN I REALIZED WHAT WAS HAPPENING.
LUCKILY, HE JUST KIND OF GOING.
I HAD MY GLOVES AND I STARTED PROBING A LITTLE BIT
AND THEN I FOUND THE END AND SURE ENOUGH,
WHEN I RETRACTED THE FORESKIN, POOP! GLANS.
I DIDN'T KNOW. STUPID, BUT I JUST WANTED TO MAKE SURE THAT YOU ARE NOT SO OUT THERE.
SO FIND THE GLANS, THE HEAD. IT'S GOT TO BE THERE.
DON'T JUST POKE INTO SKIN. AND THEY CAN RETRACT.
STUDENTS COME BACK TO ME ALL THE TIME, "BUT I JUST DIDN'T KNOW."
I KNOW. I KNOW. NO ONE TELLS YOU.
THEY JUST DO THIS AND SAY, "GO CATH HIM."
"OH, YEAH, RIGHT."
OKAY. SO THAT WAS THAT STORY. MY NEXT STORY.
I COULD TELL CATHETER STORIES FOR THE DAY
SO I REALLY RESTRICTED IT TO MY FAVORITES.
OKAY. I AM IN THE HOSPITAL
AND I AM PUTTING A CATHETER IN THIS GENTLEMAN.
AND I CAN'T REMEMBER WHY, BUT I HAD TO PUT A CATHETER IN.
AND I PUT IT IN AND PUT IT IN, BUT IT WOULDN'T GO.
I AM MEETING RESISTANCE.
AND I ADJUST.
THEY TELL YOU THAT IF YOU CAN'T GET IT IN ALL THE WAY
THAT YOU PUT MORE TRACTION ON THE PENIS.
AND THEN SHIFT A LITTLE BIT TO STRAIGHTEN IT OUT.
AND I HAD DONE ALL THE STUFF. AND YOU KNOW, IT'S NOT GOING.
SO I HAD ANOTHER NURSE COME IN AND TRY AND SURE ENOUGH,
SHE COULDN'T GET IT THROUGH. PROBLEM?
PROSTRATE GLAND.
VERY OFTEN IT'S ENLARGED
AND YOU CAN'T GET THE CATHETER PAST THE PROSTRATE.
SO IF YOU KEEP POKING,
YOU WILL POKE THROUGH THE URETHRA.
THIS IS NOT A GOOD THING.
SO YOU CAN'T JUST POKE AND THINK IT WILL GET IN.
SO TWO OR THREE OF US HAD TRIED AND IT WAS A NO GO.
WE EVEN CHANGED SIDES. WE WENT FROM 16 TO 14.
IT WAS A NO GO, WE COULDN'T GET IT PAST.
SO WE CALLED THE DOCTOR. AND THE DOCTOR COMES IN
AND HE COMES WALKING IN WITH THIS, LIKE, LITTLE CLARINET CASE.
"OH, THAT'S INTERESTING."
HE COMES INTO THE ROOM AND HE OPENS UP THIS LITTLE CLARINET CASE
AND INSIDE THIS LITTLE CASE ARE THESE RODS.
AND THEY LOOKED LIKE TO ME -- AND THIS IS JUST LAMENISH.
BUT THEY LOOKED LIKE KNITTING NEEDLES, WITHOUT THE LITTLE HOOK,
BUT WITH A LITTLE CURVE.
KIND OF LIKE OUR HUBER NEEDLE.
YOU KNOW, IT HAD THE LITTLE BEND IN IT.
IT'S JUST A LITTLE BEND WITH A ROUNDED EDGE.
AND THEY WERE IN ALL DIFFERENT DIAMETERS. SO SKINNY, TIP THERE.
AND HE TAKES ONE OF THOSE OUT, HITS THAT GUY.
OH, BABY. AND HE JUST MOVES THAT PROSTATE OUT WITH HIS LITTLE TOOLS.
BUT HE WAS A NEUROLOGIST. SO THAT IS WHAT NEUROLOGISTS DO.
MOVE THAT PROSTRATE OUT AND PUT THAT CATHETER IN. GOOD TO GO.
SO, I WAS A LITTLE SURPRISED. CLARINET CASE.
SO IF YOU SEE THE CLARINET CASE WALKING IN, OH, YOU KNOW.
OKAY. SO LAST BUT NOT LEAST.
THIS IS THE FUNNIEST STORY OF ALL.
I WENT LAST YEAR WITH NATIONAL STUDENT NURSE ASSOCIATION,
UP TO THEIR CONFERENCE IN PHILADELPHIA.
AND I WENT WITH THE STUDENTS TO THE HUMORIST.
THEY HAD A COMEDIAN, A NURSE COMEDIAN, THAT WAS DOING A TALK.
AND AT THE END OF HIS TALK, HE DECIDES TO SHARE WITH US HIS CATHETERIZATION.
AND HE SAID THAT HE HAD BEEN IN A SURGERY
AND AFTER THE SURGERY, HE WENT HOME AND HE COULDN'T VOID.
BUT HE WAS A HOME CARE NURSE AND HE KNEW JUST WHAT TO DO.
HE NEEDED TO CATHETERIZE HIMSELF.
AND HE SAID, "SO THAT'S WHAT I DID."
AND HE SAID, "YOU KNOW, HAVE YOU EVER TRIED TO CATHERIZE YOURSELF?"
HE SAID YOUR BODY DOES THE NATURAL THING IT WANTS TO DO.
HE SAID, "I CLEANED MYSELF. I GOT THE CATHETER.
KEPT MOVING BACK. HE SAID BECAUSE I JUST COULDN'T DO IT.
HE SAID, "FINALLY, WHEN I HIT THE WALL,
THERE I WAS."
AND HE SAID, "SO, HERE'S A NET."
HE FINALLY GOT IT AND HE GOT THERE
AND HE STARTED PUTTING IT IN AND HE SAID,
"AND YOU DO WHAT YOUR BODY WANTS TO DO NATURALLY.
GO SLOW.
VERY SLOW." AND HERE'S THE REASON.
I THIS WAS FASCINATING TO ME BECAUSE I DIDN'T KNOW THIS.
AND HE SHARED THIS STORY AND I AM LAUGHING.
THE STUDENTS DIDN'T REALLY KNOW WHAT HE WAS TALKING ABOUT AT THIS POINT.
BUT, I HAD ALWAYS, KIND OF, PRIDED MYSELF ABOUT BEING VERY EFFICIENT.
PUT THE CATHETER IN. WHAM, WHAM, WHAM, WHAM!
WHAM! PUT IT IN.
AND HE SAYS, "IT HURTS! DON'T YOU DO IT THAT WAY."
BECAUSE THE MALE HAS A LONG URETHRA
AND IT GOES INTO SPASM, RIGHT? MAN WHO HAS HIS SPASM.
THE URETHRA GOES INTO SPASM AND OH, NOT COMFORTABLE.
SO, HE SAID, "IF I LEAVE YOU WITH ANY MESSAGE
BEFORE YOU GO TODAY, GO SLOW.
THERE'S MY MALE STORIES. ALRIGHT.
LET'S GO AHEAD AND DC FROM OUR MALE.
AND TO DC THE CATHETER, ONCE AGAIN WE ARE GOING TO DO OUR HI-FIVE .
YOU WOULD HAVE AN ORDER TO DC.
GATHERING UP SUPPLIES IS RATHER SIMPLE.
YOU NEED JUST SOME REGULAR, CLEAN GLOVES.
YOU NEED A 10 CC SYRINGE. AND BY THE WAY,
WE DO PUT THE FULL 10 CC SYRINGE INTO THE BALLOON
BECAUSE IT KEEPS IT FROM FALLING OUT.
I HAVE ALREADY SHARED STORIES ABOUT PEOPLE PULLING 'EM OUT.
AND YOU CAN'T. THE URETHRA STRETCHES, BUT...
OH! OUCH!
SO A 10 CC SYRINGE.
YOU WANT TO CLEAN UP AS NECESSARY.
AND I DON'T THINK I NEED ANY OF THIS, EXCEPT FOR MY CHUX.
ALRIGHT. WASH MY HANDS, PUT ON MY GLOVES,
IDENTIFIED MY CLIENT MR. SAM SPADE AND PROVIDED PRIVACY.
I USUALLY DON'T DO ANYTHING,
ESPECIALLY AS FAR AS DRAPING GOES.
BUT THIS, I WOULD JUST...
PUT A LITTLE CHUX OUT SO THAT I DON'T MAKE A MESS.
I THINK I PROBABLY NEEDED A GROUP OF TOWELS,
BUT I DIDN'T GET ONE SO WE'LL WING IT HERE.
OKAY. YOU WANT TO GET YOUR CHUX DOWN.
I AM GOING TO DO MY CLEANING UP LATER.
WHAT I WANT TO DO AT THIS POINT IS JUST UNTAPE...
THE CATHETER AND THEN DRAIN ALL THE URINE
OUT OF THE CATHETER,
SO IT DOESN'T DRIBBLE SO MUCH ON HIM.
NOW -- I AM GOING TO PUT A WASHCLOTH UNDER HERE
JUST TO CATCH THIS AND GET MY SYRINGE,
HOOK IT TO THE ARM, THE ARM
AND THEN IT WILL JUST AUTOMATICALLY COME OUT
BECAUSE OF THE PRESSURE IN THAT BALLOON.
WHICH BY THE WAY, I SHOULD HAVE MENTIONED,
WHEN YOU ARE PUTTING THE CATHETER IN
AND YOU FILL THE BALLOON,
YOU HAVE TO KEEP YOUR HAND ON THE SYRINGE OR REMOVE IT.
OR WHILE YOU ARE TUGGING AND DOING STUFF IT WILL DEFLATE
AND YOU WILL PULL THE THING RIGHT OUT. YOU WILL SABOTAGE YOURSELF.
OKAY. ONCE THE BALLOON --
IT IS IN HERE IT APPEARS,
THEN WHAT YOU WANT TO DO IS GET YOUR PAPER TOWEL OR CLOTH OR WHATEVER,
AND CLOSELY TO THE MEATUS, AND THEN JUST TUG GENTLY
TO MAKE SURE IT'S GOING TO COME EASILY.
IT IS NOT ADHERED TO ANYTHING.
AND THEN IF YOU TELL THE CLIENT JUST TO TAKE A DEEP BREATH FOR DISTRACTION
AND THEN PULL OUT JUST STEADY AND SLOW TILL IT COMES OUT
AND THEN I TRY TO CATCH THE END AND IT DRIBBLES.
THAT'S WHY I LIKE TO REALLY HAVE A PAPER TOWEL
BECAUSE THEN I CASE THE END IS IN MY GLOVE.
WHICH I CAN'T FIT INTO THAT.
OK. WELL, LET'S JUST LEAVE THIS IN CASE THERE IS A LITTLE DRIBBLE.
CLEAN UP YOUR CLIENT. PERI CARE.
GET RID OF THIS.
AND YOU WANT TO DUMP THIS
AND THEN DOCUMENT, "I KNOW." WHEN YOU DC IT.
IT WILL ALL GO INTO TRASH AT THIS POINT.
WASH YOUR HANDS. AND THEN WHAT YOU WANT TO DO
IS OFFER YOUR CLIENT FLUIDS EVERY TWO TO FOUR HOURS.
WELL, EVERY TWO HOURS. IT WILL BE NICE IF YOU GIVE HIM FLUIDS.
AND REALLY ENCOURAGE FLUIDS.
AND THEN OFFER THEM BED PAN EVERY TWO TO FOUR HOURS
TO MAKE SURE THEY ARE VOIDING.
THEN YOU ALSO WANT TO BE WATCHING FOR SIGNS AND SYMPTOMS
OF URINARY TRACK INFECTION AND YOU WANT TO TEACH THEM
ABOUT THE SIGNS AND SYMPTOMS OF URINARY TRACK INFECTION.
WHICH ARE?
- BURNING FREQUENCY.
- BURNING FREQUENCY. URGENCY. SO THAT THEY WILL KNOW.
TEMPERATURE, ALSO TO BE ADDED TO THAT LIST.
SO THAT THEY CAN FOLLOW WITH THE POSITION ON THAT.
HOW LONG WOULD YOU LET A PATIENT GO WITHOUT VOIDING
BEFORE YOU CALLED THE PHYSICIAN AND ASKED FOR ANOTHER CATHETER?
- FOUR HOURS.
- HOW MANY? - FOUR HOURS.
- USUALLY THE GUIDELINE IS EIGHT OR MISERABLE.
SO WE DON'T LET THEM GO FOREVER AND IF THEY ARE MISERABLE IN TWO HOURS,
YOU ARE NOT GOING TO MAKE THEM WAIT FOR EIGHT,
THE MAGICAL NUMBER,
SO BE WATCHING FOR ABDOMINAL DISTENSION
AND THAT THEY ARE STABLE
AND TRY EVERY INTERVENTION YOU CAN TO GET SOMEONE TO GO.
WHAT KINDS OF THINGS WILL HELP SOMEONE GO TO THE BATHROOM?
- COFFEE. - COFFEE?
THAT WAS A GOOD ONE.
LAUGHING. THEY WOULD JUST RELAX.
SO IF YOU CAN GET A GOOD FRIEND IN THERE WITH THEM, GET 'EM LAUGHING.
WARM WATER, RUNNING WATER.
ANY OF THOSE THINGS RELAX SOMEHOW.
IT GETS YOU SO TENSED UP TOO ABOUT NOT GOING.
OKAY. WELL, LET'S GIVE EQUAL TIME TO OUR FEMALE HERE.
THIS MALE AND THAT'S ESSENTIALLY WHAT YOU ARE GOING TO TEST ON.
PUT A CATHETER IN, TAKE A CATHETER OUT.
THE BIGGEST THING TO WATCH FOR IS
BASICALLY, STERILE TECHNIQUE,
AND THAT'S WHAT I WILL BE KEEPING MY EYE ON.
MAKE SURE YOU DON'T CONTAMINATE YOURSELF,
SO BRING THOSE EXTRA GLOVES.
ALRIGHT, SAME THING. WE HAVE THE DOCTOR'S ORDER.
WE ARE GOING TO CATHETERIZE A FEMALE.
WE ARE GOING TO PICK A 16 FRENCH, JUST TO GET STARTED.
WE'RE GOING TO GATHER UP OUR EQUIPMENT, WHICH IS --
FOR THE FEMALE,
I WOULD LIKE TO HAVE A LIGHT.
I WOULD MAYBE USE ONE OF THOSE EQUIPNET LIGHTS.
YOU CAN SEE IT OVER THERE BY THE MIRROR
BECAUSE IT WOULDN'T BE IN MY WAY OR A FLASHLIGHT,
WHICH I BROUGHT JUST AS A PROP SO I WOULDN'T FORGET.
LIGHTING IS SO MUCH MORE CRITICAL WITH FEMALES THAN MALES
AND YOU WILL APPRECIATE THIS SOON.
ALRIGHT. I AM GATHERING MY EQUIPMENT WHICH IS MY KIT. EVERYTHING'S IN IT.
THIS TIME I AM GOING TO DO AN APPLICATOR AND THESE ARE KIND OF NEAT.
DID I SHOW YOU THESE LAST SEMESTER? I DON'T THINK SO.
IF YOU PUT THESE ON THE LEG,
THEY HAVE THE SELF ADHESIVE STUFF ON THE BACK.
SO YOU PUT IT ON THE LEG, AND THEN THERE IS A LITTLE VELCRO THING,
AND THEN YOU JUST PUT THE CATHETER IN HERE,
AND THEN VELCRO IT AROUND.
AND YOU PUT IT IN THE SAME PLACE, RIGHT THERE BY THE ARM,
UP WHERE THE BALLOON IS AND THAT WILL KEEP IT FROM SLIDING.
AND IT'S PRETTY STABLE. IT'S BETTER TAPE.
SO THESE ARE GOOD. THEY ARE CALLED CATH SECURE, SO YOU WILL SEE THOSE.
THEY ALSO HAVE THE ONES THAT THEY ARE ELASTIC STRAPS THAT ARE ON THE LEGS.
THERE IS ALL KINDS OF DIFFERENT GADGETS.
SO WHATEVER, BUT TAPE WILL WORK WHEN YOU CAN'T FIND WHAT YOU WANT.
ALRIGHT. WE ARE GOING TO CLEAN. BACK-UP GLOVES.
AND THIS IS WILL BE WHERE IT WOULD BE REALLY IMPORTANT THAT YOU HAVE AN APPLICATOR TO POINT.
YOU CAN ALWAYS FIND THE MALE, THAT'S PRETTY EASY.
WITH FEMALES WE GOT A LOT OF TARGET ZONES HERE,
SO YOU WANT TO MAKE SURE YOU GOT THE RIGHT SPOT,
AND THEN WE WANT TO DRAPE.
SO THAT WE CAN DRAPE OUR FEMALE WHICH WE ARE GOING TO DO A LITTLE DIFFERENTLY.
WASH YOUR HANDS, PROVIDE PRIVACY,
IDENTIFY OUR CLIENT, WHICH IS A FEMALE CLIENT.
ALRIGHT. THIS IS FEMALE CLIENT.
"WE ARE GOING TO PUT A FOLEY CATHETER IN
WHICH IS A CATHETER TO DRAIN YOUR URINE,
SO YOU DON'T HAVE TO GO TO THE BATHROOM.
IF YOU ARE HAVING TROUBLE THERE, IT WILL JUST DRAIN IT OUT.
YOU HAVEN'T TO GET UP TO GO TO THE BATHROOM."
DOES IT HURT TO PUT A CATHETER IN?
NOT REALLY. NOT IF YOU DO IT RIGHT. IT SHOULDN'T.
THEY WILL FEEL A LITTLE PRESSURE AND SOMETIMES THEY COMPLAIN
THAT THEY HAVE TO GO BECAUSE THEY CAN FEEL THE CATHETER IN THEM.
SO IT JUST VARIES AS TO HOW YOUR CLIENT'S FEELING.
ALRIGHT. WE ARE GOING TO DRAPE OUR CLIENT.
SO IF YOU GET THE FEMALE CLIENT, THIS IS WHAT YOU GET TO DO.
YOU WANT TO OPEN UP YOUR BATH BLANKET
AND MAKE IT LIKE A DIAMOND ON YOUR CLIENT.
AND FOLD IT THROUGH.
SO HERE IS THE GOAL. THIS IS WHAT'S IMPORTANT.
THE TIP OF THE BLANKET NEEDS TO COME TO THE END
AND THESE TWO PIECES NEED TO COME TO THE SIDE.
NOW, WHAT WE ARE AIMING TO DO HERE
IS WE WANT OUR CLIENT TO BE IN A DORSAL RECUMBENT POSITION.
AND DORSAL RECUMBENT IS LAYING ON THEIR BACK
WITH THEIR KNEES UP AND SPREAD.
SO IF WE COULD GET HER KNEES UP AND SPREAD...
THEN SEPARATE IT AS BEST YOU CAN.
NOW, I WENT TO --
I GO TO CLASSES ALL THE TIME AND STUFF.
AND I WENT TO THIS CLASS ONE TIME THEY SAID,
"OH, THE BEST WAY TO DO IT FOR A WOMAN
IS MAKE SURE SHE PUTS HER HEELS TOGETHER
AND THEN SPREAD AND YOU WILL GET A MUCH BETTER VIEW."
OH, IT'S THE LOUSIEST THING EVER.
I AM THINKING, "OH, OKAY, WHATEVER."
SO I GO TO DO THAT. WHERE DO YOU PUT YOUR KIT?
THERE IS NO ROOM. IT'S DUMB.
SO, I GOT RID OF THAT IDEA RIGHT AWAY.
JUST COS SOMEONE SAYS IT, DOESN'T MAKE IT THE BEST.
I MEAN, IN PRACTICE IT JUST DIDN'T WORK.
YOU WOULD HAVE TO GET A TABLE OR SOMETHING
BECAUSE THIS JUST DIDN'T WORK WELL AT ALL.
ALRIGHT. SO DORSAL RECUMBENT.
WHAT'S THE DIFFERENCE BETWEEN DORSAL RECUMBENT AND LITHOTOMY?
- THAT WOULD BE IN STIRRUPS.
- STIRRUPS. EXACTLY.
SO IT'S STILL KNEES BENT,
BUT THE LEGS ARE PARALLEL TO THE BED.
THE CATH PART. SO THEY ARE UP, THEY ARE IN STIRRUPS,
LITHOTOMY VERSUS DORSAL RECUMBENT.
GET YOUR BED POSITIONS DOWN.
IT'S A HUGE TESTING THING ON INCLEX.
THEY WANT TO MAKE SURE YOU KNOW POSITIONS RELATED
TO CERTAIN DIAGNOSTICS SO MAKE SURE YOU'RE GOOD ON THAT.
ALRIGHT. SO, KNEES HERE A LITTLE ABDUCTED AND ALL THAT.
SO NOW WHAT WE WANT TO DO IS, YOU HAVE THIS CORNER,
YOU JUST WANT TO TAKE ONE WRAP AROUND HERE
AND JUST HOOK THE END JUST UNDER THEIR FOOT.
AND THEN SAME THING WITH THIS ONE.
JUST GIVE IT A QUICK WRAP. IT DOESN'T HAVE TO BE PERFECT,
BUT JUST ENOUGH SO THAT THEY ARE COMFORTABLE.
SO THEN WHAT YOU HAVE.
PRETTY COOL ONE.
ALRIGHT. AND THEN SHE'S COVERED UP HERE.
IF I COULDN'T SEE WELL,
WHAT I COULD DO IS PUT A ROLL HERE WHICH I HAVE DONE,
AND PUT MY FLASHLIGHT WHEN I WAS DESPERATE.
AND THE MOST DESPERATE WAS WHEN YOU CAN'T REALLY SEE THAT WELL,
COS ONCE I GET MY KIT HERE AND MY HEAD HERE, I COULDN'T SEE.
SO ONE TIME -- IT'S GROSS.
BUT I CLEAN MY PENLIGHT AND I PUT IT IN MY MOUTH.
BECAUSE I COULDN'T SEE.
IT'S HORRIBLE. IT WAS JUST HORRIBLE.
THE THINGS YOU CONFESS TO, BUT, YOU KNOW?
- IT'S LIKE WHEN WE GO CAMPING. - I KNOW.
WHEN YOU ARE IN A HOME, IT'S SO DIFFERENT THAN THE HOSPITAL.
BECAUSE IN THE HOSPITAL, "OH, YEAH, GO GET ME A EQUIPNET LAMP.
OH, I GET ME THIS AND THAT."
WHEN YOU ARE IN THE HOME -- I KNEW THIS LADY,
SHE HAD THE BIGGEST BACKSIDE IN THIS SOFT SQUISHY BED,
I HAD TO PUT CATHETER IN HER.
SO HER BUTT'S SUNK IN THE BED,
I CAN'T SEE...
SO, PENLIGHT, MOUTH. AND THERE WAS NOTHING.
OKAY, FIRST THINGS FIRST.
PUT YOUR GLOVES ON AND YOU WANT A CLEAN PERINEUM.
AND AGAIN, YOU JUST HAVE TO SAY THAT YOU WOULD CLEAN.
THERE IS NOTHING MUCH TO CLEAN...ON HERE.
SO FEMALES...
FRONT TO BACK.
YOU PUT A LITTLE CHUX DOWN TO CLEAN, JUST TO SEE HOW THINGS ARE GOING HERE.
TOUCH THE THIGH. CLEAN FRONT TO BACK, SHE'S GOOD.
ALRIGHT.
NOW JUST DO THE LIGHT AS WE'RE GOING TO GET HERE.
TAKE YOUR GLOVES OFF.
NOW, SHE LOOKS A LITTLE FUNNY BECAUSE...
YOU GUYS PROBABLY WON'T BE ABLE TO SEE ME VERY WELL,
SO YOU MIGHT WANT TO JUST COME OVER HERE.
COS I CAN'T DO THIS WITH HER LEGS LIKE FLAT.
I WILL BE BLOCKING YOU ANYWAYS.
OKAY. WE ARE GOING TO SET UP OUR KIT JUST LIKE BEFORE.
AND NOTICE AT THIS POINT, ONCE I GO TO SET UP MY KIT,
MAKE SURE YOU THAT YOU HAVE GOT THIS BLANKET BACK AND OUT OF THE WAY,
SO IT'S NOT FALLING IN YOUR WAY CONTAMINATING THINGS.
YOU CAN TRASH THAT. HARDLY EVER USED THEM. THERE IT IS.
ALRIGHT. I AM GOING TO SET UP STERILE SUPPLIES HERE BETWEEN YOUR LEGS,
SO IF YOU CAN HOLD STILL, I'D REALLY APPRECIATE IT.
HOLD ARE YOUR LEGS DOING? ALRIGHT?
TALK TO THEM AND SEE BECAUSE YOU MAY NEED TO ADJUST.
IF THEY CAN'T HOLD THIS POSITION,
EVERYBODY'S IN TROUBLE.
OK. OPEN UP HERE.
JUST WORK UNDER LEGS. WHATEVER I GOT TO DO.
ALRIGHT. PUT THE DRAPE ON, GRAB A CORNER.
READY?
NOW, I AM GOING TO BE CAREFUL.
I DON'T WANT TO CROSS OVER MY FIELD.
AND WHAT HAVE I CONTAMINATED AT THIS POINT?
THESE TWO CORNERS LIKE -- LET'S DO THIS.
SO, I WANT TO GO THIS WAY, SO I DON'T CONTAMINATE THINGS.
NOW IF SHE CAN LIFT HER BUTTOCKS UP, THAT'S GOOD.
AND A KEY TO THE FEMALE IS AND YOU WILL FIGURE THIS OUT,
WHEN YOU PUT THE BETADINE IN,
IT RUNS RIGHT DOWN THEIR PERINEUM DOWN THEIR BUTT
AND IT LANDS LIKE RIGHT IN THE MIDDLE IN THE BACK.
SO YOU THINK YOU HAVE DONE SOME GOOD,
YOU PUT YOUR DRAPES AND ALL THAT STUFF
AND THEN THERE IS THIS LITTLE PUDDLE OF BETADINE WHEN YOU ARE ALL DONE.
SO I TRY TO GET MY HANDS UNDER THERE AND JUST SLIDE IT UNDER.
I WENT TO ANOTHER CLASS ONE TIME.
AND THEY SAID WHAT YOU SHOULD DO IS PUT YOUR --
FOR PUTTING A DRAPE UNDER.
IS IF YOU PUT YOUR STERILE GLOVES ON
AND THEN PICK UP YOUR DRAPE AND WRAP IT AROUND YOUR HANDS
AND STUFF IT UNDER, THEN YOU COULD DO IT THAT WAY.
WHAT'S WRONG WITH THAT?
- YOU'RE TOUCHING THEIR SKIN.
- IF IT'S OUT OF SIGHT, IT'S NOT STERILE, RIGHT?
SO WHERE ARE MY HANDS? UNDERNEATH.
I HAVE NO IDEA IF THEY HAVE GOTTEN CONTAMINATED UNDERNEATH.
SO AGAIN, BAD TECHNIQUE.
NOT EVERYTHING PEOPLE THINK UP IS GOOD.
SO PLAY IT THROUGH WHAT YOU KNOW FOR BEST TECHNIQUE.
- COULD YOU PUT A CHUX BEFORE YOU STARTED UNDERNEATH THE BACK?
- UH-HUH. CERTAINLY YOU COULD, YEAH.
THAT WAS A GOOD IDEA. WHY DIDN'T I EVER THINK OF THAT?
YEAH, YOU ARE GOING TO GET PUDDLE OF BETADINE ALMOST INVARIABLY.
ALRIGHT. I AM GOING TO GET MY GLOVES ON HERE.
I JUST PUT THEM ON ON THE FOOT OF THE BED.
I DON'T WORRY SO MUCH ABOUT THE DRAPE PART UNDERNEATH THE KIT
BECAUSE I AM GOING TO JUST WORK OUT OF MY KITS,
YOU KNOW, OUT OF THE TRAYS.
THESE ARE ALWAYS SUCH A WAD WHEN THEY COME OUT OF THESE KITS.
SO YOU CAN WORK WITH YOUR GLOVES
AND THEN IF THEY GET REAL AWFUL,
YOU CAN PUT NEW NON-STERILE ONES ON.
ALRIGHT. I NEVER USE THIS ON A FEMALE.
ONE, THERE IS NOTHING TO REALLY HOLD IT IN PLACE LIKE THE MALE,
AND SO IT JUST FALLS AND GETS IN THE WAY.
SO WHAT I DO IS I JUST LAY IT OVER TO THE SIDE.
AND THEN IF I NEEDED TO,
FOR EXAMPLE, WHAT IF MY BLANKET STARTS SLIPPING,
I CAN GRAB THIS WITHOUT CONTAMINATING MYSELF AND PUSH THIS UP.
AND SO I HAVE GOT KIND OF A SPARE THING IN THERE.
THAT'S READY BEFORE.
ALRIGHT, I AM GOING TO SEPARATE MY TRAYS AGAIN.
AND I DON'T SEPARATE THEM IN THIS ORDER,
I GOING TO JUST ADJUST THEM A LITTLE, JUST SO YOU CAN SEE.
AND SAME THING I DID BEFORE.
SEPARATE THOSE COTTON BALLS.
MY TONGS.
OTHER PEOPLE -- THERE IS SO MUCH BAD TECHNIQUE OUT THERE.
USE YOUR FINGERS TO CLEAN WITH INSTEAD OF THE TONGS.
THEN WHAT HAPPENS TO YOUR FINGERS?
- THEY GET CONTAMINATED. - THEY GET CONTAMINATED!
BAD TECHNIQUE.
THEY OUGHT TO TRACK SOME OF THESE AND JUST SEE
WHERE THE URINARY TRACT INFECTIONS COME FROM.
NOW, YOU GOT TO CHECK OUR CATHETER.
I THINK THIS TIME WE WILL DO IT LIKE THIS.
BUT MAKE SURE THAT WHEN YOU TAKE YOUR PLASTIC OFF...
I JUST DON'T WANT TO BE CROSSING OVER WHEN YOU JUST GIVE HER THE...
LEAVE THE SYRINGE ATTACHED, ALSO, ONCE YOU CHECK YOUR BALLOON.
AND SO I AM LOOKING FOR BASIC SYMMETRY AND NO LEAKS
AND THAT IT FILLS AND SO FORTH.
I NOTICE, AS SOON AS I LET GO, IT JUST UNDOES ITSELF.
YOU CAN LEAVE IT SITTING HERE IF YOU WANT.
BUT SOMETIMES PEOPLE INADVERTENTLY GET THEIR SLEEVES INTO IT,
BECAUSE YOU'RE SO BUSY CLEANING AND WORKING DOWN HERE
THAT YOU DON'T SEE WHAT YOU'RE DOING ON THIS OTHER END.
SO AGAIN, I LIKE TO SET IT IN MY TRAY WHERE I KNOW IT'S SAFE.
ALRIGHT. MRS. SMITH, I AM GOING TO CLEAN YOU UP HERE
BEFORE I PUT THIS CATHETER IN WITH A LITTLE DISINFECTANT.
AND IT'S COLD. SO NO PAIN AT THIS POINT,
I WILL TELL YOU WHEN I PUT THE CATHETER IN.
SO AGAIN, I TOUCH THE THIGH AND I KIND OF PUT MY HAND UP HERE IN THE PUBIS.
NOW, THIS IS THE TRICKIEST PART OF ALL
BECAUSE MY HANDS ARE STERILE UNTIL I TOUCH DOWN.
AND WHEREVER YOU TOUCH DOWN IS WHERE YOU NEED TO KEEP YOUR FINGERS.
YOUR FINGERS WILL GET EXHAUSTED AND CRAMPY
BECAUSE YOU ARE TRYING TO HOLD THAT LABIA APART.
AND OUR HERE IS TO SEPARATE THE LABIA MINORA, NOT THE MAJORA.
WE GOT TO GET INSIDE TO GET TO THE MEATUS, OKAY?
SO A LITTLE ANATOMY REVIEW, FEMALES.
WHEN YOU SPREAD THE LABIA,
YOU SHOULD KIND OF GET THIS V-ISH LOOKING UPSIDE-DOWN V.
UP AT THE TOP IS THE CLITORIS, THEN THE MEATUS THEN THE VAGINA.
OKAY? SO OUR GOAL HERE IS TO CLEAN DOWN AND DROP,
ALL OF THE WHILE LOOKING FOR THAT MEATUS, OKAY?
THAT IS TRICKY TO FIND.
BECAUSE SOMETIMES THE CLITORIS AND THE MEATUS BLEND TOGETHER LITTLE BIT.
SO THAT'S OUR GOAL.
NORMAL, AVERAGE JUST SIT NICE AND PRETTY, UP TO YOU LIKE THIS.
OKAY? I AM GOING TO CLEAN YOU.
SO I AM GOING TO GET MY HANDS IN AND MY GOAL HERE IS,
WHAT I HAVE FOUND IS THAT IF I PUT MY FINGERS DOWN BY THE VAGINA
AND THEN I KEEP THEM FLAT AND SPREAD,
I CAN SPREAD THE MINORA OUT, MY FINGERS DON'T CRAMP SO BAD
AND I CAN GET NICE AND CLEAN DOWN THERE.
THIS IS WHAT I DON'T WANT TO SEE.
THE CLAW.
TWO LITTLE FINGERS THAT GO IN AND HOLD WITH THE TIPS.
ARGH!
THAT HURTS ME JUST TO THINK ABOUT IT.
SO, THE CLAW, NO, NO, NO.
MY NICE, FLAT FINGERS DOWN HERE.
AND THINGS ARE SLIPPERY DOWN HERE SOMETIMES.
THERE IS DISCHARGE AND WHATEVER.
ESPECIALLY, WHEN YOU ARE DOING LADIES IN LABOR AND DELIVERY.
THERE'S SO MUCH DISCHARGES. IT IS SO SLIPPERY.
SO THAT'S THE TRICKIEST PART. AND IT LOOKS ABOUT LIKE THIS.
BUT THIS WAY YOU CAN REST YOUR HAND HERE A LITTLE BIT
AND IT'S JUST NOT SO SLIPPERY,
BECAUSE YOU DON'T WANT TO SHIFT YOUR FINGERS.
ALRIGHT. IT'S COLD, THERE'S NOT MUCH ROOM HERE,
SO I AM JUST GOING TO GO FROM TOP TO BOTTOM,
LOOKING, LOOKING, LOOKING FOR THAT MEATUS.
LOOKING. WHERE IS IT?
NOW, THERE'S A COUPLE OF THINGS THAT YOU CAN LOOKING FOR.
ONE, IF THEY CALL IT THE WINK
AND THAT IS THAT WHEN YOU ARE CLEANING
THAT THE BETADINE KIND OF COOLS WHERE THE MEATUS IS.
IT KIND OF FALLS IN THERE AND IT GETS A LITTLE DARKER IN THERE.
SO THERE IS MORE BETADINE. YOU CAN SEE IT.
THE OTHER THING I FOUND IS IF I PUT A LITTLE PRESSURE --
AND NOT A LOT, YOU DON'T WANT TO HURT HIM --
BUT IF I PUT A LITTLE PRESSURE AND STRETCH,
SOMETIMES I CAN CATCH THE HOLE.
OLDER LADIES GET WRINKLIER AND WRINKLIER DOWN HERE.
AND I AM TELLING YOU WHAT IT IS HARD TO FIND THAT MEATUS.
NOW IF I HAD DONE TWO OR THREE SWIPES AND I AM NOT FINDING IT,
THEN I DO ANOTHER WIPE AND I LEAVE MY COTTON BALL IN THE VAGINA.
JUST LIKE THAT.
BECAUSE A COUPLE OF THINGS HAPPEN WITH THE FEMALE.
YOU GO TO PUT THE -- THE MEATUS MAY BE SO CLOSE TO THE VAGINA
THAT YOU GO TO PUT YOUR CATHETER IN AND SLIDES AND IT GOES IN INTO THE VAGINA.
IF IT GOES INTO THE VAGINA, IT'S CONTAMINATED
AND YOU GOT TO START ALL OVER AGAIN, OKAY?
NOW, MY HANDS ARE ABOUT TO DIE,
AND I THINK I HAVE FOUND MY MEATUS.
PRETTY GOOD SHAPE HERE SO GET MY CATHETER OUT
AND SAY, "OKAY, A LITTLE BIT OF PRESSURE HERE."
AND THEN I JUST TAKE AND I GO IN, AGAIN, SLOWLY.
PUT IT STRAIGHT IN, ABOUT THREE TO FOUR INCHES ON THE FEMALE.
I GET URINE. THEN YOU GO ANOTHER INCH OR TWO MORE.
THEN YOU CLEAR THAT BALLOON PAST THE URETHRA.
AND ONCE I AM POSITIVE I AM IN,
I TAKE THESE TWO FINGERS THAT ARE ABOUT TO DIE,
AND I CLAMP RIGHT HERE SO IT DOESN'T GO SLIDING AROUND.
AND THEN I TAKE THIS HAND AND I FILL THE BALLOON.
AND IT IS AT THIS POINT, YOU GOT TO EITHER DISCONNECT
OR HOLD ON TO IT UNTIL YOU GIVE THAT TUG
TO MAKE SURE IT'S IN PLACE.
THEN RELEASE THIS. OTHERWISE IT WILL JUST UNDO.
ALRIGHT. WOO! WE ARE GOOD.
I THINK I AM JUST GOING TO SWITCH MY GLOVES.
THERE IS SO MUCH BETADINE ON HERE.
WHEN I GO TO TAPE SOMETIMES, IT'S A MESS.
SO, YOUR FAULT, HOW MESSY IT GETS IN THERE.
SHOULD BE DRAINING PRETTY FAIR AT THIS POINT.
TAKE YOUR CATHETER BAG.
ALWAYS THE CATHETER SHOULD GO OVER THE LEG,
NOT ON THE SIDE RAILS, ON TO A STABLE POINT.
TAKE A WASHCLOTH AND CLEAN THE FRONT.
LIKE THAT.
I HAVE READ IN A LOT OF BOOKS AND I WAS ALWAYS TAUGHT,
WHEN YOU CLEAN THE FEMALE TO PUT THE CATHETER IN,
THAT YOU SHOULD DO THE FIRST WIPE IN THE MIDDLE
AND THEN THE SECOND WIPE ON THE RIGHT SIDE
AND THIRD WIPE ON THE LEFT SIDE. YEAH, RIGHT.
THERE IS NO WAY. THERE IS NO ROOM.
IF YOU ARE REALLY HOLDING THE MINORA APART, NOT THE MAJORA.
I MEAN, IF YOU ARE IN THERE, THERE IS ONLY THAT MUCH ROOM.
THERE IS ONLY MIDDLE, MIDDLE AND MIDDLE.
AND THAT'S ALL THERE IS.
OKAY? I AM GOING TO CLEAN UP MY MESS...
GET THAT BETADINE OUT OF THERE.
ACTUALLY, I DON'T REALLY WANT TO PUT THIS ON BECAUSE --
I DON'T HAVE MY STICKY. THAT I WOULD STICK IT ON.
AND THEN IT GOES RIGHT DOWN HERE AT THIS LOWER PORTION.
OKAY? AND THAT HOLDS IT IN PLACE SO YOU DON'T GET SLIDE.
AGAIN, NOT ON THIS HARD TUBING. IF THERE'S TOO MUCH WEIGHT,
THEN IT PULLS THE CATHETER OFF,
AND YOU DON'T WANT IT UP HERE BECAUSE THEN IT COMPRESSES.
ALRIGHT, SO I TAKE THIS ON.
GET ALL MY SUPPLIES OUT OF HERE.
UNDRAPE HER, MAKE HER COMFORTABLE HERE.
ALRIGHT.
WASH YOUR HANDS,
DOCUMENT THE SIZE OF THE CATHETER I PUT IN,
THE COLOR OF THE URINE, THE QUANTITY. I KNOW.
BAD CHOICE FOR A PLACE ON THIS BED.
BUT THIS IS A HORRIBLE BED BECAUSE IT'S A BERTHING BED
AND THERE'S NO BARS.
OH, THAT'S ALRIGHT. GO BACK AND PUT THE LIGHTS OUT.
OKAY, SAME THINGS THAT YOU WASH...
AS YOU OTHER CLIENT, AND THEN A PARTIAL DC.
ALRIGHT.
FEMALE STORIES.
OH! IF IT WAS ALL THAT EASY. IT WOULD BE A BREEZE.
THE PROCEDURE IS THE SAME. FINDING A SPOT IS NOT THE SAME.
PROBABLY MY BEST STORY EVER IS HOME CARE.
HOME CARE IS THE BEST STORIES EVER.
I HAD TO GO IN AFTER THIS LADY HAD...
CEREBRAL PALSY I THINK.
SHE WAS A YOUNG GAL, TWENTY-FOURISH
AND HAD CHRONIC CATHETER.
I HAD GONE TO CHANGE CATHETERS.
I ALWAYS LIKE THOSE VISITS. THEY ARE PRETTY CONCRETE?
YOU HAD A JOB TO DO AND YOU JUST DO IT.
TAKE A CATHETER OUT, YOU JUS CAN SEE GOOD, CATH IN, BEAUTIFUL.
SO I WENT IN, IT WASN'T MY PATIENT
AND I WAS FILLING IN FOR ANOTHER CASE MANAGER.
SO I WENT TO DO THIS LADY AND SHE WAS ON THIS RED COUCH.
I WILL NEVER FORGET THE RED COUCH.
THE RED COUCH WAS THIS HIGH, OKAY?
SHE IS LAYING ON THE RED COUCH
AND SHE CAN'T GET UP OR WALK OR MOVE OR ANYTHING.
SO I CAN'T GET HER INTO A BED BECAUSE SHE'S TOO --
I MEAN, SHE WAS LIKE 120LB,
BUT STILL, I AM NOT HOISTING HER ANYWHERE.
I AM GOING TO HAVE TO DO THIS CATHETER ON THIS RED COUCH.
OH, MAN. BODY MECHANICS AND HOME CARE IS THE PITS, YOU KNOW?
YOU HEARD ME ALREADY, ON THE FLOOR AND NOW ON THE RED COUCH.
AND SO NOT ONLY DID THIS LADY -- WHATEVER HER DIAGNOSIS WAS,
I CAN'T REMEMBER EXACTLY, BUT SHE WAS CONTRACTED.
SO HER KNEES -- I MEAN, PICTURE THESE AS LEGS.
HER KNEES WERE UP AND THEY WERE...TOGETHER BENT.
"WOW! OKAY."
SO, I GOT MY SUPPLIES READY, SHE'S ON THE RED COUCH
AND I WENT TO GET THE CATHETER OUT,
AND THERE IS LIKE NOT ANY SPREAD HERE.
THESE ARE LIKE PUNCH-GRIP KNEES, YOU KNOW WHAT?
SO I GOT MY SYRINGE, I PULLED OUT NEEDLE.
"OH, THIS IS GOING TO BE TOUGH.
HOW AM I GOING TO GET THIS IN? I CAN'T SEE."
YOU KNOW, NO LIGHT, NO NOTHING.
SO, HER KNEES WERE ALREADY UP.
THAT WASN'T PROBLEM SO I KIND OF SET MY SUPPLIES AT HER FEET.
I WAS DOWN ON MY KNEES
AND I GOT TO GET HER APART AND TO CLEAN.
SO, ALL I COULD THINK OF AT THE TIME WAS IF I PUT
MY CHIN HERE AND HOLD IT, AND I PUT MY HEAD HERE,
AND THEN I COULD GET IN THERE AND ARGH!
AND SO THAT'S EXACTLY WHAT I DID.
I GOT DOWN AND I... TRY TO CLEAN HER.
"OH, GOSH I AM GOING TO DIE."
AND MY HANDS ARE IN A CRAMP BECAUSE I AM HOLDING.
MY HEAD IS IN A VISE GRIP. AND THEN I AM CLEANING AND CLEANING.
AND I PUT THE CATHETER IN.
NO URINE.
OH! HOW CAN THIS BE? BUT I COULD HAVE SEEN SOMETHING.
OH, I JUST MISSED THE SPOT AND I PULLED IT OUT.
MY GOSH, I GOT TO DO THIS SLOW.
SO I GOT ANOTHER CATHETER. SHE HAPPENED TO HAVE THREE.
I GOT ANOTHER CATHETER.
I WAS SWEATING.
I SAID, "OKAY, I AM GOING TO DO THIS AGAIN."
NOW THIS LADY IS ALERT AND ORIENTED,
AND SHE IS JUST KIND OF WATCHING ME AND...
OKAY! SO, THIS DOWN, I SETUP.
I GO BACK IN.
PUT MY HEAD THERE.
AND I STARTED CLEANING IT. PUT IT IN.
NO URINE!
"NO. HOW CAN THIS BE? HOW CAN I NOT HAVE URINE?
WHERE ELSE CAN IT BE? THERE'S ONLY TWO HOLES. IT'S GOT TO BE IN THE RIGHT PLACE."
NO URINE.
OH, BY NOW I AM LIKE TOTALLY -- COS I AM LIKE SWEATING.
I THINK I AM GOING TO DIE.
AND THE LADY LOOKS AT ME, AND I PULL IT OUT, AND I SAID, "I AM SORRY.
I DON'T KNOW WHY THIS ISN'T WORKING."
SHE SAYS, "WELL, YOU KNOW,
EVERYONE ELSE DOES IT FROM BEHIND."
OH, I WANTED TO HURT PEOPLE.
OKAY, NOW HERE IS THE SAD STORY.
WHY DIDN'T ANYONE WRITE THAT ON THE CARE PLAN?
WHY DIDN'T ANYONE PUT THAT IN THE CARDEX.
THIS IS LIKE SUPPOSED TO BE UNIVERSAL KNOWLEDGE.
OKAY. I AM HAVING THIS FLASHBACK NOW OF NURSING SCHOOL WHERE THEY SAY,
"OH, YOU CAN PUT CATHETERS IN FROM BEHIND."
BUT, HEY, I HAVE BEEN A NURSE FOR 15 YEARS AND I HAVE NEVER HAD TO DO THAT,
SO THAT LITTLE PIECE OF INFORMATION JUST, KIND OF, WENT OUT THE DOOR.
SO I JUST SMILED AND SAID, "OKAY, CAN YOU JUST ROLL OVER?"
OH, SHE'S JUST SO MAD.
SHE ROLLS OVER, HER LITTLE LEGS BENT AND I JUST, "FINISH PLEASE."
YOU CAN SEE EVERYTHING FROM BEHIND BECAUSE THINK ABOUT IT,
IF A WOMEN BENDS THIS WAY, EVERYTHING'S THERE.
OH, YEAH! SO REMEMBER,
IF YOU CAN'T SEE AND THEY HAVE GOT THOSE WIDE SPREAD KNEES,
PLEASE THE HEAD THING.
ROLL OVER.
FROM BEHIND. IT WILL WORK JUST FINE.
OKAY? AND THAT'S A WOMAN THING NOT A MALE THING, RIGHT?
OKAY. THE RED COUCH. OH! WHAT A BEAUTIFUL DAY THAT WAS.
OKAY. ONE OTHER THING.
I WILL HAVE TO CONFESS OF THE WHOLE STORY.
YOU THINK I COULD GET IT IN, RIGHT?
BECAUSE I HAD IT IN THE EXACT RIGHT HOLE AND EVERYTHING.
NO URINE.
WELL, I AM NOT FILLING THE BALLOON WITH NO URINE.
I DIDN'T KNOW WHAT TO DO AT THIS POINT.
I WAS KIND OF GREEN AS FAR AS HOME CARE AND CATHETERS.
I HAD NEVER DONE SO MANY CATHETERS UNTIL I DID HOME CARE. SO I PULLED IT OUT.
I SAID, "YOU KNOW, I AM REALLY EMBARRASSED, BUT I JUST CAN'T GET THIS IN.
AND SO I CALLED THE OFFICE. THAT'S EMBARRASSING.
"OKAY, I CAN'T GET THE CATHETER IN."
SO THIS OTHER GAL, A LITTLE ELTHIAN COMES OUT. SHE PUTS IT IN THREE TIMES.
SHE SAYS, "I DON'T KNOW WHAT YOUR PROBLEM WAS."
"I WILL TELL YOU WHAT MY PROBLEM WAS."
SHE DIDN'T EVEN KNOW WHAT MY PROBLEM WAS.
MY PROBLEM WAS I HAD IT IN EVERY SINGLE TIME, EVERY SINGLE TIME.
I AM CONVINCED OF THIS.
MY PROBLEM WAS, SHE WAS A CHRONIC CATHETER.
WHAT HAPPENS TO THE BLADDER WHEN YOU ARE CHRONIC CATHETER?
THERE IS NONE. IT ATROPHIES.
BECAUSE WE AS HEALTHY HUMAN BEINGS HAVE A BLADDER
THAT DISTENDS AND EXPANDS TO HOLD OUR URINE UP TO 400-600 CC,
BUT WHEN YOU GOT A CATHETER IN THAT'S ALWAYS DRAINING IT,
THAT BLADDER DOESN'T HAVE TO DO NOTHING BUT SHRINK UP.
SO IT WAS IN, BUT THERE WAS NO URINE.
TOO BAD. COME OUT. I DIDN'T KNOW.
SO WHEN YOU HAVE SOMEONE THAT'S A CHRONIC CATHETER,
IT WOULD BE REALLY HELPFUL IF THEY DRINK A GLASS OF WATER BEFORE YOU COME.
YOU PUT THE CATHETER IN AND THEN YOU JUST STAND THERE
AND YOU WAIT, UNTIL YOU SEE A LITTLE CONDENSATION OR A LITTLE TRICKLE
OR A LITTLE SOMETHING COMING OUT OF THERE TO REASSURE YOU,
YOU ARE IN THE RIGHT PLACE.
SO ANOTHER NURSE SHARED THAT LITTLE TIP WITH ME
AND THEN I FIND IT IN MY READING AND IT ALL COMES TOGETHER.
BUT, OH MAN.
BUT THEN SEE I WOULDN'T HAVE A GOOD RECAP STORY TO TELL YOU.
ALRIGHT. MY VERY FIRST CATHETER
AND LIKE I WOULD SAY MY VERY FIRST OF EVERYTHING IN NURSING WAS HORRIBLE.
I THINK IT'S BETTER THAT WAY. YOU JUST GET IT OUT OF THE WAY.
BUT MY VERY FIRST CATHETER -- I MEAN, WE TALKED ABOUT IT IN SCHOOL AND I WAS READY TO GO.
AND SO I GO IN THERE AND I SEPARATE IT AND I HAVE DONE MY ANATOMY REVIEW, WHAT'S FIRST?
CLITORIS, MEATUS, VAGINA, BULL'S EYE.
IT'S ALWAYS IN THE MIDDLE, ALPHABETIC ORDER.
I MEAN, EVERYTHING THAT -- IT'S THAT ONE.
BECAUSE YOU DON'T GET ANYTHING.
"OH, WHERE IS IT? TOP TO BOTTOM."
SO I HAD IT ALL STRAIGHT IN MY MIND, I WAS READY TO GO.
AND I HAD MY THING, MY SET UP AND I WENT TO CLEAN AND I AM CLEANING,
"NO MEATUS." CLEAN. "NO MEATUS?"
I AM CLEANING AGAIN. "THERE IS NO MEATUS."
"I HAVE PUT A COTTON BALL IN THE VAGINA AND THERE IS NO MEATUS.
"I KNOW THAT IS CLITORIS. I KNOW THAT IS."
THERE IS NO MEATUS. WELL, THAT'S A PROBLEM.
NOW I KNOW SHE IS VOIDING. THERE HAS GOT TO BE ONE.
HOWEVER, I CANNOT FIND IT. SO EMBARRASSING. WHAT DO YOU DO?
I CLOSED UP MY STUFF AND GOT ANOTHER NURSE AND SAID,
"THIS IS EMBARRASSING, BUT I JUST CAN'T FIND THE MEATUS.
I JUST CAN'T FIND IT." AND SHE SAYS, "OKAY. ALRIGHT, YOU KNOW."
SO SHE GOES IN AND SHE SETS UP.
SHE CLEANS. SHE CLEANS.
"THERE'S NO MEATUS." "I KNOW, I TRIED TO TELL YOU."
SO, BUT SHE WAS A SEASONED PERSON.
SO SHE HAD HER FINGERS HERE AND SHE TAKES HER LITTLE FINGER
AND SHE GOES UP AND SHE FEELS UP IN THE VAGINA
AND RIGHT UNDER THE LIP OF THE IS THE MEATUS.
SO, I DON'T REMEMBER EXACTLY HOW SHE DID IT,
BUT SHE GOT HER CATHETER AND KIND OF TOOK HER FINGER
AND KIND OF SPREAD IT IN AND JUST WENT RIGHT UNDERNEATH AND DID IT BY FEEL.
OH, YEAH.
I WASN'T FEELING TOO BAD ABOUT THAT ONE.
SO SOMETIMES THE MEATUS REALLY IT IS KIND OF IN A DIFFERENT LOCATION
THAN WHAT YOU WERE ANTICIPATING, OKAY?
BUT BE CAREFUL, YOU DON'T WON'T TO GO POKING AT A CLITORIS JUST BECAUSE YOU THINK --
- WAS THAT AN OLDER LADY OR WAS THAT A YOUNGER LADY?
- OH! MAN MIDDLE AGED.
JUST AN AVERAGE, NORMAL PERSON THAT WAS A LITTLE ABNORMAL
AS FAR AS...WHERE HER MEATUS WAS LOCATED.
IT IS KIND OF LIKE A HYPOSPADIAS ON A MALE,
THE MEATUS CAN BE ON THE UPPER PART OF THE GLANS INSTEAD OF BEING RIGHT CENTER.
AND SO SAME THING, HERS WAS UNDER.
ALRIGHT. SOMETIMES --
I HAVE ALLUDED TO THE HEAVY SET LADY THAT WAS IN THE SOFT CUSHY MATTRESS AND I COULDN'T SEE.
WHAT I DID THAT HELPED ME WAS I HAD HER SIT UP OR ROLL OVER.
I CAN'T REMEMBER WHICH. BUT I PUT A TOWEL ROLL UNDER HER BUTTOCKS
SO THAT I COULD TIP HER BUTTOCKS UP SO I COULD SEE.
IF YOU CAN'T SEE WHAT YOU ARE AIMING FOR, IT'S JUST IMPOSSIBLE TO DO.
BECAUSE SHE WAS JUST TOO SUNK INTO THE BED.
SO REMEMBER THAT YOU COULD PUT SOMETHING UNDERNEATH TO LIFT 'EM.
I HAVE HAD MY CATHETER ON THE FEMALE.
I AM AIMING FOR THE MEATUS. I KNOW EXACTLY WHERE I AM, BUT IT SLIPS
AND IT GOES INTO THE VAGINA?
JUST...GOES.
WELL, THEN IT'S CONTAMINATED.
SO JUST LEAVE THE CATHETER IN THE VAGINA.
THEY WILL HOLD UP THAT SPOT.
IT'S CONTAMINATED. IT'S A DONE DEAL.
JUST LEAVE IT THERE, GET YOURSELF ANOTHER ONE
AND PUT THE OTHER ONE IN PLUS THE COTTON BALL WILL HELP.
ALRIGHT.
VERY GOOD. A COUPLE OF THINGS I JUST NEED TO GO OVER WITH YOUR TERMINOLOGY CREDE.
IT'S ONE OF YOUR VOCABULARY WORDS.
PEOPLE DON'T SEEM TO PICK UP ON IT VERY WELL
AND YOU NEED TO KNOW WHAT THIS WORD IS.
AND WE USE CREDING TO HELP SOMEONE URINATE
WHEN WE ARE DOING BLADDER TRAINING.
AND WHAT CREDING IS, IS A MASSAGE OF THE BLADDER.
AND SO IT IS VERY OFTEN USED WITH YOUR QUADRIPLEGICS
OR PEOPLE THAT ARE TRYING TO TRAIN THEIR BLADDER.
AND SO WHAT YOU WILL TEACH THEM TO DO IS TO MASSAGE DOWN
INTO THE PUBIC AREA TO HELP EMPTY BLADDER
BECAUSE THEY ARE NOT ABLE TO DO IT ON THEIR OWN.
SO WE CREDE, WE MASSAGE THE UPPER STOMACH --
THE UPPER PELVIS HERE.
SOMETIMES THAT WILL HELP YOUR CLIENT THAT'S NOT ABLE TO LIKE GO.
AND SO IF YOU CAN PUT A LITTLE PRESSURE ON THAT, JUST IN THE BLADDER, OOH!
THAT WILL KIND OF GET HIM GOING THERE A LITTLE BIT.
BLADDER TRAINING IS ANOTHER THING WE DO AND
IT'S ACTUALLY MORE EFFICIENTLY DONE IN YOUR REHAB UNITS
BECAUSE THAT IS WHAT THEY ARE AIMING TO DO.
BUT WHEN WE GET THEM STARTED IN HOSPITALS SETTINGS AND IN HOME CARE SETTINGS
WHAT WE OFTEN DO IS THEY WILL HAVE A CATHETER
AND WE WILL CLAMP THE CATHETER FOR INTERVALS OF TIME.
START STRETCHING OUT THAT BLADDER AND LETTING IT FILL UP.
SO, YOU MAY START WITH JUST AN HOUR AT A TIME,
THAT'S ALL THEY CAN TOLERATE. CLAMP IT,
SEE HOW THEY DO AND THEN RELEASE AND SEE HOW MUCH YOU GET.
AND THEN CLAMP IT AGAIN FOR AN HOUR
AND THEN YOU JUST START EXTENDING THAT TIME TILL YOU CAN GET UP TO TWO OR THREE HOURS
AND THEN IT'S TIME THEY CAN HAVE THE CATHETER REMOVED.
SO JUST HELPS BUILD A LITTLE TONE ON THEIR BODIES.
ALRIGHT. I JUST WANT TO SHOW YOU..
A COUPLE OF LITTLE THINGS HERE IN YOUR PASS, FAILS.
ONE OF THOSE IS A CBI...
WHICH IS CALLED CONTINUOUS BLADDER IRRIGATION.
AND WHAT HAPPENS WITH A CBI
IS THAT THEY GO TO SURGERY TYPICALLY FOR A TURP,
A TRANSURETHRAL RESECTION OF THE PROSTATE.
AND THE PHYSICIAN THEN WILL PUT IN A THREE-WAY CATHETER.
SO NOW YOU HAVE THE BALLOON ARM,
YOU HAVE THE CATHETER, THE DRAINAGE BAG ARM
AND THEN YOU HAVE ANOTHER LUMEN OR ANOTHER ARM FOR IRRIGATION.
OKAY? SO THIS WOULD BE INTO THE CLIENT.
PUT IN THERE FOR THE MOMENT.
AND THE GOAL IS THAT WE ARE GOING TO BE IRRIGATING THE BLADDER
TO KEEP BLOOD CLOTS FROM FORMING.
SOMETIMES AFTER A TRP, THEY ARE JUST BLOODY.
IT'S A BLOODY SURGERY.
AND IF THAT BLOOD CLOTS AND THE BLOOD PULLS UP INTO THE BLADDER,
IT WILL KEEP THEM FROM BEING ABLE TO URINATE AND THAT'S NO GOOD.
SO WHAT OUR GOAL IS THEN IS TO KEEP THIS RUNNING FAST ENOUGH
THAT WE KEEP THE URINE FREE OF CLOTS AND PINK-TINGED.
THERE IS NO RATE.
IT'S JUST CONTINUOUS BLADDER IRRIGATION.
IT'S YOUR CALL HOW FAST TO RUN IT.
IF THE UROLOGIST HAD ANYTHING TO TELL YOU,
HE WOULD SAY, "KEEP THAT THING RUNNING SO THAT THEY DON'T CLOT OFF."
YOU OPEN THIS UP AND YOU JUST COUNT THE DRIPS.
AND THE KEY IS THAT IT'S AN AUTOMATIC RINSE, FLUSH AND OUT.
SO YOU ARE GOING TO SEE RIGHT AWAY IN YOUR DRAINAGE BAG
AND IN YOUR TUBING THE URINE CLEARS UP OR NOT.
SO YOU ARE WATCHING FOR THE COLOR OF URINE
AND FOR THE CLOTS COMING THROUGH TO MAKE SURE.
SO YOU DO YOUR HI-FIVE, YOU HAVE A SET UP.
YOU RUN THIS AT A CONTINUOUS RATE.
THE KEY BEING ON THIS WHOLE THING FAST ENOUGH,
NO CLOTS AND PINK-TINGED.
IF YOU HAVE IT RUNNING AT A GOOD RATE
AND YOU COME BACK LATER AND IT'S RED, WHAT DO YOU DO?
SPEED IT UP. THAT'S IT.
NOW IT'S REALLY NICE IF YOU HAVE THIS DOUBLE SET-UP.
IT'S KIND OF LIKE THE PIGGYBACK SYSTEM.
YOU GET THIS ONE RUNNING, DOING ITS THING
AND THEN THAT ONE IS READY FOR BACK UP.
COS YOU CERTAINLY DON'T WANT TO GET BUSY AND HAVE IT DRY UP
BECAUSE THEN THEY WILL GET TO BLEEDING AND CLOTTING OFF
AND THAT IS A PROBLEM.
WELL, OKAY. CONFESSIONS OF A NURSE.
NO ONE TOLD ME MUCH ABOUT --
NO ONE TAUGHT US ANYTHING ABOUT BLADDER IRRIGATION WHEN I WAS IN SCHOOL.
IT WAS A SAD DAY.
AND I WAS ON A MED-SURG FLOOR AND THAT SEEMED TO BE ALL WE GOT WAS THIS --
WE HAD A WHOLE BLOCK OF UROLOGY PATIENTS AND WE GOT A LOT OF TURFS.
AND MOST OF THE TIME THEY RAN FINE AND THEY WEREN'T BLOODY.
BUT THIS ONE SURGEON, MAN, HIS WERE ALWAYS REALLY BLOODY.
AND I HAD ONE OF HIS CLIENTS ONE DAY.
AND, DADGUM, IF THAT THING DIDN'T CLOT OFF.
WELL, I DIDN'T KNOW.
SO -- I MEAN, I KNEW THE CLIENT WAS GETTING MISERABLE
AND I KNEW NO URINE WAS COMING OUT, SO I CALLED THE SURGEON.
OH, HE WAS TICKED, TICKED TO SAY THE LEAST.
SO HE COMES IN MAD AS CAN BE.
AND THEN I'M JUST KEEPING A STOIC FACE ON.
WHAT? SOMETIMES THEY JUST SHOOT THE MESSENGER.
ISN'T THAT THE TRUTH OF IT.
SO HE COMES IN. HE IS JUST MAD AS CAN BE.
AND HE GETS HIS SUPPLIES OUT AND HIS SUPPLIES ENTAIL THIS.
HE GOT AN IRRIGATION TRAY, HE GOT NORMAL SALINE
AND HE GOT A PISTON SYRINGE, NOT A BULB SYRINGE.
YOU OPEN UP YOUR KIT,
YOU DITCH OUT THE BOWL. NO VALUE.
THEN...
YOU DUMP IN, KEEPING EVERYTHING STERILE,
YOUR NORMAL STERILE SALINE. FILL IT UP.
AND THEN WHAT YOU WANT TO DO IS
YOU AREN'T STERILE WHEN YOU ARE DOING THIS,
BUT YOU NEED TO KEEP THE TIP OF THE SYRINGE STERILE.
SO YOU GET A CATHETER TIP PISTON SYRINGE
AND IT GOES INTO HERE.
THEN WHAT HE DID WAS CAME ON DOWN HERE
AND HE CAME TO...
I DON'T THINK IT REALLY EVEN MATTERS. HE DISCONNECTED...
OH, I WOULD HAVE A CHUX HERE. THAT'S WHAT I WOULD DO.
HE DIDN'T PLUG THE CATHETER,
BUT IF I WAS WORKING MYSELF, THIS IS WHAT I WOULD DO.
GET MYSELF A LITTLE CATHETER PLUG...
STERILE, AND YOU DISCONNECT.
OK, THAT'S THE WRONG END FOR WHAT I GOT GOING HERE
SO THAT'S NOT GOING TO WORK.
I AM JUST GOING TO HOLD THIS WITH MY OTHER HAND.
THEN YOU PULL UP...
YOU PULL UP A BUNCH OF SALINE
AND THEN YOU TAKE IT IN HERE, PUT IT IN HERE.
OH, I GOT TO DO THIS.
AND THEN YOU FORCE THIS IN, WHOOSH,
TO TRY TO BREAK OUT THE CLOT
AND THEN YOU PULL BACK AND THEN YOU TRY TO REMOVE CLOTS.
HE WAS VIGOROUS. PULLS IT BACK -- WELL, HE WAS MAD, TOO.
TAKES THIS, SQUIRTS IT OUT, GETS SOME MORE SALINE.
TAKES IT AND PUTS IT INTO HERE
AND HE FORCES IT IN AND THEN HE PULLS IT OUT.
SO THAT HE CAN GET THE CLOTS AND GET THE URINE OUT.
HE RELEASED THE CLOTS IN THE URINE BY MANUAL IRRIGATION.
OKAY? SO ONCE THAT WAS DONE...
HE SQUIRTED THAT BACK IN THERE.
YOU COULD WIPE THIS WITH ALCOHOL.
WIPE. RECONNECT.
AND THEN TURN THIS UP, GOT HIM RUNNING AGAIN, AND GAVE ME A EARFUL.
WITHOUT MAKING SURE THAT THING WAS RUNNING ALL THE TIME.
YOU GOT TO KEEP IT PINK AND SO ON AND SO FORTH.
SO THAT IS THE TRUTH OF IT.
AND THE KEY HERE IS
THAT YOU CAN HAVE A CONTINUOUS IRRIGATION GOING ON YOUR CBI'S
AND YOU CAN DO MANUAL IRRIGATION INTERMITTENTLY TO CLEAR CLOTS.
OKAY?
YOU CAN ALSO MANUALLY IRRIGATE ANY CATHETER.
WE DON'T DO IT VERY MUCH BECAUSE YOU NEVER WANT TO BREAK
INTO AN OPEN SYSTEM OR A CLOSED SYSTEM, RIGHT?
YOU ALWAYS WANT IT TO STAY CONNECTED TO STAY STERILE.
BUT PEOPLE THAT SOMETIMES NEED IRRIGATION ARE PEOPLE WITH CHRONIC CATHETERS.
BECAUSE WHAT HAPPENS? THERE IS NO URINE, RIGHT?
SO THE BLADDER IS COMPRESSED.
THE BLADDER MAKES SEDIMENT AND MUCUS.
SO SOMETIMES IF THEY ARE NOT WELL HYDRATED
AND THEY ARE MAKING A LOT OF SEDIMENT,
IT WILL CLOG UP THE CATHETER.
AND SO THEY NEED TO BE IRRIGATED PERIODICALLY TO KEEP THEM FLOWING.
AND SO YOU WOULD DO IT THE EXACT SAME WAY.
WITH GLOVES, OBVIOUSLY.
YOU WOULD JUST DISCONNECT HERE, PROTECT THAT END,
THEN SYRINGE IT IN YOUR STERILE SALINE,
TWO OR THREE TIMES
AND THEN RECONNECT THEM.
- DO YOU PULL IT OUT ALSO?
- IF YOU CAN.
I FOUND THAT SOMETIMES THE THING OF HOW THE --
THE CATHETERS IN THE BLADDER,
I'LL PUT ALL THAT FLUID IN AND THEN PULL BACK
AND I GET NOTHING, WHICH IS A DRAG.
BECAUSE IT'S JUST NOT POSITIONED WELL.
IF I HAD THEM ROTATING ALL OVER IN THE BED,
THEN I MIGHT BE ABLE TO GET IT BACK RIGHT AWAY.
SO WHAT I DO IS I KEEP TRACK OF MY IRRIGANT
SO THAT I CAN SUBTRACT IT FROM THE TOTAL VOLUME OF URINE IN THE CATHETER.
AND I'LL GO RYAN OVER BRIEFLY WITH THAT.
OKAY. ONE OTHER THING JUST IN A BRIEF REVIEW HERE.
IF YOU NEED A URINE SPECIMEN FROM A CATHETER...
YOU WOULD --
DO YOUR HI-FIVE AND ALL THAT KIND OF GOOD STUFF.
GET SOME ALCOHOL SWABS, A 10 CC SYRINGE AND A SPECIMEN CUP.
YOU WOULD COME OVER TO YOUR CATHETER
AND, OF COURSE, DRAIN IT ALL OUT AND THEN CLAMP IT.
AND YOU ARE GOING TO CLAMP IT BELOW THE PORT
SO THAT YOU TRAP PRESSURE UP ABOVE.
YOU CAN CLAMP IT WITH ANYTHING.
THEY HAVE REAL CLAMPS, I JUST NEVER KEEP MINE.
I JUST GET A RUBBER BAND
AND I JUST PUT A RUBBER BAND AROUND IT AND THAT WILL CLAMP IT.
THEN COME BACK IN 15-20 MINUTES.
AND I ALWAYS REMIND MY CLIENT.
"IF I DON'T GET BACK HERE IN 15 OR 20 MINUTES,
WILL YOU PUT YOUR CALL LIGHT ON SO I GET BACK HERE."
BECAUSE I DON'T WANT HIM CLAMPED OFF FOREVER.
THEN YOU CLEAN YOUR PORT WITH ALCOHOL.
GET A 10 TO 20 CC SYRINGE, DEPENDING ON HOW MUCH URINE YOU NEED,
AND IT'S THE PORT THAT'S ON THE GRAVITY DRAINAGE BAG.
THERE IS NO PORT ON THE CATHETER ITSELF.
PUT YOUR NEEDLE INTO THE PORT
AND THEN WITHDRAW YOUR SPECIMEN.
RELEASE THE CATHETER.
PUT YOUR SPECIMEN...
INTO THE CONTAINER.
LABEL IT. BIOHAZARD. OFF TO THE LAB.
THEN PUT THIS INTO THE SHARPS CONTAINER.
OKAY. IF YOU WEREN'T IN A POSITION TO DO THAT,
YOU COULD ALWAYS SAFETY LOCK IT DOWN, OKAY?
LET ME JUST SHOW YOU REAL QUICK HOW TO DO A I&O ON CBI'S.
CBI IRRIGATION.
IF...WE STARTED IT AT LET'S JUST SAY EIGHT O'CLOCK, CBI.
AND THE MILLILITERS IN THE BOTTLE WAS 2000.
THOSE WERE 2000 ML BOTTLES.
AND THEN AMOUNT RECEIVED IN MILLILITERS IS 1000.
THEN THAT MEANS 1000 WENT IN.
BUT OUR CREDIT IS 1000 LEFT FROM LIKE THE NEXT SHIFT,
DOWN HERE WHEN WE GIVE HIM OUR TOTAL.
WHAT WE NEED TO DO OVER HERE IS CBI OUT.
SAME THING, 1000 CC.
BUT THEY HAD 2500 OF URINE.
HOW MUCH URINE DID THEY REALLY HAVE?
- 15?
- 1500. OOPS, I DID THAT WRONG.
I NEED TO PUT THE 1500 HERE.
COS THEY HAD 2500 IN THEIR BAGS.
SO YOU SUBTRACT YOUR IRRIGANT TO COME UP WITH YOUR ACTUAL URINE.
AND THAT'S ALL. SO YOU JUST HAVE TO KEEP TRACK.
YOU PUT TAPES ON THEM, JUST LIKE YOU DO BEFORE,
BUT WE USUALLY DON'T DO LIKE AN HOURLY RATE,
WE JUST PUT A MARK FOR WHEN WE FINISHED WITH OUR I & O.
SO AT SIX O'CLOCK YOU MARK IT, YOU JUST PUT YOUR DATE TIME
AND THEN WHEN I RECALCULATE AGAIN,
I WILL DO MY DATE AND TIME. AT 12 OR WHATEVER.
USUALLY WITH THE CBI'S, YOU ARE GOING TO HAVE TO EMPTY
THAT FOLEY CATHETER BAG AT LEAST EVERY FOUR HOURS
BECAUSE YOU GOT SO MUCH STUFF GOING IN ON TOP OF URINE COMING OUT.
SO CHECK THOSE FREQUENTLY SO THEY DON'T BULGE OUT.
ALRIGHT, ANY QUESTIONS ON CATHETER WEEK?
ALRIGHT, YOU WILL JUST DO ONE. PRACTICE WITH YOUR KITS.
GET INSIDE AND WORK WITH ALL THE STUFF.
FILL UP YOUR BALLOONS, DO ALL THAT.
JUST DON'T OPEN UP THE BETADINE UNTIL YOUR TEST
AND THEN WE WILL DO THAT FOR REAL.