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.