Chapters Transcript SureStep™ Foley Tray System Healthcare associated infections, or HAI's are a concern for patients and healthcare providers alike. Caheter associated urinary tract infections or caudies are among the most common HAIs. According to data published by the US Department of Health and Human Services. Codies are associated with increased morbidity, mortality, length of stay, antibiotic use, and cost of up to $500 million annually. Aseptic procedures and proper catheter maintenance play an important role in helping mitigate the risk of potty. This instructional video will provide a step by step demonstration of an aseptic technique used to catheterize male and female patients with the Sure Step Foley trace system. The Sure Step Foley tray system provides step by step instructions to help standardize insertion technique. The demonstration of the Surestep Foley catheter tray will be followed with a description of some important techniques related to ongoing Foley catheter care maintenance and urine sample collection. A Foley catheter should be placed only when necessary and discontinued when it is no longer required. Prior to placing the Foley catheter, obtain a physician order and confirm the patient meets appropriate indications for CDC guidelines or hospital policy for indwelling urethral catheter use. The key recommendations for appropriate indications that are consistent with the CDC guidelines are listed on the front of the Sure Step Foley catheter tray. Choose the Sure Step Foley catheter tray which best meets the needs of the patient. Unless otherwise clinically indicated, consider using the smallest catheter possible, consistent with good drainage to minimize bladder, neck and urethral trauma. If close monitoring of urine output is required, a pre-connected closed system urine meter tray may be selected. Likewise, if the patient requires continuous temperature monitoring, a temperature monitoring Foley catheter system may be selected. Catheterization should always be preceded by an explanation to and consent by the patient. A patient family education card provided in both English and Spanish is included within the Foley catheter tray to inform them on what it means to have a Foley and how they properly care for or maintain their catheter to help prevent coy. Ensure the patient's privacy by closing the door to the room and or drawing the curtain. Always follow and comply with your institution's rules and procedures. After thoroughly washing hands, don clean gloves in preparation for pre-cleansing of the perineal area. Ensure adequate lighting and arrange for extra nursing personnel to assist as necessary. Position the patient supine with the knees slightly apart. Open outer packaging of the Foley catheter tray. Remove the tray, remove the label, directions for use brochure, and orange sticker sheet from the top of the tray and set aside. The first step of the catheterization procedure should be a soap and water perineal cleanse. A peri care kit is provided on top of the wrap of the oy tray with simple instructions. Open the kit and remove the soap wipes and hand sanitizer. Open the packet of soap wipes, remove and unfold them. Cleanse the paraurethral area and discard wipes after use. Remove and discard your soiled gloves. Perform hand hygiene with the provided alcohol hand sanitizer gel. Position the tray so that the arrow is pointed towards the insertion site. Remove the band by lifting near the adhesive and unfold the outer wrap. Don the sterile gloves while maintaining sterile technique in an area outside of the outer wrapping. Place the underpa beneath the patient plastic or shiny side down. Use caution to maintain aseptic technique. Position the finnetrated drape over the external genitalia, so only the penis is exposed. Advance the tray toward the patient so the outer rap and underpad overlap. The sureep Foley tray is labeled to walk you through each step of the catheterization procedure. Step 1, open the packet of Povidone iodine. Step 2, pour the solution onto the 3 foam swapsticks to saturate them. Step 3, attach the syringe filled with sterile water to the inflation port. Please note that it is not necessary to pre-test the Foley catheter balloon. Step 4, locate syringe with lubricant and deposit lubricant into the tray. If hospital policy permits injecting lubricant into the male urethra, full amount will not be dispensed into the tray at this time. Remove Foley catheter from the blue wrap and place it in the lubricant. Step 5, with your non-dominant hand, elevate the penis, holding it perpendicular to the body without compressing the urethra. This hand is now contaminated and committed to non-sterile activity. With the uncircumcised patient, the foreskin should be gently retracted. Step 6, using your dominant hand, cleanse the penis with the Povidone iodine saturated foam swab sticks. Twist the swabs to remove them from the tray. Start at the urethral meatus and use swab sticks one at a time, cleansing in a circular motion. If hospital policy permits or following physician's orders, inject remaining lubricant into the urethra per established protocol. Step 7, remove the catheter from the lubricant. Insert the catheter into the urethro meatus using gentle downward pressure. Insertion may be eased by instructing the patient to take deep breaths and exhale slowly. If using a coude catheter, insert the catheter tip into the meatus with the curve facing towards the ceiling. If during insertion there is an obstruction or difficulty, stop, do not force passage, call for appropriate assistance or follow proper hospital protocol. When the catheter tip has entered the bladder, urine will be visible in the drainage tube. Advance the Foley catheter to the bifurcation of the catheter or as far as hospital policy permits to assure the balloon is within the bladder. Inflate the catheter balloon with the entire 10 mL of sterile water provided in the syringe. Only sterile water must be used to inflate the balloon. Remove syringe. Once the balloon is inflated, gently pull the catheter until the inflated balloon is snug against the bladder neck. If successful catheter insertion is not completed, including brakes and aseptic technique, replace the catheter and collecting system using aseptic technique and sterile equipment. If proper catheterization is not accomplished, use a new catheter system. After inserting the catheter, discard all materials in accordance with hospital policy and remove contaminated gloves. After thoroughly washing hands, Don cleaned gloves in preparation for pre-cleansing of the perineal area. Ensure adequate lighting and arrange for extra personnel to assist as necessary. The female patient is best catheterized in the dorsal recumbent position. An alternate position for the female patient is side-lying sims position. The knees must be adequately separated to obtain a clear view of the peri-urethral area. Open outer packaging of the Foley catheter tray. Remove the tray, remove the label, directions for use brochure, an orange sticker sheet from the top of the tray and set aside. The first step of the catheterization procedure should be a soap and water perineal cleanse. A peri-care kit is provided on top of the wrap of the foley tray with simple instructions. Open the kit and remove the soap wipes and hand sanitizer. Open the packet of soap wipes, remove and unfold them. Cleanse the peri-urethral area. And discard wipes after use. Remove and discard your soiled gloves. Perform hand hygiene with the provided alcohol hand sanitizer gel. Position the tray so that the arrow is pointed towards the insertion site. Remove the band by lifting near the adhesive and unfold the outer wrap. Don the sterile gloves while maintaining sterile technique in an area outside of the outer wrapping. Place the underpa beneath the patient plastic or shiny side down. Use caution to maintain. Aseptic technique while positioning the underpa. Position the festrated drape over the perineum, exposing the urethral meatus. Advance the tray toward the patient so the outer wrap and underpad overlap. The sureep Foley tray is labeled to walk you through each step of the catheterization procedure. Step 1, open the packet of Povidone iodine. Step 2, pour the solution onto the 3 foam swab sticks to saturate them. Step 3, attach the syringe filled with sterile water to the inflation port. Please note that it is not necessary to pre-test the Foley catheter balloon. Step 4, locate syringe with lubricant and deposit the lubricant into the tray. Remove Foley catheter from the blue wrap and place it in the lubricant. Step 5, with your non-dominant hand, carefully retract the labia to expose the urethro meatus. This hand is now contaminated and committed to non-sterile activity. Step 6, Using your dominant hand, twist the first swab stick to remove it from the tray and cleanse the labia menora furthest from you with a downward stroke and discard. Repeat on the labia minora closest to you and the area between the labia minora. Note that each swab stick should only be used for one swipe. Step 7, remove the catheter from the lubricant. Insert the catheter into the urethral meatus using gentle downward pressure until urine is seen in the drainage tube. Advance the catheter 2 more inches or around 5 centimeters and inflate the catheter balloon with the entire 10 mL of sterile water provided in the syringe. Only sterile water should be used to inflate the balloon. Remove syringe. If the patient experiences pain on balloon inflation, deflate balloon, allow urine to drain, advance catheter slightly, and reinflate the balloon. Once the balloon is inflated, gently pull the catheter until the inflated balloon is snug against the bladder neck. If successful catheter insertion is not completed, including brakes and aseptic technique, replace the catheter and collection system using aseptic technique and sterile equipment. If proper catheterization is not accomplished, use a new catheter system. After inserting the catheter, discard all materials in accordance with hospital policy and remove contaminated gloves. The Sure Step Foley catheter tray includes steps for Foley care and maintenance. Secure the catheter to the patient's thigh using the Stat lock Foley stabilization device or with the device currently being utilized at your facility. Place the device according to manufacturer's directions for use. The Statlock stabilization device, if provided, may be found in a bag hanging from the drainage hanger. Proper use of the stat lock stabilization device will be discussed at the end of this video. Hang the drainage bag near the foot of the bed. The bag should always be positioned below the bladder and should never touch the floor. Follow physician's orders or hospital policy for emptying the foley bag prior to transporting a patient. Arrange the tubing so it ensures proper flow of urine into the drainage bag. Utilize the green sheeting clip to secure drainage tube to the sheet. Maintain unobstructed urine flow and keep the catheter and collecting tube free from kinking and dependent loops. Ensure the drainage bag is completely unfolded. If a urine meter bag is used, you should exercise the spine of the bag, complete the orange stickers that were set aside earlier in order to document the procedure according to hospital policy. It is recommended to maintain a closed drainage system whenever possible by utilizing preconnected sealed catheter tubing junctions following physician's orders or hospital policy. A patient's Foley catheter system should be monitored routinely, which includes evaluating if the patient still requires a Foley catheter. The bag should be emptied at regular intervals. Drain the urine into a separate clean collection container for each patient. Do not allow the spigot to touch the sides of the container. If you need to obtain a urine sample, start by occluding the drainage tubing a minimum of 3 inches below the sample port. When urine is visible under the sample port, swab the surface of the barred easy lock sampling port with an antiseptic wipe. Follow the instructions of the antiseptic to ensure optimal result. Position the lure device over the sample port. Press firmly and twist gently to open the port. The port may also be accessed using a slip tip syringe. Aspirate the desired volume. If using a syringe, transfer the specimen into a specimen container, label it, and place it in a transport pouch. Send the specimen to the laboratory immediately or refrigerate until transported following hospital instructions. If using a specimen tube, label the tube and place it in a transport pouch. Follow the hospital specimen handling guidelines. When the patient no longer requires catheterization, remove the catheter in accordance with hospital policy and physician's orders. Remove the stat lock Foley stabilization device or other securement product prior to discontinuing the Foley catheter. Follow the device specific instructions. You may now begin the process to remove the. Cater gently insert a lurelock or slip tip syringe in the catheter valve. Never use more force than is required to make the syringe stick in the valve. Allow the pressure within the balloon to force the plunger back and fill the syringe with water. If you notice slow or no deflation, reseat the syringe gently. Use only gentle aspiration to encourage deflation if needed. Vigorous aspiration may collapse the inflation lumen, preventing balloon deflation. All of the water should be removed from the catheter balloon. If the balloon will not deflate and if permitted by hospital policy, the valve arm may be severed. If this fails, contact adequately trained personnel for assistance as directed by hospital policy. Should balloon rupture occur, care should be taken to assure that all balloon fragments have been removed from the patient. After the balloon is deflated, remove the catheter and discard it according to hospital policy. Using a permanent marker, write your initials and date of application on the stat lock device anchor pad. Place the Foley catheter bifurcation into the stat lock device retainer. The directional arrow should point towards the catheter tip. The wide channel in the clamp should hold the drainage arm, and the narrow channel should hold the balloon arm. Be sure the bifurcation hits the post in the clamp to seat the device properly. Close the lid by placing your fingers under the path and pressing the grip markers at the end of the clamp with your thumb, being careful to avoid pinching the catheter. Make sure the patient's leg is fully extended. Identify the proper securement site by gently laying the stat lock stabilization device straight on the front of the thigh, then back up 1 inch towards the insertion site. Follow Statlock stabilization device instructions for use. Cleanse and degrease the securement site with alcohol or per hospital policy. Let skin dry. Apply the provided skin protectant to the pad and direction of hair growth to an area larger than the securement site. Allow to dry completely approximately 10 to 15 seconds. Align the stat lock stabilization device over the securement site, leaving approximately 1 inch of catheter slack between the insertion site and the stat lock stabilization device retainer. While holding the retainer to keep the pad in place, peel away paper backing one side at a time and place tension free on skin. To remove the stat lock stabilization device, open the retainer by pressing the release button with your thumb. Then gently lift to open. Remove the Foley catheter, stack and fold 5 to 6 alcohol pads and wipe the edge of the pad until a corner lifts. Then continue to wipe the under surface of the pad in a back and forth motion by squeezing the alcohol out to dissolve the adhesive pad away from the skin. Foley catheters are intended for use in the drainage and or collection and or measurement of urine. The most common risk is urinary tract infection. The StatLlock device is a stabilization device for compatible catheters. Statlock stabilization device should be monitored daily and replaced when clinically indicated, at least every 7 days. Statlock stabilization devices are contraindicated on patients with known tape or adhesive allergies. Please consult product inserts and labels for indications, contraindications, hazards, warnings, cautions, and directions for use. Created by
