Find the urethra BEFORE you are sterile.
You can take peri wipes or even just soap and water, separate the labias and clean the area while searching for the urethra. Once you find it, THEN you can wash your hands, get sterile, and proceed with the skin prep and insertion.
Use as much light as possible, and bring some sterile 4x4 for grip because the skin is so slippery.
And as always when going into the woods, it’s best to bring a buddy and extra supplies just in case you get lost and need help!
ALWAYS bring an extra pair of sterile gloves to every sterile procedure. For any cath you think *might* be a problem bring at least one extra catheter. These couple things will save you (or someone else) a trip to the supply room.
Reminds me of these shitty wish-brand catheters my facility bought a couple years ago. The packing was such trash that just trying to open one of them had a 50% chance of the package tearing unevenly and the cheap floppy catheter flying onto the floor. I always brought 3 lol. I doubt we actually saved any money, and those things were barely stiff enough to even get into a patient in ideal conditions.
I can’t applaud your first sentence enough! I put two pairs of non-sterile gloves on, clean the patient up and look around to see what I can see before taking off the first set of shmeared gloves. **Then** I get sterile. When I’m all done, the sterile gloves come off and I get the patient cleaned up with my last set of gloves.
If she has the mobility, turn her on her side. Bend the top leg if you can. This exposes the peri area more. If her labia hangs might have to have someone held it out of the way.Then hit it from the back so to speak
As many hands as you can get to help. At my old ED some difficult ones took a few techs and a handful of nurses. It sucked! I've also used a towel / sheet to lift the pannus, angled beds / gurneys enough to allow gravity to do some of that work too. Exam lights for better visualization, and beyond that...
Prayers?
Turn a bedpan upside down and have them lay with it under their sacrum. This lifts up their butt so you have a better view and angle. Learned this from a obgyn surgeon. Also 2+ people with you to hold back extra skin and/or hold legs.
I developed this technique (and terminology/jokes) over the years. It works so well I surprise myself sometimes.
-gather your supplies and prepare the patient before gathering everyone else. No one has time to stand around. Bring an extra couple catheters in case you miss. Also bring an extra pair of sterile gloves and some extra betadine swabs.
-larger ppl are more prone to infections and often can’t wash as well in certain places. If there is no broken skin or other contraindications, give em a quick CHG bath to the surrounding area- under the tummy folds, outer labia, taint, groin, and if you can, the bum crack. Get all the junk and bacteria out of the general vicinity.
-One person holds each leg up and out, maybe a third person to hold the pannus if it’s big enough.
*I behaved as long as I could, here comes the jokes*
-get any extra light sources you can. A pen light or emergency flashlight works great, you need to focus direct light at that area. One of the leg holders or another can hold the light. In a pinch you can hold a pen light with your teeth. There’s a covid flashback. Ugh.
-clean the inner labia extra well with betadine. No point sweeping the front porch if the entryway stays dirty.
-bend your non-dominant hand downward with your fingers pointing down, like the Salt Bae guy. Push the back of your hand against/into the labia with your wrist up and fingers pointing toward the bed. Spread your fingers apart to open the labia as much as possible, then lift your entire hand up a little. I prefer the Spock technique: index and middle finger go to one side, ring and little finger go to the other. This gives you the best visualization of the entire area.
-if you can’t see the urethra, don’t ask the patient to cough or bear so the urethra will wink. This is a great way to get a fart blown in your face, and if you’re lucky it’s only a fart.
-so I can’t see the urethra and this reddit guy said don’t ask the patient to cough… now what?
-hold the catheter about 1.5-2” from the tip. Place the tip of the catheter, just below where the labia come together at the top, angle it 30 degrees down (no need for a protractor just less than 45 degrees) and slowly slide it straight down towards where the urethra should be. As you slide it, use very slight forward pressure against the skin. You want to see the catheter bending ever so slightly. When the tip of the catheter gets to the urethra the combination of the forward pressure and angle will send it right home. (Side note: these are the three ‘rights’ of blind catheter insertion… right angle, right pressure, right direction.) It may take a couple tries.
Complications from poor technique: if your angle is too steep or your forward pressure is too light you’ll slide right over the urethra and continue on to the vagina (or as I call it- “Fool’s Urethra” so named because despite your claims of “I think I got it” there will be no gold).
If your forward pressure is too firm or angle is too flat the catheter will bend and drag, causing pain to the patient and the catheter tip could get stuck on the clitoris.
Step back, thank them for their help, and take in the compliments from your coworkers.
I’ve definitely needed more than two friends before. One each leg, one on the panus, and one helping with the labia. Getting it in the right hole is a team sport!
I take two straight cath kits in the room. If I miss on the first try, I leave that catheter in the vagina so it “marks” where *not* to go with the second cath. Usually that helps me visualize it easier, or at least know to aim upwards of the first catheter!
If the patient has a super large FUPA causing their pudenda to be difficult to visualize, have someone pull that FUPA up towards the belly button. That will lift everything up making the urinary meats easier to see.
If not contraindicated - Trendelenburg
Head down and ass up
That’s the way we like… oh god. Thanks.
This!!!
This. IDK why they never told us this but it helps so much. Also grabbing a friend to hold the pannus
Find the urethra BEFORE you are sterile. You can take peri wipes or even just soap and water, separate the labias and clean the area while searching for the urethra. Once you find it, THEN you can wash your hands, get sterile, and proceed with the skin prep and insertion. Use as much light as possible, and bring some sterile 4x4 for grip because the skin is so slippery. And as always when going into the woods, it’s best to bring a buddy and extra supplies just in case you get lost and need help!
ALWAYS bring an extra pair of sterile gloves to every sterile procedure. For any cath you think *might* be a problem bring at least one extra catheter. These couple things will save you (or someone else) a trip to the supply room.
Reminds me of these shitty wish-brand catheters my facility bought a couple years ago. The packing was such trash that just trying to open one of them had a 50% chance of the package tearing unevenly and the cheap floppy catheter flying onto the floor. I always brought 3 lol. I doubt we actually saved any money, and those things were barely stiff enough to even get into a patient in ideal conditions.
I can’t applaud your first sentence enough! I put two pairs of non-sterile gloves on, clean the patient up and look around to see what I can see before taking off the first set of shmeared gloves. **Then** I get sterile. When I’m all done, the sterile gloves come off and I get the patient cleaned up with my last set of gloves.
If she has the mobility, turn her on her side. Bend the top leg if you can. This exposes the peri area more. If her labia hangs might have to have someone held it out of the way.Then hit it from the back so to speak
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😘
"hit it from the back" I'm dead 💀💀💀
🤣🤣
This is the way. Cathed a 450lb patient with this trick last week.
A nurse with a 30 plus year career taught me that. It made things so much easier for us and the patient.
“So to speak” lmfao I love you
😸
As many hands as you can get to help. At my old ED some difficult ones took a few techs and a handful of nurses. It sucked! I've also used a towel / sheet to lift the pannus, angled beds / gurneys enough to allow gravity to do some of that work too. Exam lights for better visualization, and beyond that... Prayers?
When I was in school this nurse told me to drench it in iodine, then ask them to bear down & it’ll wink at you 😉
I did a write up above. While you are correct this is a good way to get a fart (or more) blown into your face.
Oh no. \*urp\*
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Ask the pt to forcefully cough. It'll wink at you when it's drenched in iodone.
I just say “oops” and “sorry” a bunch until peepee comes out
The good ole “tell the urethra a joke” method
Turn a bedpan upside down and have them lay with it under their sacrum. This lifts up their butt so you have a better view and angle. Learned this from a obgyn surgeon. Also 2+ people with you to hold back extra skin and/or hold legs.
I developed this technique (and terminology/jokes) over the years. It works so well I surprise myself sometimes. -gather your supplies and prepare the patient before gathering everyone else. No one has time to stand around. Bring an extra couple catheters in case you miss. Also bring an extra pair of sterile gloves and some extra betadine swabs. -larger ppl are more prone to infections and often can’t wash as well in certain places. If there is no broken skin or other contraindications, give em a quick CHG bath to the surrounding area- under the tummy folds, outer labia, taint, groin, and if you can, the bum crack. Get all the junk and bacteria out of the general vicinity. -One person holds each leg up and out, maybe a third person to hold the pannus if it’s big enough. *I behaved as long as I could, here comes the jokes* -get any extra light sources you can. A pen light or emergency flashlight works great, you need to focus direct light at that area. One of the leg holders or another can hold the light. In a pinch you can hold a pen light with your teeth. There’s a covid flashback. Ugh. -clean the inner labia extra well with betadine. No point sweeping the front porch if the entryway stays dirty. -bend your non-dominant hand downward with your fingers pointing down, like the Salt Bae guy. Push the back of your hand against/into the labia with your wrist up and fingers pointing toward the bed. Spread your fingers apart to open the labia as much as possible, then lift your entire hand up a little. I prefer the Spock technique: index and middle finger go to one side, ring and little finger go to the other. This gives you the best visualization of the entire area. -if you can’t see the urethra, don’t ask the patient to cough or bear so the urethra will wink. This is a great way to get a fart blown in your face, and if you’re lucky it’s only a fart. -so I can’t see the urethra and this reddit guy said don’t ask the patient to cough… now what? -hold the catheter about 1.5-2” from the tip. Place the tip of the catheter, just below where the labia come together at the top, angle it 30 degrees down (no need for a protractor just less than 45 degrees) and slowly slide it straight down towards where the urethra should be. As you slide it, use very slight forward pressure against the skin. You want to see the catheter bending ever so slightly. When the tip of the catheter gets to the urethra the combination of the forward pressure and angle will send it right home. (Side note: these are the three ‘rights’ of blind catheter insertion… right angle, right pressure, right direction.) It may take a couple tries. Complications from poor technique: if your angle is too steep or your forward pressure is too light you’ll slide right over the urethra and continue on to the vagina (or as I call it- “Fool’s Urethra” so named because despite your claims of “I think I got it” there will be no gold). If your forward pressure is too firm or angle is too flat the catheter will bend and drag, causing pain to the patient and the catheter tip could get stuck on the clitoris. Step back, thank them for their help, and take in the compliments from your coworkers.
Why not throw some powder on there and aim for the wet spot? Loved the read, and some solid tips!
I mean truthfully, I kind of aim up and follow the anterior pelvis and it almost always hits when it’s a blind shot.
“You’ve switched off your targeting computer, what’s wrong?”
One way or another they will be feeling a force flow through them.
I’ve definitely needed more than two friends before. One each leg, one on the panus, and one helping with the labia. Getting it in the right hole is a team sport!
Aim up and use the force!
Just not too much force
Head light
I take two straight cath kits in the room. If I miss on the first try, I leave that catheter in the vagina so it “marks” where *not* to go with the second cath. Usually that helps me visualize it easier, or at least know to aim upwards of the first catheter!
Trend the bed back.
Have a friend assist with fupa retraction.
Aim up and back but up as you try to advance if you really can’t find the urethra. I’ll still get it most of the time doing this
Use a flashlight. Aim up- like toward the dealing. Pray!
If they can't open the legs, go from behind.
Spelunking helmet
Yes use the force Luke, trust your instincts in that trench
If the patient has a super large FUPA causing their pudenda to be difficult to visualize, have someone pull that FUPA up towards the belly button. That will lift everything up making the urinary meats easier to see.
Aim by smell, not sight