Question

Sara is a new grad nurse working in a surgical unit. Sara has been asked to insert a urinary catheter in a patient who will undergo major abdominal surgery this morning. She has assembled all of her supplies and is ready to begin the procedure. Sara washes her hands and sets up her sterile field. The patient accidentally moves, causing Sara to contaminate the catheter.

As Sara is about to ask someone for a new catheter, her charge RN stops by to tell her that the surgery schedule has been moved ahead and that her patient will be leaving for surgery in the next few minutes. Sara is now anxious and decides to quickly insert the catheter. A few minutes later, a transporter arrives to take the patient to surgery. He appears very impatient. As the patient is moved over to the transport bed, the transporter places the urinary catheter bag on the patient's abdomen. Everyone is in such a hurry that Sara questions whether she should stop the transporter or just remain silent.

1.What went wrong in this scenario?
2.What would have been the best course of action for Sara to take regarding the insertion of the catheter? Why?
3.How should Sara have handled the situation of the transporter laying the catheter bag on the patient's abdomen?
4.What are some other nursing considerations for transporting a patient with an indwelling catheter?

Answer 1

1.The major thing went wrong here is poor infection control practices (accidental contamination of catheter and insertion due to lack of time and anxiety of nurse, transporter placing the urobag on the abdomen can increase the risk of the major abdominal surgery)

2.The nurse has accidentally contaminated the catheter, in order to insert a sterile catheter in a very limited time frame the nurse should cleanse it with diluted betadine solution to decontaminate it and them insert the catheter.

3.The nurse should have immediately ordered the transporter to hang or place the catheter below the hip level or tying it to the transport bed.It should be ideally placed in between the legs to decrease the contamination rate.

4.Some of the nursing consideration for transporting a patient with an indwelling catheter are

• To secure it in lateral thighs to prevent dislodging during transportation
• Emptying the bag in case of urine in the urobag
• Following infection control practices
• Prevention of CAUTI by catheter care daily and as per need.
• Use of appropriate equipment while transferring the patient
• Following hospital policy and protocol
• Make sure it is below bladder level,place spigot in place,do nort reverse or invert the bag while trsnsfering patient.