ENCYCLOPEDIA OF NURSING Sterile Techniques

Transcription

1 HAND WASHING 1. Push wristwatch and long sleeves above wrists. Avoid wearing rings or remove during washing. 2. Fingernails should be short, filed and smooth. Nail polish should not be worn. Acrylic nails are discouraged or prohibited because of the increased chance of harboring bacteria under them. 3. Stand in front of sink, keeping hands and uniform away from sink surface. 4. Turn on water by faucet, knee, or foot pedals. Regulate temperature so that water is warm. Avoid splashing. 5. Wet hands and wrists thoroughly under running water. Keep wrists down during washing (below elbows) so that water flows from least contaminated to most contaminated area (hands). 6. Apply a small amount of soap, lathering thoroughly. 7. Wash hands using friction for 15 seconds. Interlace fingers and rub palms and back of hands to ensure that all surfaces are cleansed. 8. Clean under fingernails with additional soap, scrub brush or orangewood stick, if needed. 9. Rinse hands and wrists thoroughly, holding wrists and fingertips downward. 10. Dry hands completely from fingers to wrists and forearms with paper towel while holding hands higher than wrists. Discard paper towel in receptacle being careful not to touch any part of the container. 11. Turn off water with foot or knee pedals. If using a water faucet with handles, use a clean dry paper towel. Do not touch handles with hands. Encyclopedia of Nursing Page 1

2 INCISION CARE Applying a Dry Dressing 1. Dry dressings are used most commonly for abrasions and non-draining postoperative incisions. If a dry dressing adheres to a wound during a dressing change, the nurse should moisten the dressing with arm sterile saline before removing the gauze. This prevents trauma to the wound and pain for the patient. 2. Verify correct patient using two identifiers: information on wrist band, verbal check, birth date, or 3. Wash hands. 4. Provide for privacy and explain the procedure to the patient. Position patient comfortably and raise bed to appropriate height. Drape patient to expose only wound site. Instruct the patient not to touch wound or sterile supplies. 5. Place waterproof disposable bag close to work area. 6. Gently loosen and pull tape toward dressing while moistening skin with tape remover wipe. Use adhesive remover wipes to clean remaining adhesive from skin. Cleanse skin with clean water and pat dry. 7. Apply clean gloves. 8. Remove used dressings. Assess drainage, and then discard dressing in disposable bag. 9. Remove and dispose of gloves. 10. Assess wound for appearance- signs of infection, drainage and odor. Note the size of the wound, the depth of tissue affected, and its color. 11. Open sterile dressing tray or individual sterile supplies. Place on bedside table or other flat work space. 12. Apply clean or sterile gloves according to policy. 13. Don sterile gloves and place dressing from kit or individual package on wound. 14. Apply dry sterile dressing by placing loose gauze as contact layer. Secure with tape. 15. Assist patient to a comfortable position and lower bed. Adjust side rails. 16. Wash hands. 17. Chart dressing change and wound condition in patient record. Report unexpected outcomes to physician. Cleansing Wound 1. Cleansing the wound may be agency policy or ordered by the physician. 2. Verify correct patient using 2 identifiers: information on wrist band, verbal check, birth date or Encyclopedia of Nursing Page 2

3 3. Apply clean or sterile gloves according to policy. 4. Cleanse wound by using a separate swab or gauze for each cleansing stroke. Use only warm sterile normal saline. Discard each used swab or gauze after it has touched the wound or surrounding tissue as it is now contaminated. 5. Use dry sterile gauze to blot wound from least contaminated area to most contaminated. An easy way to remember is the inner most part of the wound should be touched by the sterile gauze first. 6. Apply antibiotic ointment if ordered. The ointment can be used for the same patient if a multidose tube is used. 7. Apply dry sterile dressing by placing loose gauze as contact layer. 8. Secure with tape. Placing Split Dressing 1. If wound has a drain, use precut drain sponges and apply snugly around drain. 2. Apply second layer of gauze and thicker top pad- (ABD or surgipad). 3. Secure dressing with tape, ties or binder. 4. Dispose of all used supplies. 5. Remove gloves. Performing Pin Care 1. Verify correct patient using 2 identifiers: information on wrist band, verbal check, birth date or 2. Before gathering supplies, check agency policy regarding cleansing solutions to be used and ointment to be applied to prevent infection. 3. Gather supplies. 4. Wash hands. 5. Inspect sites for signs of infection-pain, redness or other discoloration, swelling, pustular drainage, or warmth to the touch. 6. Pour solution in a small sterile container. Open sterile cotton swabs, leaving tips in the package. Open sterile gauze. 7. Don clean or sterile gloves according to agency policy. 8. Dip each swab in solution and remove any crusting at the pin site. Also make sure the skin moves easily around the pin. 9. Us a new swab for each application and for each pin. 10. Pat each site dry with a new cotton swab or sterile gauze. 11. Continue the procedure until the area around each pin has been cleansed. Encyclopedia of Nursing Page 3

4 12. If agency policy, a small amount of antibiotic or antimicrobial ointment may be applied to the skin at each pin site. 13. When finished, gather all used supplies and dispose of them. 14. Remove gloves and wash hands. Applying an Absorptive Dressing 1. Hydrocolloid dressings can be used to absorb wound exudate and maintain a moist wound environment for healing of clean shallow to moderately deep wounds. 2. Verify correct patient using two identifiers: information on wrist band, verbal check and birth date and 3. Wash hands. 4. If patient may experience discomfort, pre-medicate 20 minutes before procedure. 5. Apply gown, goggles, and mask, if risk of spray exists. 6. Provide for privacy and explain the procedure to the patient. Position patient to expose wound site only, covering patient as much as possible. Raise bed to appropriate height. 7. Place waterproof bag close to work area. 8. Remove tape by pulling parallel to skin, toward dressing. 9. Apply clean gloves. 10. Remove old outer dressing and dispose of it. Remove gloves and discard. 11. Open sterile dressing tray or individual sterile supplies. Place on bedside table or other flat work space. 12. Open cleansing solution and pour over sterile gauze. 13. Apply sterile gloves. Remove inner dressing. Dispose of soiled dressings in waterproof bag. 14. Assess wound for appearance and odor. Hydrocolloid dressings interact with the fluid from the wound and form a soft whitish-yellow gel that has a faint odor. Alginate dressings may also leave a residual gel substance in the wound bed. This should not be considered a purulent exudate from an infected wound. 15. Measure wound size and depth. Compare with tape measure and record. 16. Clean wound with warm normal saline using an 18 gauge IV catheter attached to a ml syringe. With most alginate dressings, the wound must be thoroughly and gently irrigated to remove the residual gel without harming the newly formed granulation tissue in the wound bed. Cleanse wound as prescribed. Thoroughly pad area dry with sterile dry 4 X Alginate dressings can be cut or folded to fit the wound. Apply absorptive dressing according to manufacturer s directions. It is important not to completely fill the wound bed with the dressing, but allow some space for the alginate to expand. 18. Apply moist sterile gauze over moist contact layer. Encyclopedia of Nursing Page 4

5 19. Apply new outer dressing and tape or secure dressing. 20. Dispose of all used supplies in proper receptacle. Remove gloves and discard. 21. Assist patient to a comfortable position, lower bed, and adjust side rails. 22. Wash hands. 23. Chart dressing change and wound condition in the patient record. Report unexpected outcomes to the physician. Wound Irrigation 1. Wound irrigation generally carries the risk of spray contacting the care giver. The need for gown, goggles, and mask should be evaluated carefully. 2. Pre-medication for the patient may be advised, if the procedure will cause discomfort. 3. Verify correct patient ID using two identifiers: information on wristband, verbal check, birth date, or 4. Wash hands. 5. Provide for privacy, explain procedure to the patient, and raise bed to appropriate height. 6. Place waterproof bag close to work area. 7. Apply gown, goggles, and/or mask, if needed. 8. Apply clean gloves and remove soiled dressing and discard in bag. 9. Remove and discard gloves. 10. Position patient on side so irrigating solution can flow through wound. Place waterproof pad under patient. 11. Open sterile supplies. Pour solution into sterile container. Position basin below wound area on waterproof pad. 12. Apply sterile gloves. 13. To irrigate wound with wide opening, fill syringe with irrigating solution and attach IV catheter. 14. Hold tip of catheter 1 inch above upper edge of wound and flush wound with continuous pressure, catching fluid in basin. 15. Refill syringe. Reattach catheter and flush wound until wound is completely cleansed, making sure catheter tip does not touch wound surface. 16. To irrigate deep wound with small opening, fill syringe with irrigating solution and attach IV catheter. Then, lubricate tip of catheter with solution and gently insert tip into wound cavity. Be sure catheter does not irritate inner wall of wound. Use slow continuous pressure to flush wound. 17. To refill syringe, twist off catheter just below syringe and keep catheter in place. Refill syringe with solution. Reattach catheter and repeat flushing. 18. Dry wound edges with sterile gauze. 19. Apply appropriate dressing. Encyclopedia of Nursing Page 5

6 20. Remove gown, goggles and mask, if worn. Remove gloves and discard. 21. Raise side rails. Assist patient to comfortable position. Lower bed. 22. Dispose of equipment and used supplies. Wash hands. 23. Document wound irrigation, condition of wound, dressing change, and patient response in patient record. Suction Drain Management 1. The suction drain system must be checked to ensure the presence of suction, drainage moving through the tubing, airtight connection sites, and no leaks or kinks in the system. The drain will not function if the reservoir is completely filled. It must be emptied and recompressed. Note the number of suction drains and check the label of each one in order to identify the source of each drain and maintain accurate output for each wound area. 2. Verify correct patient using two identifiers: information on wrist band, verbal check, birth date or 3. Wash hands. 4. Provide for privacy, explain the procedure to the patient, and raise bed to appropriate height. 5. Apply goggles if the potential for splashing exists. Apply clean gloves. 6. Place open specimen container or graduated cylinder close to work area. 7. For hemovac, maintain asepsis while opening plug on reservoir. Tilt toward opening and slowly squeeze flat ends together while draining. Empty drainage. 8. Note characteristics of drainage- color, odor, amount, and record. 9. Open alcohol wipe and hold in dominant hand. Cleanse opening and plug with alcohol wipe and immediately replace plug. Place drain on flat surface or press downward until bottom and top are in contact. 10. Check drainage system for adequate suction, patency of tubing, and secure to patient s dressing or gown. 11. If specimen is needed, empty drainage into specimen container. Replace lid on container. 12. For the Jackson-Pratt drain, open port on top of bulb-shaped reservoir. Tilt reservoir toward opening and compress bulb over drainage container. Empty and measure drainage. 13. Maintain compression and cleanse opening and plug with alcohol wipe. Replace plug immediately. 14. Position patient comfortably and lower bed. Raise side rails. 15. Wash hands. 16. Document characteristics of drainage and amount emptied from drain in patient record. Encyclopedia of Nursing Page 6

7 STAPLE OR SUTURE REMOVAL ENCYCLOPEDIA OF NURSING 1. Agency policy varies as to the application of antiseptic ointment or swabs when removing sutures and staples. Application of steri-strips varies also. 2. Verify correct patient using two identifiers: information on wrist band, verbal check, birth date, or 3. Wash hands. 4. Provide for privacy and explain procedure to the patient. Position patient and raise bed to appropriate height. Provide adequate lighting and expose suture line, covering patient as much as possible. 5. Place waterproof bag close to working area. 6. Open sterile supplies, including antiseptic swabs or ointment, if needed. 7. Apply clean gloves, remove dressing, and discard both in bag. 8. Assess wound for appearance, odor, healing. 9. Apply sterile gloves, if required. 10. Cleanse with antiseptic swabs or cotton tipped applicators moistened with normal saline, according to surgeon preference or institutional policy. Staple Removal 1. Remove staples by placing lower fork of extractor under first staple. 2. Close down on extractor handles, causing ends of staple to be pushed upward and out of the skin. 3. Keep extractor at right angle to staple in order to remove staple correctly. 4. When both ends of staple are visible, move away from skin and dispose of staple. Repeat staple extraction until all staples are removed. Steri-strips maybe applied to the incision line after staples are removed. Suture Removal 1. To remove sutures, place 4 x 4 gauze close to suture line. Hold scissors in dominant hand and forceps in nondominant hand. 2. Snip suture close to skin surface, on opposite side of knot, being sure to avoid pinching or cutting the skin. 3. Pull suture by lifting knotted end away from the skin surface. Place on gauze. 4. Repeat for each suture until entire line has been removed. 5. Following suture or staple removal, inspect incision site. Wipe with cotton-tipped applicators or antiseptic swabs to remove debris and cleanse wound. 6. Apply light dressing or leave open to air as ordered. Encyclopedia of Nursing Page 7

8 7. Discard all used supplies and remove and discard gloves. Position patient comfortably, lower bed, raise side rails, and wash hands. 8. Document staple or suture removal, condition of incision, and patient response in patient record. Encyclopedia of Nursing Page 8

9 CATHETERIZATION Female Patient 1. It may be useful to have assistance from other nursing personnel to assist to position and/or support weak or confused patients. 2. Verify correct patient using 2 identifiers: information on wrist band, verbal check, birth date, or 3. Wash hands. Provide privacy, explain procedure to patient, and raise bed to appropriate height. 4. Drape with bath blanket, covering arms and chest. Position patient. Assist to dorsal recumbent position (supine with knees bent). Ask patient to relax thighs so hip joints are externally rotated. 5. Facing patient, stand on left side of bed if right-handed (on right side if left-handed). 6. Position waterproof pad under patient. 7. Open catheterization kit, maintaining sterile field. Outer plastic bag may be placed near patient to be used for disposal of used supplies. 8. If under pad is first item in kit, hold only by two corners and place the plastic side down. Slide pad underneath buttocks, between the thighs. 9. Apply sterile gloves. 10. To apply sterile drape, pick up fenestrated drape and unfold without contaminating. Place over perineum, exposing labia. 11. Organize items on sterile field. Open package containing catheter, keeping catheter on sterile field. Check that balloon of indwelling catheter is intact by inserting pre-filled syringe into balloon port and injecting fluid. A functioning balloon will visibly inflate. If no pre-filled syringe, amount of fluid needed in printed on the catheter. Withdraw fluid completely and leave syringe attached. 12. Pour antiseptic solution over cotton balls. Lubricate tip of the catheter directly from lubricant syringe or by rolling catheter tip in lubricant placed in tray. Lubricate 1 to 2 inches. If specimen is to be obtained, remove container from tray and loosen lid. Set aside on sterile field. 13. With nondominant hand, carefully retract labia with thumb and forefinger fully to expose urethral meatus. Maintain position of nondominant hand throughout procedure. If meatus is not clearly visualized, a cotton-tipped applicator may be used to gently touch urethral orifice. Using forceps in sterile dominant hand, pick up cotton ball and clean perineal area, wiping from front to back. Using a new cotton ball for each area, wipe along the far labial fold, near labial fold, and again directly over the urethral meatus. 14. Pick up catheter 3 to 4 inches from tip. 15. Ask patient to bear down gently as if to void and slowly insert catheter through urethral meatus. Advance catheter a total of 2 to 3 inches or until urine flows. 16. If the meatus was clearly visualized during insertion and no urine is seen, gently press on the lower abdomen or wait a few seconds. Occasionally the lubricant must dissolve before urine can flow. Also, occasionally the catheter tip may be above the level of urine in the bladder. Withdrawing it part way may allow urine to flow. 17. When urine appears, advance catheter another 1 to 2 inches. Do not force against resistance. Encyclopedia of Nursing Page 9

10 18. Release labia and hold catheter in place securely with non-dominant hand. Inflate with amount recommended by manufacturer (usually 5 to10 mls). Pull catheter gently back to feel resistance, then release. 19. Collect urine specimen, if needed. 20. Allow bladder to empty fully unless institution policy restricts maximal volume of urine to drain with each catheterization. Attach end of indwelling catheter to drainage collection bag if not preconnected. Bag must be placed below the level of the bladder on bed frame. 21. Dispose of used supplies and drapes in proper receptacles. 22. Remove and discard gloves. Assist the patient to a comfortable position. 23. Tape the catheter to inner thigh with non-allergenic tape, Velcro type catheter strap or mesh adhesive dressing. Be sure there are no kinks or obstructions in tubing. 24. Wash and dry the perineal area as needed. 25. Lower bed and adjust side rails. 26. Wash hands. 27. Chart type and size of catheter in patient record. Document patient response, the amount and character of the urine and whether a specimen was sent to the lab. Male Patient 1. It may be useful to have assistance from other nursing personnel to position and support weak or confused patients. 2. Verify correct patient using 2 identifiers: information on wrist band, verbal check, birth date, or 3. Wash hands. 4. Provide for privacy, explain procedure to patient and raise bed to appropriate height. 5. Position patient supine with thighs slightly abducted. Drape patient with bath blanket, covering arms and legs, leaving genitalia exposed. But, keep covered as much as possible. Facing patient, stand on left side of bed, if right-handed (on right side, if left handed). 6. Outer plastic bag may be placed near patient to be used for disposal of used supplies. 7. Open catheterization kit, maintaining sterile field. 8. If under pad is first item in kit, hold only by two corners and place plastic side down across patient s thighs, below level of penis. 9. Apply sterile gloves. 10. Pick up fenestrated drape and unfold without contaminating. Apply drape over genitalia, exposing penis. Encyclopedia of Nursing Page 10

11 11. Organize items on sterile field. Open package containing catheter, keeping catheter in sterile field. Check that balloon of indwelling catheter is intact by inserting pre-filled syringe into balloon port and injecting fluid. A functioning balloon will visibly inflate. If no pre-filled syringe, mark on catheter indicates the amount of fluid to be used. Withdraw fluid completely and leave syringe attached. 12. Pour antiseptic solution over cotton balls. Lubricate tip of the catheter directly from the lubricant syringe or by rolling catheter tip in lubricant placed in tray. Lubricate 5 to 7 inches. If specimen is needed, remove container from tray and loosen lid. Set aside on sterile field. 13. Holding penis midway below glans, maintain nondominant hand in this position throughout procedure. If patient is not circumcised, retract foreskin. 14. With dominant hand, pick up cotton ball and cleanse meatus by wiping in a circular motion from meatus to base of glans. Cleanse three more times, using a clean cotton ball each time. 15. Pick up catheter 3 to 4 inches from tip. 16. Lift penis to a position perpendicular to patient s body. Ask patient to bear down as if to void and slowly insert catheter through urethral meatus. Advance catheter 7 to 9 inches or until urine flows out of the catheter (lubricant jelly may occlude the drain of the catheter and cause a delay in urine flow). If resistance is felt, DO NOT FORCE. It may be helpful to extend the penis while inserting to ease the catheter through the prostate bed. 17. Lower penis and hold catheter securely in nondominant hand. Inflate with amount recommended by manufacturer (usually 5 to 10 mls). Balloon should inflate easily if in bladder. Pull catheter gently back to feel resistance, then release. 18. Collect urine specimen if needed. 19. Allow bladder to empty fully unless institution policy restricts maximal volume of urine to drain with each catheterization. 20. Dispose of used supplies and drapes in proper receptacles. Remove and discard gloves. 21. Bag must be placed below the level of the bladder on bed frame. Be sure there are no kinks or obstructions in tubing. 22. Secure the catheter to top of thigh or lower abdomen with non-allergenic tape, Velcro type catheter strap, or mesh adhesive dressing. Allow slack in catheter so movement does not pull on the catheter. 23. Assist patient to a comfortable position. Don clean gloves. Wash and dry the genital area as needed. 24. Raise side rails. Wash hands. 25. Chart type and size of catheter in patient record. Document patient response. Also chart the character and amount of the urine and whether a specimen was sent to the lab. Catheter Care 1. Avoid disconnecting the catheter from the tubing and bag. Keep bag below level of bladder during turning, catheter care or ambulation. 2. Verify correct patient using 2 identifiers: information on wrist band, verbal check, birth date, or 3. Wash hands. Encyclopedia of Nursing Page 11

12 4. Provide for privacy. Explain procedure the patient. Raise bed to appropriate height. 5. Apply clean gloves. 6. Position patient correctly and cover with bath blanket, exposing only perineal or genital area. 7. Place water proof pad under buttocks for female patient or on top of thighs for male patient. 8. Provide routine perineal care if needed. 9. Assess urethral area and genitalia for inflammation, discharge or odor. 10. Ask patient if there is any discomfort. 11. Use a clean wash cloth and wipe in a circular motion around the catheter tubing away from the meatus for a length of about 4 inches. 12. Of needed, replace the tape or catheter holder. 13. Check tubing for kinks and collection bag for position on the bed frame. 14. Assist the patient to a comfortable position. 15. Lower the bed and adjust side rails. 16. Dispose of used gloves and supplies. 17. Wash hands. 18. Document catheter care, condition of perineum of genital area and characteristics of urine. Note patient response. Catheter Irrigation 1. Urinary catheter irrigation is not recommended and should rarely be done and then only if ordered by a physician when clots or sediment occlude the patient s catheter or tubing. 2. Verify correct patient using 2 identifiers: information on wrist band, verbal check, birth date, or 3. Wash hands. 4. Provide for privacy, explain the procedure to patient, and raise bed to appropriate height. Position patient in supine position and cover as much as possible with bath blanket. 5. Expose catheter at junction where it connects to drainage tubing. 6. Remove tape or Velcro catheter holder that secures the catheter to the patient. 7. Be careful not to pull on catheter. 8. Assess lower abdomen for signs of bladder distention. 9. Apply gloves. Position waterproof pad under catheter junction. 10. Open sterile irrigation tray, and pour required amount of room temperature solution into sterile solution container. Replace cap on large container of solution. 11. Place collection basin under catheter junction. Encyclopedia of Nursing Page 12

13 12. Wipe junction between catheter and drainage tubing with alcohol or antiseptic wipe; disconnect catheter from tubing and allow urine to flow into collection basin. 13. Cover open end of drainage tubing with sterile protective cap and position tubing so that it lies on bed. 14. Fill syringe with irrigating solution. Insert tip of syringe into lumen of catheter and gently instill solution. DO NOT FORCE. 15. Remove syringe, lower catheter and allow solution to drain into basin. Repeat, instilling solution and draining several times until drainage is free of clots and sediment. 16. If solution does not return, have patient turn onto side facing nurse; if solution still does not return, reinsert syringe into catheter and gently aspirate solution. 17. When irrigation is complete, remove protective cap from drainage tubing, cleanse end with alcohol wipe, and reinsert tubing into lumen of catheter to restore closed drainage system. 18. Remove and discard gloves. 19. Secure catheter to patient s thigh or leg with tape or Velcro holder. 20. Assist patient to comfortable position, lower bed and adjust side rails. 21. Dispose of supplies. 22. Raise side rails. 23. Wash hands. 24. Document type and amount of solution used as irrigant, amount returned as drainage, (subtract irrigant from drainage to obtain accurate urine output), characteristics of drainage, and patient response in patient record. Report unexpected outcomes to the physician. Collecting Urine Specimen 1. A urine specimen should not be collected from the urine collection bag because it can give a false measurement of bacteria in the urine. 2. Verify correct patient using 2 identifiers: information on wrist band, verbal check, birth date, or 3. Wash hands. 4. Don gloves. Explain procedure to patient and clamp tubing for 30 minutes. Tubing should be clamped below rubber entry port. Tubing may be kinked and held by a rubber band or a clamp to compress the tubing and prevent draining. 5. Again, wash hands. Apply gloves and position patient and catheter so entry port is accessible. 6. Cleanse entry port with disinfectant swab. Keeping syringe sterile, insert into rubber entry port. Draw urine into sterile syringe (3 ml. for culture or 20 ml. for routine urinalysis). 7. Transfer urine from syringe into sterile urine container. Place lid tightly on container. 8. Unclamp catheter and allow urine to drain into collection bag. Encyclopedia of Nursing Page 13

14 9. Dispose of syringe and needle into sharps container, other supplies into receptacle. Remove and discard gloves. 10. Raise side rails. Wash hands. 11. Attach identification label to specimen and send to lab. 12. Document that specimen was obtained and appearance of urine- (color, clarity, sediment or clots present). Retention Catheter Removal 1. Verify correct patient using 2 identifiers: information on wrist band, verbal check, birth date, or 2. Wash hands. 3. Provide for privacy. Raise bed to appropriate height and position patient in supine position. Explain to the patient that the removal may cause discomfort. Be prepared for patient to ask for urinal, bedpan, or bedside commode when catheter is removed as an urge to void is sometimes experienced upon removal of catheter. 4. Remove adhesive tape or Velcro catheter strap used to secure catheter. 5. Apply gloves. 6. Place waterproof pad in between or on top of patient s thighs. 7. Insert hub of syringe into inflation valve (balloon port). Aspirate entire amount of fluid from balloon and detach syringe. 8. Instruct client to take a deep breath and to exhale slowly. Withdraw catheter completely. DO NOT PULL IF RESISTANCE IS MET. 9. Wrap contaminated catheter in waterproof pad. Unhook collection bag and tubing from bed. Measure contents of collection bag. Wash and dry perineum or genitalia as needed. 10. Assist patient to comfortable position. Lower bed and adjust side rails. 11. Dispose of all used supplies. Remove gloves and wash hands. 12. Document that catheter was removed and patient response in patient record. Record amount of urine from bag as urinary output. Suprapubic Catheter Care 1. Verify correct patient using 2 identifiers: information on wrist band, verbal check, birth date or 2. Wash hands. 3. Provide for privacy, explain the procedure to the patient, and raise the bed to appropriate height. 4. Place patient in supine position and expose only catheter insertion site. Instruct patient not to touch site or sterile supplies. Encyclopedia of Nursing Page 14

15 5. Place waterproof bag close to work area. ENCYCLOPEDIA OF NURSING 6. Remove tape by pulling parallel to the skin toward dressing. 7. Apply clean gloves. 8. Remove old dressing. Observe drainage on dressing. 9. Discard soiled dressing in bag. Remove gloves and discard. 10. Assess the catheter insertion site for signs of infection, drainage, and odor. 11. Open sterile supplies. 12. Apply gloves, clean or sterile, according to policy. 13. Pick up catheter with non-dominant hand and hold erect while cleaning. 14. Clean site with dominant hand by swabbing in a circular motion starting closest to the catheter drain and continuing in outward widening circles for approximately 2 inches. Repeat twice with a new sterile swab each time. 15. With sterile dominant hand, apply split gauze around catheter and tape in place. 16. Dispose of all used supplies. 17. Secure catheter to abdomen. Check drainage tubing and bag to ensure there are no kinks or obstructions to tubing. Drainage bag must be placed below the level of the bladder on bed frame. 18. Remove gloves and discard. Wash hands. Lower bed. Raise side rails. 19. Document care of the catheter, noting characteristics of drainage and appearance of wound, in patient record. Note patient response. Report unexpected outcomes to the physician. Encyclopedia of Nursing Page 15

16 SURGICAL ASEPSIS Setting Up Sterile Field 1. Open back table pack by first unfolding back flap away from you. Make sure there is enough room so edge of sterile field does not touch walls or furniture. 2. It is helpful and safer for two people to open the sterile table cover. Fold out longitudinal wrap from sides staying far away from sterile areas. 3. Only sterile persons can touch the sterile field. Table is now sterile at table height. 4. Hold package firmly with thumb and index finger. To open and add sterile items in 4 corner wrapped taped packages to the sterile field, tear across the tape. 5. Hold all corners firmly with fingers and deliver contents to sterile field, releasing grip of thumb and index finger as contents leave hand. Keep corners tucked in fingers. If package is double-wrapped, open outer wrap and discard. Open inner wrap until the inner folded corners can be seen. 6. Carefully fold each corner away from contents and tuck into hand. Do not reach over the sterile contents of the package. 7. If package has double fused wrap, proceed as for single inner wrap. 8. To add sterile items from a heat sealed peel pack, check for arrows or notches which direct to correct edge. Hold package firmly with both hands. Open part way by pulling evenly on both sides of package with both hands. Turn the package so the bottom side of wrap can be pulled back along hand and arm toward body. This opens the package over the sterile field in an aseptic manner by keeping the arm covered with the sterile wrap. Approach the sterile field and gently drop the package contents on the sterile field. Scrubbing and Drying 1. Different types of antimicrobial agents are available on brushes or as foams or gels. Some agents are water-aided and others can be applied directly to the hands and arms without water. Whatever type of agent is used, the method of scrubbing is the same. The brush, antimicrobial agent and water method is used for demonstration. 2. Choose brush according to agency policy, brush availability and personal preference. 3. Turn water on and adjust temperature, if it is not automatically controlled. 4. Wet hands and arms, keeping arms flexed with hands pointed upwards, allowing water to run down arms to elbows. 5. Under running water, clean under nails with pick from scrub brush pack. Discard pick.. 6. Wet brush completely so soap will foam. Scrub should be done with bristle, not foam side of brush. 7. Continue by scrubbing finger nails of one hand 15 strokes. Rinse the brush and scrub fingernails of other hand. 8. Scrub with ten strokes on each of four sides of thumb and fingers, then the back and palm of the hand with 10 strokes each. Rinse the brush and scrub the other hand using the same procedure. Encyclopedia of Nursing Page 16

17 9. Divide the arm into half lengthwise and scrub all four sides 10 times. Rinse brush and scrub the distal half of other arm. Return to first arm and proceed with proximal forearm and end with elbow. Do same procedures on other proximal forearm. Some agencies may require the nurse to scrub by time (usually 5 minutes) rather than stroke method. The important point is to cover entire hands and arms methodically and thoroughly. 10. Keeping hands higher than elbows, discard brush. Rinse from fingertips to elbows in one continuous motion, allowing water to run off elbows. Remove arms from flow of water and continue rinsing until soap is removed. Do not touch faucet or sink. If the nurse does touch an unsterile area such as the sink or faucet, the arm or hand which was touched must be re-scrubbed 10 times. 11. Turn off water with foot or knee control or elbow, if water does not stop automatically. Let water drop into sink for a few seconds. 12. Enter the room by opening the door with the back. Keep hands elevated in front and away from body. Proceed to sterile field. 13. Stand away from the field and grasp sterile towel. Take care not to drip on or touch the sterile field. Lean over while unfolding and drying so the towel edges do not touch the unsterile uniform. 14. Make sure to cover the thumb of hand wiping with towel so it does not touch the other hand or arm. Dry one hand thoroughly, moving from fingers to elbow in a rotating motion. Turn towel to opposite end to repeat the drying process for the other hand and arm. 15. Drop the towel into linen hamper or waste container. Applying Sterile Gown 1. After drying with sterile towel, pick up gown (folded inside out) from the sterile field by grasping the inside surface of gown at the front. Be careful only to touch inside of gown. 2. Locate shoulders of gown and slip hands into sleeves. Allow gown to open and fold over arms and body. Do not touch outside of gown or let the gown touch the floor. Continue to slip both arms into armholes simultaneously. Do not let hands go through the cuff openings. Keep hands above waist level. 3. Circulating nurse or other unsterile member of the team will pull gown on by reaching inside arm seams. The unsterile person should not touch scrubbed person s arms. 4. Unsterile personnel should fasten gown at neck by either Velcro tape or snap and tie inside ties with a double loop. Do not tie in a knot or bow. 5. If wrap-around gown is used, the outside tie should not be done until after the gloves have been applied. Closed Gloving 1. With hands covered by gown sleeves and cuffs, open sterile inner glove package. Encyclopedia of Nursing Page 17

18 2. Grasp glove and place on upturned palm inside gown sleeve. Fingers of glove point toward elbow. Thumb of glove and hand will be on the same side. Grasp edges of glove (not folded edge) with thumb and forefingers. Grasp back of glove edge with other hand, and turn glove over hand while extending fingers into glove and pulling on gown cuff and glove. 3. Glove other hand in same manner. Be sure fingers are fully extended into both gloves. Completing Gowning 1. Grasp sterile waist tie and cardboard with gloved hand and untie or pull paper holder off fabric loop. 2. Pass card with tie to circulating nurse. Hold short gown tie in left hand. 3. Allowing margin of safety, turn to the left one-half turn, covering back with extended gown flap. Pull tie out of paper tab held by circulating nurse. 4. Tie both right and left ties in a bow. Working in Sterile Field 1. Because risk of splash or spray exists, protective eye wear should be worn. 2. Stand with at least 18 inches between sterile person and unsterile items. Face sterile field. Keep hands folded together at mid chest level. 3. Keep hands at level of back table, Mayo stand, or operative field. 4. Do not adjust glasses, touch mask or anything that is not sterile. 5. Pass sterile persons back to back or front to front. 6. Pass unsterile team members with enough distance so sterility is guaranteed. 7. If protective eyewear is not donned before gowning, the circulating nurse or other personnel should place them on you. Goggles or eye wear should fit snugly around face and eyes. Encyclopedia of Nursing Page 18