Scenario 1
Angela is a new graduate assigned to a surgical unit. Angela 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 equipment and supplies and is getting ready to insert the catheter. She uses sterile gloves, drape, sponges, an appropriate antiseptic or sterile solution for periurethral cleaning, and a single-use packet of lubricant jelly for insertion. Angela washes her hands before the procedure and very carefully sets up the sterile field. The patient accidently moves, causing Angela to contaminate the catheter. As Angela is about to ask someone for a new catheter, her charge nurse stops by to tell her that the surgery schedule has been moved ahead and that her patient will be going to surgery in the next few minutes. Angela is now scared and frightened and is faced with a dilemma. A few minutes later, a transporter arrives to take the patient to surgery. He appears very impatient. Angela’s patient now has a urinary catheter in place. As the patient is moved over to the cart, Angela sees the transporter place the urinary catheter on the patient’s bed. Everyone is in such a hurry that Angela questions whether she should stop the transporter or just remain silent.

Question:
What is the best course of action for Angela to take regarding insertion of the catheter? Please click on answer

  1. Stop and reinsert a new catheter.
  2. Rationalize that it is only a small break in technique and will not affect the patient.
  3. Continue the procedure in the interest of time.
  4. Tell the charge nurse that she was unable to insert the catheter and ask her to do it for her..

Question:
What should Angela do when she sees the transporter lay the urinary catheter bag on the patient’s abdomen?

  1. Nothing—this is a brief transport and time is important.
  2. Quickly move the bag to its correct position.
  3. Offer to help the transporter secure the bag correctly below the level of the bladder, explaining what she is doing and why this is important.
 
 

Answer

Correct answer: 1

Despite the pressure to move quickly, it is important to follow aseptic technique. Microoorganisms from the patient’s skin could contaminate the catheter and have the potential to lead to a UTI

Learning Points

Learning Points

Learning Points

  • Aseptic technique is used when inserting a urinary catheter. Hand hygiene is performed immediately before and after a urinary catheter insertion.
  • The source of microorganisms causing CAUTI can be endogenous, typically via meatal, rectal, or vaginal colonization; or exogenous, such as via contaminated hands of healthcare providers or equipment.
  • An estimated 17% to 69% of CAUTI may be preventable with recommended infection control measures, which means that up to 380,000 infections and 9000 deaths related to CAUTI could be prevented per year.
  • Contaminating the urinary catheter may lead to a UTI.
  • Maintain unobstructed urine flow.
  • Keep the catheter and collecting tube free from kinking.
  • Keep the collecting bag below the level of the bladder at all times.

Answer

Correct answer: 3

The urinary catheter should be kept below the level of the bladder to ensure unobstructed flow. Although Angela could do this herself without explanation, talking to the transporter is a learning opportunity that may prevent this from happening again in the future.

Learning Points

Learning Points

  • Aseptic technique is used when inserting a urinary catheter. Hand hygiene is performed immediately before and after a urinary catheter insertion.
  • The source of microorganisms causing CAUTI can be endogenous, typically via meatal, rectal, or vaginal colonization; or exogenous, such as via contaminated hands of healthcare providers or equipment.
  • An estimated 17% to 69% of CAUTI may be preventable with recommended infection control measures, which means that up to 380,000 infections and 9000 deaths related to CAUTI could be prevented per year.
  • Contaminating the urinary catheter may lead to a UTI.
  • Maintain unobstructed urine flow.
  • Keep the catheter and collecting tube free from kinking.
  • Keep the collecting bag below the level of the bladder at all times.