Nurses have to perform certain procedures when a doctor asks for them, and some can be very intimidating for new nurses. From foleys to IVs, new nurses need helpful tips on how to perform these procedures correctly.
For new nurses it is always nerve wracking to be asked to perform a skill outside the normal med pass. If you are really nervous, ask a more experienced nurse for help.
You won’t always have someone to help you though. You need to learn how to do it yourself. Here are some helpful hints when performing procedures.
1. When inserting a foley for a female patient, be sure to look for the small “asterisk” that is above the vaginal opening. Usually, this is the urethra.
2. Men with extremely enlarged prostates may not be able to be catheterized at all. You may need to call a urologist to evacuate the bladder.
3. When setting up a sterile field, it is best not to reach OVER the field, as this can contaminate it.
4. Practice putting on sterile gloves, even if you use clean gloves as a stand in. It is usually a difficult task to learn, and you need to put them on quickly when moving into a sterile field.
5. Wound vacs usually take some skill to set up correctly. Try to form the foam to meet the edges of the wound and get good suction.
6. IVs are tricky… you want to keep your hand down to get the correct angle. You should be coming in at a fifteen degree angle, just skimming across the skin.
7. Bladder ultrasound machines can help to determine if a patient is retaining urine or not making any. Not all facilities have these, but they are useful when your patient has no output.
8. NG tube insertions are always traumatic. Like they say in the textbooks, ask the patient to lower their chin and drink water through a straw. It doesn’t always work, but it can help if you are having trouble.
9. Many nurses get nervous with peritoneal dialysis, especially if it is their first time. Actually, the patient is usually a wealth of information and can even talk you through the procedure because they know their own treatment. Just be sure to keep everything sterile.
10. When inserting IVs, look for the flashback, but be very careful with advancing the needle. You could go right through the vein. However, you do have to advance somewhat to ensure that the needle is secure.
11. You need to maintain a sterile field when cleaning out a wound, especially a pressure wound. Sometimes, it may seem difficult to keep yourself sterile, but you should start from the beginning if you break the field.
12. SCDS should be applied at all times. Remind ancillary staff to put them back on after ambulating the patient. It is very easy for at risk patients to get DVTs without them.
13. When drawing blood from a central line or PICC line, always wear a mask. Some nurses try to get away with holding their breath – it’s true! But masks are necessary when accessing these lines.
14. Always check the placement of your NG tubes, even if they have been secure for a long time. Of course, look at the placement in the nose, but check your policies and procedures about testing for placement on an indwelling NG tube. Some allow for the bolus/ stethoscope method, but the best way is to check the pH of fluid aspirated from the tube.
15. When changing a colostomy bag, be prepared for stool to continue to leak out of the stoma. Have some towels on hand to keep the mess contained as you apply the new bag.