a rookie doc's rants and raves

Sunday, November 05, 2006


This is one of the most common procedures done by interns. everybody thinks they know how to do this...the anatomy, the steps, 'no touch technique'... most interns take this procedure for granted.. but this will open up your mind and will probably make you feel guilty for all the patient's whose urethras you botched up!!!!!!!....the comments are more interesting than the post.. http://www.emedicine.com/proc/topic80716.htm#Technique

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Anonymous Kedar said...

I will do it the way its told here and will tell u how it went if the houseman does not kill me

12:53 AM  
Blogger spriha said...

In our set-up on most occasions, no drape is used while a central-line is put. I've seen CLW's of scalp being sutured in sitting position where all facilities are available except LA. We prescribe syringes to patients in EMS, many times even catheters. Ppl are suspicious when you borrow some gauze for urethral catherization. No one has the sense to return the LA gelly to its original position, leave alone maintaining its sterility. Yet, if I'd seen the ideal way of inserting the Foley's ever in my life I should've practised it every time. I didn't cuz I didn't know. Ppl who knew, didn't have the time to teach and I must confess, I didn't care enough.
Internship is the phase when you decide u want to be ideal or not. If someone doesn't practise it as close as the ideal despite knowing it with the available resources and blames it on the system then it shows his/her incomtence.
The videos are superb but yet there are some practical difficulties that it doesn't address and they haven't shown a continuous procedure anyways.

8:16 PM  
Blogger samip dattani said...

thanks for the comments... yes the ideal way is either not known or not taught.. @spriha: in our set up this is what can be done and this is wat i do - i dont use a drape but i clean the area with gauze soaked in saline. i do not specifically try to keep the LA clean but i inject 2 ml of it in the urethra and wait atleast a minute before inserting the catheter. i always always place back the prepuce to prevent paraphimosis.to save time, as soonas i come on duty i prepare 5-6 2ml syringes with the LA, this way i dont have to searc for the tube everytime.... i invite more comments and suggestions.. thank you all

9:19 PM  
Anonymous smita said...

hi samip...ur preface of the write up was like a tight slap to me...as it made me remember of my first n the last blunder in ward 7 for a comatose pt(u kno i guess)(coz everybody right upto the uro-plastic surgeons knew abt it)...during strike duty...i really can't forgive myself for that...i personally never followed this exact protocol,though i knew that LA is to be injected in the urethra n not to be poured on the palm n then apply on the tip of the cathetor...never practised it man...may be the environment in which we work compels us to do it the way we are doing...As far as i am concerned since that day onwards i hv atleast been gentle n patient in my work...no hesitaion ,no hurry...now because of you(write up) i will take the utmost care to practise sum of the imp steps like...LA ijectn,aseptic precautions n above all proper positioning of the genitals...

keep writing ...

8:11 PM  
Blogger samip dattani said...

dont worry dear.... we all have done mistakes while learnig.. your's made the talk of town because it of the situation. i again stress that learning and teaching has a big role to play in minimising these kind of mistakes. yes, our enviornment as a big role to play and makes us all prone to mistakes. what we have to do is be frank and shameless in asking someone to teach and supervise. at the same time, we should come forward to teach the sklls that we have learnt... keep reading

8:22 PM  
Anonymous Ruchi said...

i guess many a times its more of a 'chalta hai' attitude which imbibes such bad clinical practices in us..i remember asking d staff for savlon in d ems last wk during my surg emerg and she laughed..i ended up cleaning with NS..wondering if it served any purpose...well abt d LA, im sure i can change dat habit..in d end its entirely upto d individual how close she/he can come to d ideal situation, working within d system with all its limitations...d suggestion abt pre filling syringes with la is a good one..il try it in my nxt emerg

2:29 PM  
Blogger samip dattani said...

good.. seeing me do that one of the staff had an idea.. she too prefilled some syringes with inj TT.. when i report to the ems for duty i also check if the foll items are available - 5 to 6 foley catheters of 14F and 16F each, 2ml,5ml and 10ml syringes and needles of diff sizes, adequate bulbs(vials), ecg paper, lever to adjust the beds, spirit and swabs, RTs of diff sizes, gloves, paper to prescribe medicines and order tests.

3:35 PM  

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