NVQ evidence

I assisted my Assessor which she catheterised Cedric, a 79 year old man who had come into hospital with worsening Congestive Cardiac Failure and increasing shortness of breath.

I first made sure that when my assessor explained the procedure that to Cedric that he understood and had all the information he required to make informed consent for the procedure.
I then applied clean, non-sterile latex glove, after washing and drying my hands and a plastic apron to clean the trolley, using hot water and detergent. As I finished cleaning one area of the trolley, I then discarded the wet wipe I used for that area and then used a new paper towel to clean that area afterward. I worked from top to bottom of the trolley, ensuing hat all surfaces were attended to.


I then sort all the apparatus required for the procedure:-

Various sizes of short term male catheters
A cathertisation pack
A Urometer drainage bag which was needed as he was going to be on hourly urine measurements due to his condition.
Some “instilagel” – lubricant anaesthetic gel to facilitate the passage of the catheter which also helped to numb the urethra to some extent to reduce pain on passing the catheter.
I determined the size of my assessor’s hands and located the correct size of sterile gloves.
A Steripod of normal saline for meatal cleansing
An incontinence pad to absorb any spillages

I checked that all of these were in date and that all packaging was intact.

I placed these on the bottom shelf of the trolley

We then went to Cedric, asked him if it was convenient to undertake the procedure and positioned him in the bed so that he was comfortable but also that the area that we needed to accesses was easily done so. We laid him on an incontinence sheet for his comfort after suggesting it to him and gaining his concent.

I washed and dried my hands.

I took it to Cedric’s bed side and shut the curtains not only to maximise his dignity but also to reduce infection.

I then applied clean, non-sterile latex glove, after washing and drying my hands and a plastic apron. I then went to get the trolley from the treatment room where I had cleaned it. I did not touch the clean surfaces, I only touched the legs.

I then put opened the Catheterisation pack, only touching the edges of the paper and carefully opened it out.

I opened the other sterile items and put them on the sterile field. My assessor then put on the sterile gloves and rearranged the items more tidily. I showed her the label of the Normal Saline before I poured it into the galipot.

My assessor then catheterised Cedric. She provided an explanation of when was going to happen prior to it happening. I ensured that Cedric was alright at various parts of the procedure.

When the procedure was over, I ensured that
the catheter tubing was comfortable for Cedric
the bed was clean
all the apparatus used was discarded in the appropriate waste bin
the trolley was cleaned in a similar manner as described above
Cedric was comfortable in the bed
I asked him if there were any questions that he needed to ask and also offered the assistance of my assessor if he had any major worries.
he had his call bell to hand prior to leaving him.

I returned at regular intervals to check that the chamber of the urometer was not overly full. I then measured his urinary output on an hourly basis, on an hourly basis and recorded the result.

Reflections

Feelings

I have been assisting with catheterisation for many years now. I feel that sometimes I can take the procedure for granted and forget about how humiliating the process can be for individuals. Cedric was acutely unwell and accepted that he needed to be catheterised for medical reasons. He looked quite anxious so it was very important that he had all steps in the procedure explained and agreed prior to them being undertaken.

When we had completed the procedure, I felt that he accepted that situation. He was not entirely happy about the situation but accepted that this was the best option.

Evaluation

I feel that the procedure went quite well. Cedric was not pressured into having the catheter. He realised that this was medically important that he should have the catheter. I feel that had he not had the full explanation throughout, he may had declined it which, eventually, could have been life threatening. He had been given diuretics so he would have need to use a bottle very frequently, and urgently too. This way, it was much easier for him and comfortable. He was on a cardiac monitor so accessing the bottle would have been more cumbersome for him.

I really looked at how I perform any sterile activity. Large workloads can cause standards to slip sometimes; however, it could be life-threatening if standard slip so extra vigilance is always important. I find some motor skills difficult. I am not always the most deft of individuals. I sometime need more time to perfect a procedure but once I get it, then I get it. I have learned from experience that I may need a little more time than the average individual.

Analysis

I really need to think about the sequence of activities. I have always had a problem with sequencing. Again, it is something that sometimes takes me more time. The NVQ process has given me time to look at things and analyse how I do things sometime. I feel that sometimes I need to concentrate more on the job in hand. On this occasion, things went well. I was able to keep focused and did not make any mistakes. I am aware that I can make mistakes. If I do, then it is human and I must not beat myself up about it. It is also important to admit my mistakes. I feel that it is very important to do this. It I something that I do as this is safe practice as not admitting when mistakes occur can be VERY dangerous. I did a counselling course some years ago where I learned to own my own feeling and mistakes. I feel comfortable with this. I accept that sometimes, others do not feel comfortable with this but this I feel overrides this here/

Conclusion
All in all, I feel things went quite well. I was pleased with the outcomes here. I feel that the time taken to make sure that things were carried out safely was time well spent and at the end of the day, Cedric's catheterisation went better because of it. And he was less stressed too!!!