PJCGAGNO’S MAR [15-04]:Ripples Run Far

Index Title: PJCGAGNO’S MAR [15-04]
MAR Title: Ripples Run Far
Period of Observation: May 2015
Tag: Inspiring others from a simple procedure done.
Category: Professional/Ethical-Reinforcement
I was duty at the emergency room when a colleague from the Department of Internal Medicine referred a patient who was managed as a case of heart failure. The patient, also a known case of benign prostatic hyperplasia, was referred for Foley catheter insertion after several times of attempt. I gladly accepted the referral and came to find out that the patient was the former chairman of the Department of Surgery of Ospital Ng Maynila Medical Center. I immediately went to his bed and saw that one of the nursing heads accompanied him. I introduced myself and asked consent for Foley catheter insertion, which he voluntarily permitted. I then asked for a larger sized Foley catheter. As I performed the procedure properly using Fr 24 Foley catheter, the nursing head was observing me. I was able to insert the catheter successfully without any complications. The patient and the nursing head then thanked me for the successful insertion of the catheter.
Three months after, I was approached by the said nursing head when I was in the OR completing my census. She was looking for me during her usual rounds in the operating room. She eagerly told me that she encountered the same case of benign prostatic hyperplasia in their hometown. She verbalized that she was the only medically inclined personnel in their place and tried to insert the Foley catheter recalling the technique I did before. She said: “Doc, naalala nga kita nong naglalagay ka ng Foley catheter kay Dr. M dati sa ER. Buti na lang napanood ko kung pano kayo maglagay. Salamat po.” (Doc I remembered you when you were inserting foley catheter on Dr. M. Im glad I was there to witness how you insert properly a foley catheter. Thank you.) She then happily told me that she successfully inserted the catheter.
(Physical, Psychosocial, Professional/Ethical)
(Stimulus, Discovery, Reinforcement)
Ripples spread out when a single pebble is dropped into water” a famous saying by Dalai Lama explains that small actions of an individual can have far-reaching effects. I never expected that a simple routine procedure (Foley catheter insertion) that we usually do in the wards or emergency room could affect other lives beyond the four walls of our hospital.
The incident reinforced me on proper technique of Foley catheter insertion in patients with Benign Prostatic Hyperplasia (BPH). In dealing patients with BPH, it is recommended to use appropriately sized catheters. It is encouraged to use a catheter Fr 18-24 with BPH compared to the usual catheter size for a normal adult, which is Fr 16. Larger sized catheters are usually used because they are stiffer as compared to the usual Foley catheters. These will easily overcome the mechanical obstruction of a hyperplastic prostate obstructing the urethra. Also, there is a need to use lidocaine impregnated lubricating gel to minimize the pain upon insertion and aid the smooth insertion of catheter. Proper maneuver of handling a male genital and sterile technique should also be observed during the procedure.
For the sake of our newly rotated clerks, proper insertion of catheter are as follows: 1. Secure consent, 2. Proper aseptic technique 3. Apply sterile drapes, 4. Generously coat the distal portion of the catheter with lubricating gel, 5. If female, separate labia using non-dominant hand. If male, hold the penis with the non-dominant hand, 6. Pick up catheter with gloved (and still sterile) dominant hand. Hold end of catheter loosely coiled in palm of dominant hand, 7. In the male, lift the penis to a position perpendicular to patient’s body and apply light upward traction (with non-dominant hand), 8. identify the urinary meatus and gently insert until the bifurcation at the proximal end of the catheter, 9. Inflate balloon, using correct amount of sterile liquid, 10. Gently pull catheter until inflation balloon is snug against bladder neck, 11. Connect catheter to drainage system, and finally 12. Secure catheter to thigh.
As I learn, I was also able to educate my fellow healthcare professional in this incident. Being physicians, we must never fail to teach our fellow doctors and other members of the team despite the busy workload. We, residents, are being observed by medical clerks, interns, nurses and others from simple procedures to major clinical decision-making we do. And with these, they also learn. Hence, as physicians, we must do things with integrity and excellence. We can impart to them by being role models.
I came across a saying that says: “The mediocre teacher tells. The good teacher explains. The superior teacher demonstrates but the great teacher inspires.” In small things we do, we must do what is right. Though mistakes are inevitable since we are still in training, we must strive for excellence because we might inspire others to touch lives unexpectedly.
ROJoson’s Notes (17feb8):
Do good things that can be seen by everybody and let them emulate you.  Be an inspiration.  Be a role model.
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