30 Inpatient Nursing Hacks for Med-Surg Nurses

If you're positioned but can't find the urethra, have the patient clear their throat and cough. This often makes the urethra "wink" and stand out as your target.

If a catheter ends up in the vaginal canal, never pull it and reinsert the same one (hello UTI). Instead, leave the misplaced foley in the vaginal canal, open a new kit, and aim just above it. Second time's a charm.

After cleaning, leave the betadine swab/stick in the vaginal canal to "block" it, then aim above it. Don't forget to remove the stick when you're done.

For patients with a larger vaginal canal, use a thicker clean roll of Kerlix to block the canal, making the urethra easier to enter.

Sterile technique is required, but cleanup gets messy and sterile gloves saturate with lube and fluid. Wash your hands, put on a clean pair of gloves first, then your sterile gloves (size up as needed). After insertion, peel off the soiled sterile pair and clean up — and secure the foley — with the clean gloves underneath.

Patients get transported and ambulated constantly, and you don't want the foley catching and ripping out. Tie a glove around the IV pole below bladder level and hook the foley onto it as a portable hook.

Foleys aren't the only option, and they carry infection risk. Many hospitals stock PureWick catheters that hook to suction — a great choice for elderly female patients with urinary incontinence to prevent lying in urine and skin breakdown.

When cleaning a messy stool situation, double or triple glove with clean gloves. As the outer pair gets soiled, peel it off and keep going — and if one rips, you're still protected.

When stool has dried onto the skin, apply shaving cream from the clean utility, let it sit a few minutes, and wipe off with soap and water or cleaning wipes. It comes off without issue.

For a patient hoping to have a bowel movement, microwave prune juice with a little butter for 20–30 seconds and serve it warm. It often works, has no significant side effects, and needs no order. For significant abdominal discomfort or nausea/vomiting, call the provider instead.

A reducible rectal prolapse can usually be reduced with lubricant and firm pressure. For a large prolapse that's hard to reduce, sprinkle some sugar on it and let it sit ~15 minutes — this dehydrates and shrinks the tissue, making reduction easier.

NG tubes tend to curl in the oropharynx. Curl the distal portion around your finger and freeze it in ice water for 10–15 seconds so it holds the shape. Insert (lubed) with the curl pointing downward toward the pharynx, then twist 180° right before the oropharynx so the "hook" faces posteriorly and won't curl back out the mouth.

To make insertion more tolerable, you can numb the nare (requires an order). Either squirt 2% viscous lidocaine via a Uro-Jet into the nare 5 minutes beforehand (effective, though it can make the tube stickier to pass), or give 3–4 mL of nebulized lidocaine (2–10%) and insert immediately after — which reduces pain but can increase epistaxis risk.

To crush meds for a PEG tube: pull the plunger out of an empty 10 mL syringe, drop the pills in, reinsert the plunger to the pills, aspirate 3–5 mL of tap water, plug the tip with a gloved finger, and pull back to create a vacuum that crushes the pills. Dilute and administer.

When you can't flush or aspirate, try simple maneuvers. Raise the arm above the head, or have the patient turn their head the opposite way, take a deep breath, and cough — this changes pressure and catheter position and often restores flow.

For a partial or complete occlusion by a thrombus, alteplase (CathFlo) — the same drug as stroke TPA but a much lower dose meant to stay in the line — can be used. Instill 2 mg in 2 mL into the PICC and let it dwell 30–120 minutes. For a complete occlusion, use a three-way stopcock to create negative pressure and slowly draw the alteplase in. After dwelling, aspirate 4–5 mL of blood and waste, then flush with sterile saline. Can be repeated once. Always follow your facility's policy.

Old, dry electrodes conduct poorly. Electrodes should typically be replaced every day.

Dead skin, dirt, and grime interfere with conduction. Wash the chest with soap and water or a wipe; in a pinch, an alcohol wipe over the electrode sites helps exfoliate. Let it dry before applying new electrodes.

Chest hair interferes with conduction. If the patient is hairy where electrodes go, shave those areas.

Sometimes it's the wires or box. Swap out the equipment or wires and recheck.

Electrical signals from other devices cause artifact. Keep the wires and telemetry box away from equipment like an IV pump, and make sure electrodes aren't placed over a pacemaker or ICD.

If artifact persists, adjust the amplitude and change the lead view to get the cleanest tracing with the least artifact.

Hang the extremity below heart level (off the bed). This vasodilates the veins, making them easier to see, feel, and cannulate.

A warm compress or hot pack causes vasodilation and improves your odds.

With an order, a small amount of 2% nitroglycerin ointment applied to the planned site also causes vasodilation.

Pump a bedside BP cuff to just above the patient's systolic pressure. It engorges the veins without the excess pressure of a tourniquet, helping prevent a blown vein.

No flash on the first advance? Pull the needle and catheter back, re-palpate, and redirect along the vein. If the patient tolerates it, this saves extra pokes.