Monday, March 5, 2018

Finger Cots - Minimum Coverage Saves Vintge Hospitals from Bankruptcy

"Here is your daily allotment of gloves. Use them judiciously and I better not here about one shift hogging them - remember they have to last 24 hours."
Finger cots substitute for gloves in budget minded hospitals

This was the warning issued by one of those stern nursing supervisors as she reluctantly surrendered a box of one size fits all gloves. A box of 24 latex (nobody was allergic to this substance in the good old days) gloves was supposed to suffice for three busy wards inhabited to the gills with patients vomiting, excreting, and  oozing every bodily fluid known to mankind. At least these fluids were organic, the Cidex based cleaning solutions we used on hospital equipment would make unprotected skin boil and bubble up like a dousing with boiling water. We always tried to handle cleaning solution soaked rags with forceps, but sometimes the volatile fumes were enough to accelerate skin lesions. Nasty stuff indeed and don't dare get caught wearing a precious glove on an ordinary cleaning mission.

Old school nurses eschewed gloves for reasons other than the negative impact such extravagant expenditures had on hospital budgets. Nursing was a hands on affair and this meant bare hands  with skin to skin contact. Gloves imposed an unnatural barrier and were viewed as an offense to the patient.

I was conditioned like Pavlov's dogs when I had gloves on. This was just not right and my shoulders hunched over with a strong sense of self consciousness. Even when using gloves appropriately, I was anticipating that cranky old nursing supervisor in the background  hollering and belittling me.

Finger cots came from the supplier in boxes and were clean (hopefully) but unsterile. Sterile finger cots like Montgomery straps and scultetus binders were produced in house by cantankerous, past their prime nurses who toiled diligently in central supply. Three finger cots were oriented in the same direction and placed in a glassine finished envelope which was then autoclaved. A piece of autoclave tape sealed the envelope and verified sterility by proudly displaying diagonal black stripes.

You could do lots of fun tasks with sterile finger cots such as dressing changes or Foley catheter insertions without bankrupting the hospital on  exorbitant expenditures like sterile gloves. Donning sterile finger cots took lots  more practice than  sterile gloving. After carefully opening the sterile packaged fingercots with your ever present bandage  scissors, place them business end down on a bedside stand. Judiciously apply a very small dab of tincture of benzoin to the tips of your thumb, index, and second finger with an applicator  and blow dry with a couple of puffs. Smokers (which compromised 95% of all nurses) with their comprised tidal volume might need three puffs.  Press your thumb into the very center of the rolled finger cot and let the tincture of benzoin work it's adhesive magic. With the finger cot firmly stuck to your thumb slowly and carefully unroll it with your free hand while touching only the inside surface of the finger cot. Rinse and repeat for your index and second finger.

Now that you're all  gloved cotted up it's time to rock 'n roll. To maintain sterility it is essential that you curl up your bare naked  third and fourth fingers. For the time being just pretend they don't exist (I used to make believe  they were burned off in a Bovie mishap.) You do not want them flopping about contaminating the sterile field or the catheter.  You can now use your finger cot festooned fingers to make like a forceps and guide that Foley home to pay dirt. When you're in (urine) haha, its time to peal off those finger cots and hook up the drainage bag.

Finger cots have limited surface area compared to gloves and can be predisposed to slipping off your digit at inopportune times.  The no finger cot left behind doctrine incorporates several measures to prevent in vivo loss of cot custody. The tincture of benzoin trick helps ameliorate wandering finger cot issues when sterile technique is used. For the more common everyday uses of finger cots  the keyword is restraint. Discretion is definitely the better part of valor when exploring any internal orifice with a finger cot. Never ever inset the finger cot into anything past it's cuff. If you poke that finger cot in deeper past the cuff all it takes is a sphincter contraction to strip it off faster than  a chimp can peal a banana.  It's a real challenge to gain purchase on a retained finger cot and the best course of action is probably benign neglect while hoping that it works itself out.
A tenaculum  grasping cervix and a cot on
the index finger. Note the 3 exposed fingers
providing traction on the tenaculum. Gloves optional.


  1. Thank the Lord I worked patrol in the day of the nitrile glove. I made sure I had 4 pairs - 2 pairs in each front pocket - before I left the station. I never knew what kind of horror - living or dead - I was going to have to stick my hands into. Although usually it was just some transient drunk who hadn't had a bath in six months.

  2. So glad I worked after this, and retired before I had to deal too much with new nonsense. A friend who's orienting new nurses says it's a problem getting them away from the computer and hands on with the patient.

  3. We weren't permitted to wear gloves during procedures either - same reason as you mention, we were told gloves would make the patient feel bad about themselves. I still have this feeling of discomfort about wearing them and am glad I am out of nursing now.

    I do think some skin to skin contact is really important though - when you are very sick, the touch of your nurse's hand simply taking your pulse can be comforting. Sue.

  4. Witnessing modern whippersnapperns provide patient care with brightly colored nitrile gloves really shivers my timbers. It's like advertising you are erecting a barrier between you and the patient. For those of us oldfoolrns who were conditioned that donning gloves for anything less than surgery was a mortal sin, brightly colored blue ones seem like over the top ballyhooing. I'm certain that's something that would provoke a blood curdling scream from just about any old crusty bat of a nursing supervisor. We actually had an especially mean supervisor we called "The bat in the hat," but that' fodder for another post. Thanks for taking the time to indulge in my foolishness!

    1. Love your sense of humour OFRN! I used to follow the blog Head Nurse - I think she was in Houston - she's stopped blogging now. She commented once that she made a point of skin-to-skin contact with a patient at least once a day.

      I often used to take a patient's wrist pretending I was checking a pulse when in reality I wanted to observe them and think - and because I was well aware that a sick frightened patient can find this touch comforting.

      I worked for a while in a large private hospital where we gave back rubs to patients at night to relax and comfort them. No gloves for that and it was one of the jobs we most enjoyed. A bit of time to pamper the patient and talk to them... this custom has long gone sadly. Cheers,S.

  5. 41 years in, and TO THIS DAY I cannot feel a difficult vein with gloves on. I generally rip off the end of the left index finger.

  6. Wearing gloves to protect against needle sticks doesn't work. Needles poke right through. I always thought wearing gloves in potential needle stick circumstances conferred a false sense of security. Old nurses got poked by errant needles all the time and thought nothing of it, of course that was in the day before anyone gave a thought to blood born infections like AIDS or hepatitis.

  7. There is nothing like skin to skin human touch to comfort a person. I am sure that is one of the reasons nurses were always considered to be Angels of Mercy. Even some of the old battle axes had a human side that they would usually keep well hidden. Never liked wearing gloves myself, but it was necessary for dressing changes, etc.

  8. Change is hard, but if I was working today I would be gloved. We knew nothing of blood born illness. Ignorance is bliss...sometimes.