12 Outdated Nursing Practices

Updated on

February 19, 2019

1. Rotating tourniquets
2. Use of the artificial lung: "The Iron Lung Machine."
3. Reuse of urinary catheters and syringes
4. Notable antiseptic: Dakin’s Solution for wounds
5. Penthrane and Trilene inhalers for labor pain
6. Sliding scale insulin with urine dipstick results
7. Antacid to pressure ulcers
8. Controlling foul wound odor with charcoal
9. Instilling saline solution to rinse mucus during suctioning.
10. Cut the Foley catheter before removal.
11. Milking chest tube drains
12. Coca-Cola to unclog nasogastric tubes.

Have you ever wondered what nurses do during the historic times? When mechanical ventilators are not yet invented, how do nurses manage to survive? Rather, did their patients back then survive?

Charles Darwin once said, “It is not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change.”

Pondering upon this quote, we realize that the nursing profession survived because of our ability to adapt to changes. It is dynamic. Whatever innovation in nursing techniques we have not is because of how we embraced the evolution of healthcare.

Nightingale said: “Unless we are making progress in our nursing every year, every month, every week, take my word for it, we are going back.”

The past is important to move forward. And yes, we are entering a new era of nursing interventions.

Let’s hop in a time machine and travel back in time and learn about the practices we don’t do (hopefully for good) anymore.

1. Rotating tourniquets

Also known as congesting cuffs, are often used to treat patients with acute pulmonary edema secondary to heart failure during the 1960s. The idea was to pool the blood in the veins and decrease the venous return therefore ultimately decreasing pulmonary congestion. Congesting cuffs were placed on three extremities and inflated to 20 to 80 mmHg to achieve its effect.

Tourniquet invented by Morell. Image via: commons.wikimedia.org

Why did it disappear? Aside from being time-consuming, potent drugs like diuretics are available today. Studies also cannot support the effectivity of this practice.

2. Use of the artificial lung: “The Iron Lung Machine.”

Colloquially known as the “iron lung”, enables a person to breathe when normal muscle control has been lost. It consisted of a large airtight tank in which the patient laid in, with his or her head sticking out. — Colloquially known as the “iron lung,” enables a person to breathe when normal muscle control has been lost. It consisted of a large airtight tank in which the patient laid in, with his or her head sticking out.

According to Wikipedia, the first of these devices to be widely used was developed by Drinker and Shaw in 1928. The iron lung often referred to in the early days as the “Drinker respirator,” was invented by Philip Drinker (1894–1972) and Louis Agassiz Shaw, Jr., professors of industrial hygiene at the Harvard School of Public Health.

Some of the Iron Lung machines are still used in the US, but only a few extinct nurses know how to use them.

Why did it disappear? The use of modern treatment and portable ventilators including the eradication campaign against polio – the last case of naturally occurring polio happened in 1979 – sparked the decline of the iron lung machine.

3. Reuse of urinary catheters and syringes

These were glass with a metal plunger. 10-20cc were used for blood taking, and 2 cc. For drug injection. They were heat sterilized and immersed in alcohol.the needles were not single use and were sharpened manually. Image via: https://samhs.org.au/ — These were glass with a metal plunger. 10-20cc were used for blood taking and two ccs. For drug injection. Image via: https://samhs.org.au/

Back then, resterilization of syringes and urinary catheters were a trend. Syringes were made of glass and catheters were made of metal instead of the silicone we use today. Since they’re made of hardened materials, they were heat sterilized and immersed in alcohol– a practice that would be frowned upon today. Needles were not for single use and had to be sharpened manually. Yikes.

Metal urinary catheters. Image via: https://samhs.org.au/

Why did it disappear? Single-use disposable syringes are the standard today ever since the occurrence of HIV and blood-borne pathogens. Different reusable equipment was produced because it’s safer and prevents cross contamination. Also, resterilizing is more costly for hospitals.

4. Notable antiseptic: Dakin’s Solution for wounds

Dakin’s solution was used mostly during the Worlds War I. It is composed of sodium hypochlorite and baking soda, and invented by a chemist and a surgeon. After the war, it was widely used for bedsores and infected wounds.

Dakin's Solution|healthykin.com — Dakin’s Solution|healthykin.com

Why did it disappear? It didn’t! Some institutions still use this today though others prefer proven antiseptics like povidone iodine, etc.

5. Penthrane and Trilene inhalers for labor pain

An inhaler for pain relief was once introduced for pregnant women who can’t tolerate labor pain.

Analgizer. Image via: anaesthesiaheritagecentre

Trichloroethylene (Trilene) and methoxyflurane (Penthrane) were popular analgesics used in obstetrics during the 1900s. These were administered via a calibrated, temperature-compensated vaporizers given to a mother for PRN pain relief during labor.

Why did it disappear? The drugs were effective for pain relief, so effective that they caused maternal sedation as well as neonatal depression. It also caused vomiting and accumulation causing renal damage. Due to its adverse effects, its use was discontinued.

6. Sliding scale insulin with urine dipstick results

Before the dawn of the great glucometer, nurses have to obtain a patient’s urine sample before meals to test for the presence of glucose.

Why did it disappear? Usage of the urine dipstick test was not longer recommended as glucometer devices provide a more accurate measurement of a patient’s glucose levels.

7. Antacid to pressure ulcers

A retired senior nurse recalled applying an antacid to pressure ulcer believing it would heal the wound faster.

Why did it disappear? It is now well known that moist wound healing is the ideal environment for faster healing, according to various studies.

8. Controlling foul wound odor with charcoal

Back then nurses used to dab teaspoons charcoal and wrap gauze around an infected open wound to facilitate faster healing and to minimize the foul odor – thinking charcoal would absorb the odor.

Leg wound treated with charcoal poultice.|charcoalremedies.com

Why did it disappear? It didn’t. Actually, some people still use activated charcoal for wounds thought the risk of infection is high in some instances.

9. Instilling saline solution to rinse mucus during suctioning.

It was then thought that saline acts as a lubricant in facilitating the ease of passage of the suction catheter with the same concept, it was also thought to loosen and dilute secretions and enhance a cough.

Why did it disappear? Instilling was often traumatic for patients, and cough reflex was not always elicited especially for people with tetraplegia with little or no diaphragm innervation. Prevalence of mucolytics to enhance mobilization of secretions is most commonly used. Studies have also proved that the practice increases the patient’s risk for pneumonia and the possibility of pushing bacterial formation deeper into the lungs.

10. Cut the Foley catheter before removal.

An old-school practice that deserves to stay as it is. The practice involves snipping an inserted indwelling foley catheter to facilitate easy removal.

Why did it disappear? The practice can be considered dangerous because the tension can cause the end left with the patient to retract into the bladder.

11. Milking chest tube drains

This involves squeezing, twisting, or kneading the chest tube to create bursts of suction to move clots and remove any visible secretions.

Why did it disappear? The reason is the risk of air leakage within the chest tube, which can cause irritation and tissue trauma around the insertion site of the tubing.

12. Coca-Cola to unclog nasogastric tubes.

Coca-cola (or any carbonated soda) is a notorious unclogger for feeding tubes. The acidity in cola is believed to help unclog the tube.

Why did it disappear? Coke, being an acidic fluid, can damage the integrity of the NG tube. It can also contribute to clogging by denaturing proteins in some enteral formulas. Water or replacing the tube is recommended.

Knowing these interventions is a revelation for present nurses. Nevertheless, these practices taught us a lesson: to continually improve and render the best and proven care we could give to our patients.

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27 responses to “12 Outdated Nursing Practices”

Amanda Matthaei

July 22, 2016

We have doctors still oder Dakins Solution for wound care & I work at a major teaching hospital.

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Feigben F

January 25, 2019

Thank God I didn’t learn to practice these at the school

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1. Janice
  
  January 24, 2022
  
  Really…. they still milk chest tubing. It is good to know the basics of even old things so you can respond. I once had to instruct a new nurse in how to do rotating cuffs in a cardiac situation. Do not be egotistical in thinking new is better. Because it is not always. Medicine is about to really really change and what you know will be discarded as useless and ineffective. What would you do without your bedside machines?
  
  Reply
Barbara D'Onofrio, RN

July 20, 2019

I entered nursing in 1958. We did not use metal catheters. They were a rubber material, but were sterilized (autoclaved) and reused, as were rectal tubes..

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1. Caroline Dunphy
  
  September 20, 2019
  
  I remember the metal ones being used in surgery to dilate the urethra. They were called “sounds”. But remember the red rubber carbs that were resterilized. Never resterilized Foleys,however. I was in training 64 to 67. I remember doing most of the things on this list.
  
  Reply
QL7, MSN RN

August 16, 2019

Remember them well

Reply
e evans

October 14, 2019

I worked for a group of anesthesiologist in a major hospital, in a major city in the mid 70s routine then was to wash, soak in “Cidex”, rinse and reuse red rubber endotracheal tubes. It was important to ck the cuff prior to insertion to make sure the tube was not damaged and held air as the CIdex solution dried the rubber. We also used plastic and metal airways, both reused after Cidex soak. Cardiac monitors were not routinely used (the metal airways are now wind chimes lol). Pulse ox was not available and not a standard of care until the mid 80s. The airway was often controlled manually by squeezing the bag on the anesthesia machine. Induction was with Thiopental, the patient paralyzed with Anectine, and anesthesia agents most commonly used were Ethrane and Halothane My Job description was broad and I became very comfortable managing an airway. This experience served me exceptionally well throughout my career, but did nothing to instill confidence on the receiving end of anesthesia LOL.

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1. paul
  
  April 13, 2023
  
  remember tubex?
  
  Reply
  1. carol
    
    October 17, 2023
    
    oh yes, Used them many times!!
2. Linda
  
  July 24, 2023
  
  Oh, that Cidex was toxic, evil stuff! We used it extensively in the operating room early in my career.
  
  Reply
Melanie

October 19, 2019

We still use the urine dip sticks, gives an early indication prior to sending off for further examination

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Barbara D'Onofrio, RN

November 11, 2019

(add. to prev.) The rotating tourniquets DID work, but were time consuming. We used Dakins solution for douches before vag. hyst.

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Rita Watson

January 21, 2020

When I was a Student Nurse in the late 60’s- to early 70’s , for our annual Tb Test. We were taken en mass to the TB Sanitorium. There the same needle & same syringe was used for all Student Nurses. If the needle got dull,they would sharpen it & then pass it through a Bunson Burner to “sterilize”it.

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1. Matt Vera, BSN, R.N.
  
  January 22, 2020
  
  Yikes.
  
  Reply
Nancy S White

May 22, 2020

I wrote a book about when I was a nursing student in the early 1960s(Starched Caps A Nurses Memoir) and describe a lot of the procedures mentioned.

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1. Marissa Wilhelm
  
  June 20, 2024
  
  I want to read this!
  
  Reply
Gayle Hartman-Weatherford

January 27, 2021

My Mother was a WAC/ARMY nurse during WWII, she was stationed stateside at the Army/Navy Hospital, Hot Springs, Ark. She saw too much of the horror of war, God bless her because she suffered from PTSD and major depression for the rest of her life. I was her POA when she got dementia and Alzheimer’s. I witnessed her having ” flashbacks ” in the ER.and I ‘ll tell you it was frighteningly horrible. She passed away in 2011 and even though I miss her she is free!! Most Americans don’t realize what our military goes through. I remember her showing us (My sister n I) the glass syringe with no needle, part of her nurses uniform, duffle bag, lapel pins and old photos. “Like the military saying- ” All give some, but some give all”.

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1. Merry
  
  November 19, 2024
  
  My mother was an army nurse and was stationed in the Philippines during WW II. it was hard work and many times sad. She said many young men did not live from their injuries and they were her age. . She never had any flashbacks of horrible memories. Decades later she would go to Army reunions and travel to different parts of the country. She continued in nursing until she was 70.
  
  Reply
paul

April 13, 2023

remember foam med trays? Capping syringes? Urine fractionals? CVP lines?–PFN

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Sharron French, RN

July 1, 2023

I love reading about ‘older’ practices in nursing! As a nurse I wondered how those who came before could work and NOT have some of the tools we gave today. But as a missionary nurse for 12 years, I quickly found out! Some of those ‘outdated’ practices and techniques still work!! When I’d start an IV, I used the old method of calculating drip rates / younger nurses were startled they had no pumps to rely on. Some didn’t know how to calculate dosage ss that was done by the pharmacy before meds were sent to the floor. One patient came to us in heart failure and pulmonary edema. We only had oral diuretics. She couldn’t lie down because she couldn’t breathe. Then I remembered an entry in a 1936 Red Cross home nursing handbook. I grabbed a straight back chair and flipped it over. The chair was placed in the bed (lying on the front of the seat) and the straight back formed a perfect 45 degree for the patient to lie against. Technology and advances are good, buy don’t often work in third-world countries!

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KW

November 15, 2023

I worked in the OR in the early 70’s. A packet of Adolf’s Meat Tenderizer was always on hand in the EENT room with bronchoscopy setups. This was used during the procedure to soften prior food contents prior to removal – most often aspirated meat – mostly around Thanksgiving – eating too much too fast. In my future cooking endeavors I never could look at this pantry item the same ….

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1. Matt Vera BSN, R.N.
  
  November 16, 2023
  
  Hi KW, That’s such an interesting story from your OR days. It’s wild to think about how Adolphs Meat Tenderizer was used like that. It definitely gives a whole new angle to a regular pantry item, doesn’t it? I hope that practice stays outdated! 😄 It’s amazing how much practices have changed over time. Got any more quirky or old-school stories from back then? Always cool to hear how things were in the medical world way back when.
  
  Reply
Claudia RN

February 1, 2024

I went to LPN school in 1970 and one of the instructors had been an Army RN in a VD clinic. She told us about using a 10cc glass syringe. She said the standard dose was 1cc. So they drew u the 10cc and changed only the needles between doses. After I became an RN I worked in the ER for many years. One of the things I remember best was a woman who came in with severe respiratory distress and we were giving her massive doses of IV Lasix. I knew she did not have the strength to crawl on and off of the bedpan so I asked the Dr for permission to put in a foley. I assured him I would prepare every thing before we laid her down and zip the cath in quickly. He agreed. So I had an aide with me and we got everything set up and ready and whipped her down. Unfortunately she had both a small penis and a urinary meatus. We sat her back up while we tried to figure out what to do. I finally asked the aide to go out in the waiting room to see if she had children. She did, so I went for the meatus. And it worked. Just one more situation that reminded me that each case is individual. And like others I remember most of the treatments described above.

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1. Matt Vera BSN, R.N.
  
  February 2, 2024
  
  That’s quite the story! It reminds me of a time early in my nursing career, working night shifts in the ER. We had a male patient come in with what he described as “the worst pain of his life.” Turned out, he had a severe kidney stone.
  
  Preparing him for treatment, we needed a urine sample, but he was in too much pain to move. I remembered a trick from a seasoned nurse about making patients comfortable in awkward situations. So, with a bit of creativity and a lot of reassurance, we managed to get that sample without moving him much.
  
  It was one of those moments that taught me the importance of adaptability and patient comfort—lessons that textbooks just can’t teach. Every day and every patient indeed teaches you something new in nursing! Thank you for sharing your experience!
  
  Reply
William Watkins

August 13, 2024

Penthrane is still used as a pain relief drug in Pre Hospital Care. Trilene was used in the late 1960s to 1970s as a pain relief medication, but was found to be sedating and was used as a cleaning agent. The Ambulance Service in Sth Australia still use Penthrane (Methoxyflurane) as a secondary drug to Morphine or Ketamine for major pain management.

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susan a pfettscher

February 3, 2025

What you are really describing here is the equipment that was available to perform procedures and treatments. I’m just wondering if all our advances are so great given that we now generate so much plastic waste from what we are doing. Maybe multipe use, resterilized equipment wasn’t so awful after all. As for the iron lungs—their successor of ventilators were in great demand and use during the COVID epidemic–they could have been lined up in much the same way but the design of hospitals has changed.

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Shalva del Castillo

April 14, 2025

My grandmother was a nurse in the 1920s. They used to taste urine to see if diabetics were “spilling sugar” into their urine. She also had to sharpen hypodermic needles and resterilize them.

We also did not routinely wear gloves to draw blood or start IVs. Only if we suspected a blood borne illness. And we never used machines to regulate IV rates. We had the drip rate on the tubing box, the doctor’s orders a watch with a second sweep hand and the roller clamp to adjust rate. After awhile you could eyeball it and get the rate right.

Also we were using coke to unclog g-tubes as late as 12 years ago. You don’t see ng tubes as often as you did in nursing homes in the early 90’s. I had 8 patients with ng tube for nutrition and only one with a g-tube. We’d change them once a week.

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