Urinary Catheterization Introduction of catheter into the urinary bladder Diagnostic purposes to help determine the etiology of various

us genitourinary condition

Maybe inserted as: as in and out for immediate drainage or short term drainage left in dwelling for long term drainage (eg: during surgery) pt w/ chronic retention

Diagnostic indications include the ff: collection of uncontaminated urine specimen monitoring of the urine output imaging of the urinary tract

Therapeutic indications include the ff: acute urinary retention (eg: benign prostatic hypertrophy; blood clots chronic obstruction that cause hydronephrosis initiation of continuous bladder irrigation intermittent decompression for neurogenic bladder hygienic care of between pt

Hazard: infection trauma

Commonly made of: rubber plastic latex silicone polyvinyl chloride

Purposes: straight and retention 1. To relive discomfort due to bladder distention to provide gradual decomposition of distended bladder 2. To assess the amount of residual urine of the bladder empties incompletely 3. To obtain a sterile urine specimen 4. To empty the bladder capacity prior to surgery 5. To facilitate accurate measurement of urinary output for critically ill pt whose output needs to be monitored hourly 1. 6.To provide intermittent or continous bladder drainage or irigation 6. To prevent urine for contracting an incision after perineal surgery 7. To manage incontinence when other measures have failed Purposes: Condom catheter 1. To collect urine and control incontinence 2. To permit the client for physical activity while controlling urinary incontinence

Different Type of Catheter 1. Straight Catheter - a single lumen tube w/ a small eye or opening about 1 1/4 cm (1/2 in) from the insertion tip y Coude catheter is a variation of straight catheter o more rigid other than straight catheter o maybe need for men w/ prosthetic hyperthrophy, more easily controlled and easily traumatic on insertion

2. Retention of Foley Catheter - is a double lower catheter large lower drains urine from the bladder second small lumen is used to inflate a balloon over the tip of the catheter to hold the catheter in place w/in the bladder 3 way catheter - clients who require continous on intermittent bladder irigation and has a third lumen through w/c strike irigating fluid use to inflate them

3. Condom catheter - are extend catheter connected to a urinary drainage can be used for incontinent males determine the client's experiences in incontinence

Procedures used to insert a foley catheter in a female pt. 1. Verify the doctors order 2. Indentify the pt. and explain the procedure 3. Position the pt. Male: supine, with legs abducted Female: dorsal recumbent position 4. Wash your hands, open the sterile catheterization kit using sterile technique. Prepare the other materials needed 5. Put on sterile gloves to non dominant, then squeeze a lubricant jelly to the side of a gloved hand. Place the fenestarted drape on the pt. w/ the hole over the female genitalia 6. Apply sterile lubricant liberally to the catheter tip. Lubricate at least three inches of the catheter for the female. Leave the lubricated catheter over the cotton balls 7. Place the thumb and forefinger on your non dominant hand between the labia minora, spread and separate upward. The gloved hand has touched the pt. is now contaminated 8. Using the forceps, pick up a cotton ball saturated w/ antiseptic solution. Use one cotton ball for each stroke. Swab from above the meatus downward toward the rectum 9. Keeping the labia separate, cleanse each side of the meatus in the same downward manner and not to go back overly previously cleansed 10. Deposit each cotton ball into the dispose bag. After the last cotton ball is used, deposit the forceps into the bag as well 11. Continue to hold the labium apart from cleansing. Insert the lubricated catheter into the female pt's urinary meatus 12. Angle the catheter upward as it is advanced. If the catheter will not advance, instruct the pt to inhale and exhale slowly. This may relax the sphincter muscle. Do not force the catheter 13. When urine start to flow. Insert the catheter appx one inch further. Place the cup under the stream of flow urine to obtain a sterile specimen if required 14. Hold the catheter in place while the urine drains into the collection container NOTE: if the catheter is inadvertently placed in the pt's vagina, leave it in place temporarily 15. Insert another catheter properly by repeating the entire procedure using another sterile set; then remove the catheter from the vagina 16. Attach the syringe to the balloon port of the catheter. Inject the water slowly to inflate the balloon. If the water will not inject easily or the pt complain of the pain, deflate the balloon completely and advance the catheter further, then re-inflate 17. Remove the syringe. To position the balloon correctly, pull on the catheter gently until you feel resistance 18. Connect the drainage bag to the catheter. Secure the catheter to the inner aspect of the female pt's thigh 19. Attach the urinary drainage bag to the bed, below the level of the bladder but off the floor. Coil any extra tubing on the floor 20. Remove any lubricant or antiseptic on the pt's skin. Remove your gloves, the drapes from around the pt 21. Discard disposable equipment and return reusable equipment to the appropriate area. 22. Record the time that the procedure was done and by whom, the pt's reaction to the procedure, all pt teaching done, and the pt's level of understanding. Report observations to the cargo nurse to include: a. The amount, color, and the clarity of the urine b. Any difficulty w/ the procedure c. The presence of the blood in the urine

Inserting the Foley Catheter in a Male pt 1. 2. 3. 4. The following procedure are need to insert the foley catheter ina a male pt Verify the doctor's order Identify the pt and explain the procedure Wash your hands. Open sterile catheterization kit, using sterile technique. Preparer the other materials needed 5. Put on the sterile gloves, non dominant hand, then squeeze a lubricant jelly to the side of the gloves 6. Open the sterile drape and place on the pt's thigh. Place fenestrated drape w/ opening on the penis 7. Apply sterile lubricant; liberally to the catheter tip. Lubricate at least six inches of the catheter. Leave the lubricated catheter on the sterile field 8. Grasp the pt's penis between your thumb and your forefinger of your non dominant hand. Retract the foreskin of an uncircumcised male. The gloved hand that has touched the pt is now contaminated 9. Use the forceps to the hold the cotton balls. This will maintain the sterility of one hand. Using the forceps, pick up one cotton ball and swab the center of the meatus outward int circular motion 10. Continue outward, using a new cotton ball. After the last cotton ball is used, drop the forceps into the disposal bag as well 11. Hold the penis at 90 degree angle. Advance a catheter into the pt's urinary meatus. You may encounter resistance at the prosthetic sphincter a. Pause and allow the sphincter to relax b. Lower the penis and continue to advance the catheter NOTE: never force the catheter to advance. Discontinue procedure from the charge nurse or the physician 12. When the catheter has pass through the prostatic sphincter into the bladder, urine will start to flow int the collection bag while it's pre-connected. If it is not pre connected, collect the specimen of required, then place the end of the catheter into the tubing of the sterile receptacle 13. Attach the syringe to the balloon port and inject the water slowly to inflate the balloon. Connect the urine collection bag if it is not pre connected. Anchor the catheter tubing to the lateral abdomen w/ tape 14. Secure the urinary collection bag the below the level of the bladder and off the floor. Coil any extra tubing on the bed 15. Remove your gloves, the drapes and protectors from around the pt, and any lubricant or antiseptic on the pt's skin 16. Discard disposable equipment and return reusable equipment to the appropriate area 17. Record the time that the procedure was done and by whom, the pt reaction to the procedure, all pt teaching is done and the pt's level of understanding. Report any significant observation to the charge nurse to include: a. The amount, color and the clarity of the urine b. Any difficulties w/ the procedure c. The presence of blood in the urine

Removing an Indwelling Catheter Eventually, a catheter must be removed because the need for it no longer or it is crusting and must be changed. The nurse usually removes tha catheter 1. Assemble all supplies and equipment a. 10 cc syringe b. Washcloth and towel c. Exam gloves 2. Identify the pt and explain the procedure to him. Advise him that there will be a slight burning during removal of the catheter 3. Provide privacy and assist the female pt into a dorsal recumbent position. The male should be in a supine position. Place a towel under the pt's buttocks and provide proper draping 4. Wash your hands and put on exam gloves 5. Empty balloon by inserting the barrel of the syringe and withdrawing the amount of fluid used during inflation 6. Clean the perineum or penis w/ antiseptic swab. Dry the area well 7. Empty the drainage bag. Measure the amount of urine and record on the input and output sheet 8. Remove the gloves and wash you hands 9. Discard disposable supplies and return reusable supplies and equipment to the appropriate area 10. Record that the catheter was removed, the time and the date and by whom. Note the amount, color, and clarity of the urine in the drainage bag. Also document all pt teaching done and the pt's level of understanding 11. After removal of the catheter, assess the pr's for 24hrs for patterns of urinary elimination 12. Note the time and amount of the first voided urine. Report any of the ff: a. Inability to void w/in 5-10hrs b. Frequency, burning, dribbling, or hesitation in starting the stream of urine c. Cloudiness or any other unusual color or characteristics of the urine 13. Provide a level of fluids similar to the intake when the catheter was in place 14. Record that the catheter was removed, the date and time, and by whom