Session 12Urethral Catheterization

Session 12Urethral Catheterization

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Learning Objectives

Learning Objectives

By the end of this session, students are expected to be able to:

Define catheterization

Explain indications for catheterization

Identify types, size and type of catheter materials

Describe procedure for catheterizing a female and male patient

Describe lifespan considerations regarding catheterization

Describe home care consideration in relation to catheterization

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Definition of Catheterization

Definition of Catheterization

Catheterization to patient: The introduction of a sterile catheter through the urethra into the bladder for the purpose of removing urine.

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Indications for Catheterization

Indications for Catheterization

Catheterization may be performed for several common reasons, which include

Relieving retention of urine when other nursing measures have failed.

Emptying the bladder before giving a bladder irrigation or instillation.

Ensuring that the bladder is empty before, during and after pelvic surgery.

Obtaining a sterile urine specimen when collection of ‘Mid–stream’ specimen of urine is impractical, for example when a woman is menstruating or when the patient is incontinent.

Splinting the urethra following urethral surgery or trauma.

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Types, Size and Type of Catheter Materials

Types, Size and Type of Catheter Materials

Catheters are made of different materials, shapes and sizes.

Most catheters are made of plastic, latex rubber and silicone.

Silicone catheters are used for long-term indication for catheterization (2 to 3 month duration) because they create less encrustation.

Catheters may be non-retaining; there are intended for intermittent catheterization.

Self-retaining: Are used if catheter must remain in place for some days.

The most commonly used for self-retaining catheter is the ‘Foley’s type’.

It has balloon which has to be filled with either sterile water or air after it has been introduced into the bladder.

Catheter is sized according to the french scale.

A size 8-10 is used for children, 14 – 16 for adult females and 18-20 adult males.

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Descriptions of Technique of Catheterizing a Female and Male Patient

Descriptions of Technique of Catheterizing a Female and Male Patient

Purposes

To relieve discomfort due to bladder distention or to provide gradual decompression of distended bladder.

To facilitate accurate measurement of urinary output for critically ill clients whose output needs to be monitored hourly.

Assessment

Determine the most appropriate method of catheterization based on the purpose and any criteria specified in the order.

Assess the client’s overall condition and determine if the client is able to cooperate.

Determine if the client can be positioned supine with head relatively flat.

Determine when the client was last void or was last catheterized.

Percuss the bladder to check for fullness or distention.

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Planning: Equipment

Planning: Equipment

Sterile catheter of the appropriate size

Sterilization kit containing

Water proof drape

Antiseptic solution

Cleansing cotton wool balls

Sterile gloves

Dissecting forceps

Water soluble lubricant

Urine receiver

Specimen container

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For Indwelling Catheter

For Indwelling Catheter

Syringe pre filled with sterile water in amount specified by catheter manufacturer’s collection bag and tubing 2% Xylocaine gel.

Supplies for performing perineal cleansing.

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Performance (Technique for Catheterizing a Female)

Performance (Technique for Catheterizing a Female)

Explain the procedure to the patient in order to gain cooperation and minimize embarrassment.

Provide privacy.

Position the patient supine with her knees flexed and abducted.

Turn down the top bedclothes to knee level.

Cover her with a sheet.

Place the mackintosh and towel under her buttocks.

Ensure that there is sufficient light in the room.

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An artificial light may be needed.

An artificial light may be needed.

Ask your assistant to wash and dry hands and open the sterile catheterization pack using sterile technique.

Scrub hands, dry them using the sterile towel provided and put on the gloves.

Arrange the sterile equipment for convenience on the sterile area.

Ask the assistant to do the following

Open the outer wrapper on the catheter and take it out using sterile forceps and place it on the sterile field.

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Pour Savlon or other antiseptic into the gallipots.

Pour Savlon or other antiseptic into the gallipots.

Squeeze the K Y gel on to a sterile swab. (Or pour a lubricant into a galipot).

Open the spigot and drop it on the sterile field.

Hold the ampoule or bottle of sterile water while you disinfect the top of bottle with an antiseptic swab and with the sterile syringe and needle you draw up 20ml of water and place it on sterile field.

Turn back the sheet covering the patient.

Place the fenestrated drape over the external genitalia so that the hole on the drape exposes the labia.

Remove the catheter from the inner wrapper and lubricate about 3 to 5cm of catheter tip and place it in the sterile receiver.

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With your thumb and forefinger of left hand, separate labia and pull up to identify the meatus.

With your thumb and forefinger of left hand, separate labia and pull up to identify the meatus.

Keeping your left hand in place separating the labia, pick up forceps with your right hand and take antiseptic swab.

Clean inner folds of labia, the meatus and surrounding area thoroughly.

Using the saturated antiseptic cotton wool swabs wipe from above the meatus down-wards with one stroke.

Discard swab after each stroke.

Keep fingers of left hand in place and discard the forceps with your right hand.

Place the sterile receiver on the drape between the patient’s thighs close to buttocks for receiving urine.

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Release labia and hold catheter securely with your left hand to prevent it from slipping out.

Pick up catheter with your gloved right hand; gently insert the lubricated end into the urethra about 4 to 5cm until urine begins to flow.

If there is some slight resistance during insertion, rotate the catheter gently and ask the patient to deep-breathe.

Release labia and hold catheter securely with your left hand to prevent it from slipping out.

If a specimen is needed, pinch catheter with thumb and forefinger of left hand to stop the flow of urine.

Place the sterile specimen container at the end of the catheter without touching it.

Release the pinch and allow 30-40ml to drain in the specimen container.

Re-pinch catheter and place catheter end into the receiver.

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Dry perineal area with a gauze swab.

Dry perineal area with a gauze swab.

Remove equipment. Remake the bed and leave the patient clean, dry and comfortable.

Record the procedure in the patient’s chart.

Record the amount of urine passed and its characteristics.

Label specimen and send to the laboratory promptly.

If it is retention catheterization (indwelling catheter) inflate the balloon with sterile water or air after the bladder is emptied.

The amount of water required is indicated on the catheter.

Connect the drainage bag to the end of Foley’s catheter without contaminating.

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If a drainage bag is not necessary cover end of catheter with a sterile spigot.

If a drainage bag is not necessary cover end of catheter with a sterile spigot.

Fix the catheter to inner thigh with a plaster strapping.

Wash and dry perineum.

Remove equipment.

Assist the patient to a comfortable position.

Record data on appropriate charts.

Check for the important anatomical landmarks during catheterization of female patient.

Foley catheter inserted in the bladder.

The balloon is inflated.

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Female Catheterization

Female Catheterization

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Performance (Technique for Catheterizing a Male Patient)

Performance (Technique for Catheterizing a Male Patient)

Equipment: Same as for female catheterization

The technique: Similar to that described for catheterizing female patient except for the following points:

Position patient supine with knees slightly abducted

Place drape or towel so that the penis goes through the hole making sure the genital area is well covered

Lubricate the catheter for about 15 to 18 cm

With your left hand place a sterile swab over the neck of the penis, hold the penis and retract the foreskin (if is uncircumcised) clean the head of the penis with antiseptic swab moving from the meatus towards the base of the penis.

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Slight traction to the penis helps to straighten the urethra.

Slight traction to the penis helps to straighten the urethra.

Insert the catheter into the urethra advance the catheter 15 to 25 cm (6 to 10 inches) until urine flows.

If resistance is felt at the external sphincter, slightly increase the traction on the penis and apply steady, gentle pressure on the catheter.

Ask patient to strain gently (as if passing urine) to have help relax sphincter.

NEVER use force if catheter resists entering.

Try to rotate it gently and if resistance continues stop and report to the supervising nurse or doctor.

When urine begins to flow, advance the catheter another 2.5cm (1 inch).

Lower the penis and allow the urine to flow into the receiver. Secure the penis with your left hand.

Caring for a patient with an indwelling urethral catheter

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The presence of an indwelling catheter causes irritation to the urethra.

When the patient is having an indwelling catheter it is normally connected to closed drainage system which consists of: an indwelling catheter, a connecting tube, and collecting bag.

There is a drainage valve which enables the collecting bag to be emptied usually the collection bag is a disposable plastic bag which is calibrated in order to make measuring of the urine easy.

The presence of an indwelling catheter causes irritation to the urethra.

Urethral secretion is increased and if the secretion is left to dry it causes damage to the mucous membrane which can lead to urethral stricture.

If care of the indwelling catheter is inadequate the patient will develop a urinary tract infection.

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The following are nursing measures appropriate for a patient with an indwelling catheter.

The following are nursing measures appropriate for a patient with an indwelling catheter.

The connecting tube should be long enough to allow the patient move freely in bed. It should be hang below the level of the collecting bag.

The collecting bag is attached to the bed frame and the tubing fixed to the bedding in order to keep it in place.

The collecting bag should always be lower than the patient’s bladder to prevent reflux of urine.

Always ensure that the tubes are not kinked or twisted as this may allow pools of drainage to collect in the loops of the tubing.

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The collecting bag should be emptied at least every 8 hours or whenever it is full.

The collecting bag should be emptied at least every 8 hours or whenever it is full.

The urine should be measured and any abnormalities noted and recorded.

The catheter must be cleaned at least twice daily or as often as necessary.

Starting from the urethral meatus and moving downwards.

Use warm soapy water, rinse and dry.

Some authorizes recommend cleaning the area around the urethral meatus with povidone iodine (Betaldine).

If not contraindicated encourage the patient to be up and about.

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Encourage fluid intake and record the intake and output in the patient’s fluid balance chart

Encourage fluid intake and record the intake and output in the patient’s fluid balance chart

Assist the patient in personal hygiene e.g. hands washing after contaminating the hands or after bowel movement.

The doctor will order when to change the indwelling catheter.

Usually is it changed on weekly basis if the catheter material is not silicone.

Always maintain the catheter free from tension.

Fix the drainage tubing to abdomen or upper thigh to male patients.

Maintain the integrity of the closed drainage system.

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Male Catheterization

Male Catheterization

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Lifespan Considerations regarding Catheterization

Lifespan Considerations regarding Catheterization

Infants and children

Adapt the size of the catheter for pediatric clients.

Ask a family member to assist in holding the child during catheterization, if appropriate.

Elders

When catheterizing older adults, be very attentive to problems of limited movement especially in the hips.

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Home Care Consideration in Relation to Catheterization

Home Care Consideration in Relation to Catheterization

For intermittent catheterization, instruct the client to

Follow instructions for clean technique.

Wash hands well with warm water and soap prior to handling equipment or performing catheterization.

Monitor for signs and symptoms for Urine Tract Infect (UTI)

Ensure adequate intake of fluid

For indwelling catheter, instruct the client to

Never pull on the catheter.

Ensure that there are no kinks or twists in the tubing.

Keep the urine draining bag below the level of the bladder.

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Key Points

Key Points

Urinary catheterization is frequently required for clients with urinary retention but is only performed when all other measures to facilitate voiding fail.

Sterile technique is essential to prevent ascending urinary infections.

Selection of the appropriate catheter material is important to prevent complications.

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Evaluation

Evaluation

What is catheterization?

What are the indications for catheterization?.

What are the types and sizes of catheters for the females, males and children.

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References

References

Adams, M. P. et al. (2008). Pharmacology for Nurses. A Pathophysiologic Approach. (2nd ed.). New Jersey: Pearson.

Kozier, B. et al. (2004). Fundamentals of Nursing. Concepts Process and Practice. (7th ed.). New Jersey: Pearson Education, Inc.

MOHSW (2008). Basic Nursing Procedures. A manual for Nursing Practice in Tanzania. (3rd ed.). Dar es Salaam, Tanzania: Ministry of Health and Social Welfare.

Rice, J. (2006). Principles of Pharmacology for Medical Assisting (4th ed.). Delmar CENGAGE Learning.

Wong, D.L. et al. (2003). Nursing Care of Infants and Children (7thed.) Mosby

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Slide 29

"Be ashamed to die until you have won some victory. … It is not death that a man should fear, but he should fear never beginning to live

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