Urinary Elimination: Urinary Catheterization

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URINARY CATHETERIZATION

It is the introduction of a' tube (catheter) through the urethra into the urinary bladder to drain the urine.
·        Catheters are sized in units called French
Purposes:
·        To get sterile urine specimen for diagnostic purposes.
·        To empty the bladder in retention.
·        To determine whether failure to void is due to retention or suppression.
·        To measure residual urine.
·        To empty the bladder prior to surgery.
·        To prevent urine passing over a wound.
Principles
Ø Microorganisms are present in the environment, on the articles, & on the skin.
Ø Cleaning an area where there is less number of organisms, before cleaning an area where there are more organisms, minimize the spread of organisms to the clean area.
Ø Urinary bladder is a sterile cavity & the urinary meatus acts as a portal for pathogenic organism.
Ø A break in the integrity of the skin & mucus membrane provides ready entrance for micro - organisms.
Ø To provide for intermittent or continuous bladder drainage & irrigation.
Ø To manage incontinence.
Ø Lubrication reduces friction.
Ø Thorough knowledge of anatomy & physiology of the genitourinary tract facilitates catheterization of urinary bladder.
Ø Systematic ways of doing saves time, energy & material.
Ø Any unfamiliar situation produces anxiety.
TYPES OF CATHETERS
·        Straight /single lumen/intermittent —inserted to drain the bladder and immediately removed.
·        Retention or Foley catheters/ double lumen —remains in bladder to drain urine
·        Three way Foley catheter
Types of catheterization
Intermittent
Retention/indwelling
Indications for catheterization
Guidelines for appropriate catheter selection
Procedure
Preliminary Assessment
Ø Check physician's orders
Ø Check purpose of catheterization
Ø Check for specific precautions/ any contraindications
Ø Check the level of consciousness and ability to follow instructions
Ø Check general condition of patient
Ø Determine when the client last voided or was last catherized
Ø Percuss the bladder to check for the fullness or distention
Articles
Ø A sterile tray containing bowl with gauze piece/ cotton bowls/swabs (to clean perineum), sponge holding "artery forceps (to hold the swab), thumb forceps (to squeeze the cotton swab), Kidney tray (to collect urine), Dressing towel with slit
Ø Sterile catheter (Fr 14 or Fr 16)
Ø Antiseptic solution Sterile gloves.
Ø Lubricant.
Ø Syringe with distilled water (to inflate the balloon of the catheter)
Ø Urinary bag with drainage tubings
Ø A clean tray with
ü Kidney tray / paper bag.
ü Spot light
ü Clean linen, mackintosh, and towel.
Steps




















































Care of patients with urinary drainage
Catheter care
Ø Secure safely
Ø Maintaining patency of catheter & tube
Ø Patient should not lie on the tubing
Ø Never leave the tube clamped.
Ø Ensure plenty of oral fluids
Ø Bag should always be below the level of bladder
Prevention of infections
Ø Strict asepsis
Ø Hand washing
Ø Prevent backflow of urine
Ø Empty the bag every 8 hours
Ø Perineal care at least 2/day
Ø Prophylactic antibiotics
Ø Vit C tablets/cranberry juice 2-3 glasses /day
Maintaining comfort
Ø Explain about the procedure
Ø Teach how to move in bed
Ø Instruct increased fluid intake
Ø Instruct to keep perineum dry & clean
Restoring normal bladder functions
Ø Bladder training program
With an indwelling catheter in place the bladder muscle does not stretch and contract regularly as it does when the bladder fills and empties by voiding.
few days before removing the catheter may be clamped for specified periods of time( 2-4 hors) and then released to allow the bladder to empty. This allows bladder to distend and stimulate the musculature.
Fluids
Clients should drink 3,000 ml per day if permitted
Large amount of fluid ensure large urine output which keeps bladder flushed out
Maintain intake and output chart
Dietary measures
Acidifying the urine of clients with a retention catheter reduces the risk of urinary tract infection and calculi formation. Foods such as egg, cheese, meat, whole grain, tomato tend to increase the acidity of urine. Most fruits & vegetables, legumes, milk & milk products result in alkaline urine
 Perineal care
No special cleaning other than routine hygienic care is necessary for clients with retention catheters.
Changing catheter and tubing
Collecting of sediments in the catheter or tubing and impaired urine drainage are indicators for changing catheter and drainage system.
Removing catheters
Catheters are removed after its purpose has been achieved.
To remove the retention catheter follow the following steps.
Ø Ask client to assume a supine position
Ø Remove the tape or catheter securing device attached to the patient.
Ø Insert the syringe in to the injection port and withdraw the fluid from the balloon.
Ø Gently withdraw the catheter and place in the waste receptacle.
Ø Determine the time and amount of first voiding after the removal.
SUPRA PUBIC CATHETERIZATION
Ø It is inserted through the abdominal wall above the symphysis pubis, into the urinary bladder, under local anesthesia.
Ø It may be secured in place with sutures, if retention balloon is not used & attached to a closed drainage system.
Care
·        Regular urine assessment
·        I/O assessment, comfort.
·        Maintenance of patent drainage system.
·        Skin care around insertion site.
·        If temporary orders may include leaving catheter open to drainage for 48-72 hours then clamping the catheter 3-4 hours during which the client can void satisfactory amounts.

·        Sterile dressings using povidine iodine solution

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notes.nursium.com: Urinary Elimination: Urinary Catheterization
Urinary Elimination: Urinary Catheterization
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