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
COMMENTS