Nursing: Catheterization

• Wesleyan University Philippines, College of Nursing provides information on catheterization for nursing students.
• Learning outcomes for nursing students include applying appropriate nursing concepts to at-risk clients during childbearing and childbearing years holistically and comprehensively, and demonstrating caring, love of God, country, and people.

Catheterization

• It involves the insertion of a catheter into the patient's bladder to drain urine when the patient is unable to do so on their own.
• Urinary catheters are made of latex, polyurethane, or silicone.
• Catheter insertion requires aseptic technique and sterile equipment.
• Aseptic technique involves practices and procedures to prevent contamination from pathogens.

Indications for Catheterization

• Therapeutic indications:
  • Acute and chronic urinary retention
  • Intractable urinary incontinence
  • Bladder irrigation
  • Perioperative needs
  • Post spinal injury
  • Anesthesia
• Diagnostic indications:
  • Measure residual urine
  • Bladder investigation
  • Intravesical drug instillation
  • Obtain an uncontaminated urine sample

Contraindications for Catheterization

• Acute prostatitis
• Allergy to latex
• Urethral injury or trauma
• Agitated patient

Catheter Sizes

• The French scale (Fr.) is used to denote the size of catheters
• Each unit is about 0.33 mm in diameter
• A catheter with a smaller number is smaller size
• Catheter size 8 Fr - 10 Fr is for children
• Catheter size 14 Fr - 16 Fr is for female adults
• Catheter size 20 Fr - 22 Fr is for male adults

Parts of an Indwelling Catheter

• balloon
• urine drainage port
• balloon port

Types of Catheters

• Intermittent Catheter: Used to drain the bladder for a short time (5-10 minutes)
• Retention/Indwelling Catheter: Placed into the bladder, secured for a certain time.
• Condom Catheter: A soft sheath or tubing placed over the penis, with a collection bag for urine.
• Three-way Catheter: An indwelling catheter featuring three separate channels for urine drainage, balloon inflation, and continuous bladder irrigation.
• Supra Pubic Catheter: Inserted into the bladder through a small incision above the pubic area. Used for continuous drainage in cases of urethral injury/trauma, urethral obstruction, or bladder neck masses.

Purposes of Catheterization

• Monitor urine output
• Facilitate evacuation of urine
• Obtain a sterile specimen
• Determine the amount of residual urine if the bladder cannot be completely emptied
  • A volume less than 50 mL is normal
  • Greater than 100 mL is usually acceptable in patients over 65 but abnormal in younger patients
• Prevent strain on a pelvic or abdominal wound from a distended bladder
• Empty the bladder before and during surgery or certain diagnostic procedures

Assessment Before Catheterization

• Doctor's order (to ensure the right order is carried out and present any error)
• Client's level of consciousness, knowledge, and understanding (to determine ability to follow instructions)
• Kind and size of catheter to be used
  • Indwelling catheter
  • Straight catheter
  • Wrong size causes delayed time and pain during the procedure
• Availability and functionality of materials needed (to save time and energy)
• Need for collection of urine specimen (to ensure urine constituents are not deteriorated if collection is needed)

Procedure/Implementation for Inserting a Catheter

• Identify the client and explain the procedure (to ensure the correct patient receives the intended procedure, and prevent errors)
• Wash hands, wear clean gloves and other Personal Protective Equipment, (reduces transmission of microorganisms)
• Gather the necessary materials and arrange at the client's bedside table (saves time and effort, avoids leaving the client unattended, and promotes client safety)
• Close the door and draw the curtain divider (promotes client privacy)
• Raise the bed to a comfortable level, and lower the rails (helps the nurse to work at ease, and prevents strain at the nurse's back)
• Position the client in a dorsal recumbent position or bring the lower corner of top linen up within client's abdomen (provides full exposure of genitalia)
• Remove gloves, do hand rub and open the sterile package, wear sterile gloves and arrange the contents in a linear arrangement or using the inside of the package as the sterile field (prevents contamination and transmission of microorganism.)
• Place sterile protective pads under the client's buttocks and drape the client (Provides client's comfort and privacy)
• Set up the receptacle for soiled cleaning swabs (For proper disposal of soiled materials)
• Open the drainage bag and attach to the end of the catheter (to prevent spillage of urine once catheter is inserted)
• Attach syringe and test balloon by instilling sterile water and deflating by withdrawing water (to check if the catheter is functional)
• Follow these steps:
  • Hold the labia open with non-dominant hand
  • Cleanse each labia with a separate antiseptic-soaked cotton ball, using a downward stroke with your dominant hand
  • Cleanse the urinary meatus with a third antiseptic-soaked cotton ball, using a downward stroke
• Lubricate the distal portion of the catheter, then place it on a sterile field for easier insertion
• Hold the labia open again with non-dominant hand.
• Instruct the client to take a slow deep breathe while gently inserting the catheter into the urethral meatus with your dominant hand in a rotating movement.
  • Length of catheter insertion for female: 2-3 inches.
  • Taking a slow deep breathe relaxes the client.
• Inflate the retention balloon with sterile water once urine is visible along the catheter tube by attaching the syringe with distilled water into the balloon inflation port (serves as lock of the catheter)
• Gently pull the catheter after inflating the balloon. (to test if the balloon is inflated or not)
• Tape the tube to the thigh of a female client (To secure the tube properly).
• Remove gloves

Following Catheter Insertion

• Secure the drainage tubing and place drainage bag below the level of the bladder. (To prevent urine from flowing back into the bladder from the tubing and urine bag, which could cause an infection)
• Remove the drape and absorbable pad and assist the client to lower her legs.
• Fold lower corner of top linen back at the client's legs, lower the bed, raise side rails and put call light within the client's reach (to promote client's comfort, safety and privacy).
• Gather and discard disposable materials or rearrange the reusable ones in its' proper places (maintains orderliness of materials and the environment).
• Remove gloves and other PPE, discard properly and do hand washing (reduces the transmission of microorganisms).
• Evaluate client's tolerance and response toward the procedure (to guide the nurse in providing nursing management in case of client's untoward responses).
• Document the procedure and pertinent data on the client's chart as well as the nursing actions are taken (timely documentation helps to ensure patient safety and provides record of the client's care as a baseline for further management.)

Procedure/Implementation for Removing a Catheter

• Purpose - To discontinue the use of an indwelling catheter (IUC) upon the physician's order; to change the IUC.

Assessment before Removal

• Doctor's order (to ensure the right order is carried out and prevent any error)
• Client's level of consciousness, knowledge, and understanding (to determine ability to follow instructions)

Procedure/Implementation for Removing a Catheter

• Identify the client and explain the procedure (to ensure the correct patient receives the intended procedure, and prevent errors)
• Wash hands, wear clean gloves and other Personal Protective Equipment, (reduces transmission of microorganisms)
• Gather the necessary materials and arrange at the client's bedside table (saves time and effort, avoids leaving the client unattended, and promotes client safety)
• Close the door and draw the curtain divider (promotes client privacy)
• Raise the bed to its' comfortable level and lower the siderails where you will work and put away call light (helps the nurse to work at ease, and prevents strain at the nurse's back)
• Remove gloves, do hand rub and wear clean gloves (reduces the transmission of microorganisms)
• Place protective pads under the patient's thigh (protects the bed linen)
• Empty urine into tubing into catheter bag
• Remove any tape that may hold the catheter to the leg (for easier removal of catheter)
• Insert syringe end into the balloon port and pull the plunger to remove all the air and fluid (to unlock the catheter inside)
• Gently pull the catheter as the client take a deep breathe (to prevent discomfort during the removal)
• Cleanse the client's perineal area (to avoid infection and promote client's comfort)
• Remove the protective pad, properly drape the patient, lower the bed, raise the siderails and put the call light within the client's reach (to promote client's comfort, safety and privacy).
• Dispose of used materials properly, rearrange the reusable ones in its' proper places, remove gloves and do hand washing. (prevents the spread of microorganisms and maintains cleanliness and orderliness of the environment)
• Evaluate the amount and characteristics of urine output such as color (to determine if immediate referral is needed in case of abnormal findings).
• Wipe the outside pouch with a clean, wet washcloth (to prevent infection and spread of microorganisms)
• Deodorize room if appropriate and draw the curtain divider (promotes client's comfort and to remove any unpleasant odor that may stay in the room. This may also be done at the beginning of the procedure).
• Perform hand washing to prevent the spread of microorganisms
• Document the procedure and pertinent data on the client's chart as well as the nursing actions taken.
  • Timely documentation helps to ensure patient safety
  • Provides record of the client's care and serves as a baseline for further management