Urinary Catheterisation PDF

[**[Urinary catheterisation]**](https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=7&cad=rja&ved=0CEoQFjAG&url=http%3A%2F%2Fwww.nhs.uk%2Fconditions%2Furinary-catheterization%2FPages%2FIntroduction.aspx&ei=8o86UtuGI-eM0wWx2IDIAQ&usg=AFQjCNF3qRsM2UlDayB-p57wE6-MjsvUMQ&bvm=bv.52288139,d.d2k)...

[**[Urinary catheterisation]**](https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=7&cad=rja&ved=0CEoQFjAG&url=http%3A%2F%2Fwww.nhs.uk%2Fconditions%2Furinary-catheterization%2FPages%2FIntroduction.aspx&ei=8o86UtuGI-eM0wWx2IDIAQ&usg=AFQjCNF3qRsM2UlDayB-p57wE6-MjsvUMQ&bvm=bv.52288139,d.d2k) **Alternative Names** Catheter - urine; Foley catheter; Indwelling catheter; Suprapubic catheters known as a urinary [[catheter]](http://en.wikipedia.org/wiki/Catheter) is inserted into a patient\'s [[bladder]](http://en.wikipedia.org/wiki/Urinary_bladder) via the [[urethra]](http://en.wikipedia.org/wiki/Urethra). Catheterization allows the patient\'s [[urine]](http://en.wikipedia.org/wiki/Urine) to drain freely from the bladder for collection. Catheters are small rubber or plastic tubes that can be inserted through the urethra into the bladder. Catheters are an almost sure-fire way to empty the bladder. Both men and women can use catheters.  **Indications** By inserting a Foley catheter, you are gaining access to the bladder and its contents. Thus enabling you to drain bladder contents, decompress the bladder, obtain a specimen, and introduce a passage into the GU tract. This will allow you to treat urinary retention, and bladder outlet obstruction. Urinary output is also a sensitive indicator of volume status and renal perfusion (and thus tissue perfusion also). In the emergency department, catheters can be used to aid in the diagnosis of GU bleeding. In some cases, as in urethral stricture or prostatic hypertrophy, insertion will be difficult and early consultation with urology is essential. **Contraindications** Foley catheters are contraindicated in the presence of urethral trauma. Urethral injuries may occur in patients with multisystem injuries and pelvic factures, as well as straddle impacts There are three main types of catheters: - Indwelling catheter - Condom catheter - Intermittent (short-term) catheter A [**[Foley catheter]**](http://en.wikipedia.org/wiki/Foley_catheter) ([[indwelling urinary catheter]](http://en.wikipedia.org/wiki/Indwelling_urinary_catheter)) is retained by means of a balloon at the tip that is inflated with sterile water. The balloons typically come in two different sizes: 5 cm^3^ and 30 cm^3^. They are commonly made in silicone rubber or natural rubber. is a flexible tube that is often passed through the [[urethra]](http://en.wikipedia.org/wiki/Urethra) and into the [[bladder]](http://en.wikipedia.org/wiki/Urinary_bladder). The tube has two separated channels, or [[lumens]](http://en.wikipedia.org/wiki/Lumen), running down its length. One lumen is open at both ends, and allows [[urine]](http://en.wikipedia.org/wiki/Urine) to drain out into a collection bag. The other lumen has a valve on the outside end and connects to a [[balloon]](http://en.wikipedia.org/wiki/Balloon) at the tip; the balloon is inflated with sterile [[water]](http://en.wikipedia.org/wiki/Water) when it lies inside the bladder, in order to stop it from slipping out. Foley catheters are commonly made from [[silicone rubber]](http://en.wikipedia.org/wiki/Silicone_rubber) or [[natural rubber]](http://en.wikipedia.org/wiki/Natural_rubber). The relative size of a Foley catheter is described using [[French units]](http://en.wikipedia.org/wiki/French_catheter_scale) (F). The most common sizes are 10 F to 28 F. 1 F is equivalent to 0.33 mm =.013\" = 1/77\" of diameter. http://t1.gstatic.com/images?q=tbn:ANd9GcQ7sYkJFmnnFdP9nAmgSfrNX4YiTDNX-cFzyg6I8WU5w6cag1D1SA  http://upload.wikimedia.org/wikipedia/commons/a/aa/Foley\_catheter\_in\_place.png  **Foley catheters are used during the following situations:** - - - - - - - - - - A major problem with Foley catheters is that they have a tendency to contribute to [[urinary tract infections]](http://en.wikipedia.org/wiki/Urinary_tract_infection) (UTI). This occurs because bacteria can travel up the catheters to the bladder where the urine can become infected. An **intermittent catheter/Robinson catheter** is a flexible catheter used for short term drainage of urine. Unlike the Foley catheter, it has no balloon on its tip and therefore cannot stay in place unaided. These can be non-coated or coated A coudé catheter is designed with a curved tip that makes it easier to pass through the curvature of the prostatic urethra. A hematuria (or haematuria) catheter is a type of Foley catheter used for Post-TURP hemostasis. This is useful following endoscopic surgical procedures, or in the case of gross hematuria. There are both two-way and three-way hematuria catheters (double and triple lumen) **\ ** **CONDOM CATHETERS ( also known as a \'Texas catheter\')** https://encrypted-tbn0.gstatic.com/images?q=tbn:ANd9GcSQ8TXQMizYFYiCyxvcyoHzajtPlRYmvStT52\_AMB1QJ2\_k3iA1 Condom catheters are most often used in elderly men with [[dementia]](http://www.nlm.nih.gov/medlineplus/ency/article/000739.htm). There is no tube placed inside the penis. Instead, a condom-like device is placed over the penis. A tube leads from this device to a drainage bag. The condom catheter must be changed every day. **INTERMITTENT (SHORT-TERM) CATHETERS** You would use an intermittent catheter when you only need to use a catheter sometimes. You remove these catheters after the flow of urine has stopped. **a suprapubic catheter** A urinary catheter and method of its **use for measuring the internal pressure of a human or other mammal**. The catheter includes three lumens, or channels. The first lumen is dedicated to draining urine, the second lumen is dedicated to a retention balloon, and the third lumen is available for connection to a pressure transducer. In use, the catheter is installed in a patient, the third lumen is filled with a pressure transmitting medium, connected to a pressure sensor, and the patient\'s intra-abdominal pressure is monitored without interruption of the urine flow.  DRAINAGE BAGS A catheter is usually attached to a drainage bag. **There are two types of bags:** - **A leg bag** is a small device that attaches by elastic bands to the leg. It holds about 300 to 500 milliliters (ml) of urine. You wear it **during the day**, because you can hide it under pants or a skirt. You can easily empty it into the toilet. - You can use a larger drainage device **during the night**. It holds 1 to 2 liters of urine. You hang the device on your bed or place it on the floor. Keep the drainage bag lower than your bladder so that urine does not flow back up into your bladder. Empty the drainage device at least every 8 hours, or when it is full. To clean the drainage bag, remove it from the catheter. Attach a new drainage device to the catheter while you clean the old one. Clean and deodorize the drainage bag by filling it with a mixture of vinegar and water. Or, you can use chlorine bleach instead. Let the bag soak for 20 minutes. Hang it with the outlet valve open to drain and dry.. **Equipment** https://encrypted-tbn3.gstatic.com/images?q=tbn:ANd9GcQROLAXb1c4BfPa8tNMMCK5gKUYqi-lfytmmwONRNtCOBauOTnn  Sterile gloves - consider Universal Precautions \ Sterile drapes\ Cleansing solution e.g. Savlon\ Cotton swabs \ Forceps\ Sterile water (usually 10 cc)\ Foley catheter (usually 16-18 French)\ Syringe (usually 10 cc)\ Lubricant (water based jelly or xylocaine jelly)\ Collection bag and tubing **Procedure** https://encrypted-tbn0.gstatic.com/images?q=tbn:ANd9GcToc\_d63dZyXvCKYDMrOEmhlEN5OaI9fGa\_OivhOtdL\_GBgFkLiRg ------------------------------------------------------------------------------------------------------------------------------------------------  Urinary Catheter in Male ----------------------------------------------------------------------------------- ------------------------------------------------------------ **Insertion of an urinary catheter \ **Insertion of an urinary catheter \ in a female** in a male**  http://www.med.uottawa.ca/procedures/ucath/images/t\_m.jpg **Review the female anatomy \ **Review the male anatomy \ in more detail** in more detail** ------------------------------------------------------------------------------------------------------------------------------------------------   1. Gather equipment. 2. Explain procedure to the patient 3. Assist patient into supine position with legs spread and feet together 4. Open catheterization kit and catheter 5. Prepare sterile field, apply sterile gloves  6. Check balloon for patency.  7. Generously coat the distal portion (2-5 cm) of the catheter with lubricant  8. Apply sterile drape 9. Apply sterile drape\ \  10. If female, separate labia using non-dominant hand. If male, hold the penis with the non-dominant hand. Maintain hand position until preparing to inflate balloon. 11. Using dominant hand to handle forceps, cleanse peri-urethral mucosa with cleansing solution. Cleanse anterior to posterior, inner to outer, one swipe per swab, discard swab away from sterile field.\ \ http://www.med.uottawa.ca/procedures/ucath/images/ucath\_bulb.jpg  12. Pick up catheter with gloved (and still sterile) dominant hand. Hold end of catheter loosely coiled in palm of dominant hand. 13. In the male, lift the penis to a position perpendicular to patient\'s body and apply light upward traction (with non-dominant hand)  14. Identify the urinary meatus and gently insert until 1 to 2 inches beyond where urine is noted   15. Inflate balloon, using correct amount of sterile liquid (usually 10 cc but check actual balloon size) 16. Gently pull catheter until inflation balloon is snug against bladder neck  17. Connect catheter to drainage system 18. Secure catheter to abdomen or thigh, without tension on tubing 19. Place drainage bag below level of bladder  20. Evaluate catheter function and amount, color, odor, and quality of urine  21. Remove gloves, dispose of equipment appropriately, wash hands  22. Document size of catheter inserted, amount of water in balloon, patient\'s response to procedure, and assessment of urine http://calder.med.miami.edu/pointis/images/indwelling.gif HOW TO CARE FOR A CATHETER Everyday care of catheter and drainage bag is important to reduce the risk of infection. Such precautions include: - - - - - - - To care for an indwelling catheter, clean the area where the catheter exits your body and the catheter itself with soap and water every day. Also clean the area after every bowel movement to prevent infection. If you have a suprapubic catheter, clean the opening in your belly and the tube with soap and water every day. Then cover it with dry gauze. Drink plenty of fluids to help prevent infections. Ask your health care provider how much you should drink. Wash your hands before and after handling the drainage device. Do not allow the outlet valve to touch anything. If the outlet gets dirty, clean it with soap and water. Sometimes urine can leak around the catheter. This may be caused by: - Catheter that is blocked or that has a kink in it - Catheter that is too small - Bladder [[spasms]](http://www.nlm.nih.gov/medlineplus/ency/article/003193.htm) - [[Constipation]](http://www.nlm.nih.gov/medlineplus/ency/article/003125.htm) - The wrong balloon size - [[Urinary tract infections]](http://www.nlm.nih.gov/medlineplus/ency/article/000521.htm) POSSIBLE COMPLICATIONS Complications of catheter use include: - Allergy or sensitivity to latex - [[Bladder stones]](http://www.nlm.nih.gov/medlineplus/ency/article/001275.htm) - Blood infections ([[septicemia]](http://www.nlm.nih.gov/medlineplus/ency/article/001355.htm)) - [[Blood in the urine]](http://www.nlm.nih.gov/medlineplus/ency/article/003138.htm) (hematuria) - Kidney damage (usually only with long-term, indwelling catheter use) - [[Urethral injury]](http://www.nlm.nih.gov/medlineplus/ency/article/001063.htm) - Urinary tract or kidney infections Call your health care provider if you have: - Bladder spasms that do not go away - Bleeding into or around the catheter - [[Fever]](http://www.nlm.nih.gov/medlineplus/ency/article/003090.htm) or chills - Large amounts of urine leaking around the catheter - Skin sores around a suprapubic catheter - Stones or sediment in the urinary catheter or drainage bag - Swelling of the urethra around the catheter - Urine with a strong smell, or that is thick or cloudy - Very little or no urine draining from the catheter and you are drinking enough fluids If the catheter becomes clogged, painful, or infected, it will need to be replaced immediately