Catheterization Procedure PDF

CATHETHERIZATION ARLENE D. LATORRE RN MAN  INSERTION OF CATHETER  involves the introduction of a catheter through the urethra into the urinary bladder PURPOSE 1. To relieve discomfort due to a bladder distention and to provide gradual decompression of a distended bladder. 2. To access th...

CATHETHERIZATION ARLENE D. LATORRE RN MAN  INSERTION OF CATHETER  involves the introduction of a catheter through the urethra into the urinary bladder PURPOSE 1. To relieve discomfort due to a bladder distention and to provide gradual decompression of a distended bladder. 2. To access the amount of residual urine if the bladder is to be emptied completely 3. To obtain a urine specimen to assess the presence of abnormal constituents and the characteristic of the urine 4. To empty the bladder completely prior to surgery to prevent inadvertent injury to adjacent organ 5. To manage incontinence when all other measures have failed 6. To provide for intermittent or continuous bladder drainage and irrigation 7. To prevent urine from contacting an incision after perineal surgery 8. To facilitate accurate measurement of UO POINTS TO CONSIDER  There are 2 hazards in the process, namely, sepsis and trauma, hence asepsis technique should be maintained and the catheter should be inserted gently.  When catheterization is ordered to relieve bladder distention, gradual decompression of the bladder should be done TYPES OF CATHETER  1. Straight or Robinson catheter – a single lumen tube with a small eye or opening about ½ inch from the insertion tip  2. Retention or Foley catheter- contains a second smaller tube throughout its length on the inside. This tube is connected to a balloon near the insertion tip. CATHETER SIZE  Diameter of the lumen are graded on French scale numbers  The larger the number, the larger the lumen size.  French 8 – 10 are used in children.  French 14, 16 and 18 are for adults. NURSING RESPONSIBILITIES  1. To do the catheterization/ or to delegate it to a skilled staff person  * primary concern - to prevent contamination of the bladder  2. To know the anatomy of the GUT system to avoid damage to the urethra during catheterization  3. To perform the catheterization procedure effectively and safely  4. To provide patient teaching and relieve anxiety EQUIPMENT  lamp or flashlight  mask, if required by hospital  soap, basin of warm water, washcloth, towel  disposable gloves  water soluble lubricant  sterile gloves  blanket/ drape, sterile drapes (optional)  antiseptic solution  cotton balls or gauze squares  forceps  basin for urine  sterile catheter (straight)  specimen container if required  bag or receptacle for disposal of the cotton balls PREPARING THE CLIENT  Explain the procedure  Provide privacy by draping  (Percuss and) Palpate the bladder to assess urinary retention.  Assist client to a supine position, with knees flexed and thighs externally rotated. INSERTING CATHETER TO FEMALE  1. Assemble all equipment: catheter, lubricant, sterile gloves, cleaning supplies, syringe with water to inflate the balloon, drainage receptacle.  2. Wash your hands. Use betadine or cleansing product to clean the urethral opening. In women clean the labia and urethral meatus using downward strokes. Avoid the anal area.  3. Apply the sterile gloves. Make sure you do not touch the outside of the gloves with your hands.  4. Lubricate the catheter.  5. Spread the labia and locate the meatus (opening which is located below the clitoris and above the vagina).  6. Slowly insert the catheter into the meatus.  7. Begin to gently insert and advance the catheter. rksteoxon STRAIGHT CATHETER  8. Empty or partially drain the bladder and then remove the catheter. Limit amount of urine drained to 700-1000 ml. rapid removal of large amounts of urine is thought to induce engorgement of the pelvic blood vessels and hypovolemic shock.  9. Pinch the catheter. Remove the catheter slowly.  10. Dry the perineum with a towel or drape.  11. Assess the urine.  12. Document the catheterization. INDWELLING/ FOLEY/ RETENTION CATHETER Additional Equipment: syringe prefilled with fluid (usually 15 ml) Follow steps as for straight catheterization up to #15. 8. Insert the catheter an additional 2.5 – 5 cm (1-2 in) beyond the point at which the urine began to flow to ensure that the balloon near the insertion tip will be inflated inside the bladder and not the urethra, where it could produce trauma. 9. Inflate the balloon by injecting the contents of the prefilled syringe into the valve of the catheter. 10. Ensure effective balloon inflation applying slight tension on the catheter until you feel resistance (well anchored in the bladder). 11. Tape the catheter to the inside of the female’s thigh. INDWELLING/ FOLEY/ RETENTION CATHETER  12. Secure drainage bag to the bedframe using its hook. Suspend it off the floor but keep it below the level of the patient’s bladder. Make sure the emptying base of the drainage bag is closed.  13. Document catheterization. rksteoxon MALE  Insert 6 to 9 inches / penile shaft should be angulated 45˚ from the horizontal  Return flow of urine indicates that the tip has reached the bladder; insert the catheter 1 inch further to make sure that the balloon does not inflate in the urethra  Inflate the balloon with the indicated amount of sterile water;  * for non-prefilled syringe - add 4-5ml more of sterile water because the tube leading to the balloon must also be filled MALE  Ifthe drainage bag is still not connected to the catheter, connect it at this time;  hang the bag below the level of the bladder to avoid backflow urine  secure the catheter (tape) to one side of the lower abdomen to prevent fistula formation at the penile-scrotal angle  Documentation  CARING FOR A PX W/ CATHETER  1. Measure I & O - to assess catheter function  2. Encourage the patient to increase oral fluid intake (3L/day)  3. Maintain the closed system  4. Maintain cleanliness outside the catheter  5. Keep the catheter drainage bag below the level of the bladder at all times - to prevent backflow CARING FOR A PX W/ CATHETER  6. Keep the tubing coiled by the patient’s side  7. Keep the drainage bag off the floor  8. Tape and coil the catheter in a way that prevents pulling  9. Observe for irritation at the meatal area  10. Empty the bag at regular intervals (usually every 8 hrs.) - so it does not overfill and cause urine to backup in the tubing REMOVING FOLEY CATHETER  Verify the order to remove the catheter  Determine whether a urine specimen is needed  Wash your hands for infection control  Gather necessary equipment – clean gloves, paper towels, a 10ml syringe, padding and small container  Explain to the patient that the catheter is to be removed and that it is not painful  Provide privacy  Remove sterile water from the balloon  Grasp the catheter near the meatus and gently withdraw the catheter  Pinch the catheter while pulling to prevent leakage; pull smoothly  Ask the patient to breathe in and out through the mouth to relax REMOVING FOLEY CATHETER  Wrap the end of the catheter in paper towel while keeping the catheter pinched closed  Hold the end of the catheter up to allow drainage of urine in the tube into the bag  Assist the patient to a comfortable position  Measure urine output  Dispose of the equipment  Remove gloves and wash your hands  Check if patient is voiding in adequate amounts (30 ml/hr)  Instruct patient to increase oral fluid intake to 3L/day  Documentation HEALTH TEACHING 1. A mild burning sensation may accompany urination for a short time - due to irritation caused by the catheter 2. Voiding may be more frequent and in smaller amounts than normal at first 3. During the 1st 24hrs. after removal, the nurse should be called to measure each voiding to facilitate assessment 4. Give instructions to continue increased fluid intake - to maintain proper kidney and bladder function  * others recommend daytime removal to give the patient ample time to void during the day when there are more staff on duty for assistance and assessment rksteoxon