Urinary Catheterization Procedure PDF

Urinary Catheterization Dr: Asmaa Mohamed  Objective: At the end of this lecture the student will be able to: Define the urinary catheterization Identify the purpose of urinary catheterization list types of catheter and indication of its one Enumerate the cont...

Urinary Catheterization Dr: Asmaa Mohamed  Objective: At the end of this lecture the student will be able to: Define the urinary catheterization Identify the purpose of urinary catheterization list types of catheter and indication of its one Enumerate the contraindications of urinary catheterization Determine the universal precautions of urinary catheterization. Identify the Equipment of urinary catheterization. Perform the urinary catheterization procedure. Explain the general care for a urinary catheter Determine Complications of urinary catheterization  In urinary catheterization a latex, polyurethane, or silicone tube known as a urinary catheter is inserted into a patient's bladder via the urethra.  Catheterization It may be used to allows the patient's inject liquids used for urine to drain freely treatment or from the bladder for diagnosis of bladder collection. conditions. A clinician, often a but self- nurse, usually performs catheterization is the procedure also possible.  Definition of urinary catheterization Is along, hollow, rubber drainage tube that is inserted into patients bladder. The catheter is used as a conduit to drain urine from the bladder into attached bag or container.. Purpose: 1- To maintain urine out put in pt who are undergoing surgery or who are confined to bed and physically unable to use bed pan 2- In critically ill pts who required strict monitoring of urinary output 3- Pt who are unable to completely empty the bladder during urination 4- Pt who have bladder obstruction Types of catheter 1- Single-lumen )straight( catheter (intermittent) and is immediately removed after obtaining urine. 2- Indwelling catheter (Double or triple –lumen catheters: One lumen provides urine flow out of the bladder, the other is used to inflate balloon around the catheter near the tip the third lumen is used for irrigation. It is called an indwelling or Foley catheter. The catheter will remain in the bladder (permanent). Indwelling catheter  3-External catheters Including condom catheters, are used to treat conditions like urinary incontinence. Condom catheters may cause fewer urinary tract infections than other catheters. Supra pubic catheter Indication of urinary catheter:  Obtain Obtain sterile specimen Indication of straight catheter: Determine Determine amount of residual urine in bladder after voiding Prevent contamination of wound Prevent in perineal area by urine. Allow labour to progress without Allow interfere  Irrigate bladder Measure urinary out put accurately in critically ill patient Keep incontinent or comatose Indication of patient dry folly catheter Gradually compression of overly distended bladder To empty bladder before ,during ,after surgery near bladder Contraindication Urethral trauma of urinary Urethral tear catheter Scrotal hematoma Pelvic fracture  If you shower with catheter in place avoid extremely hot or cold water. Use soap and water to wash around catheter twice per day General care of urinary Drink plenty of fluid to keep your urine flowing 6to8 glasses per day catheter: Avoid become constipated or straining by eating food high in fiber and fluid Avoid sexual intercourse  Complication: Urethral trauma Infection Bleeding after 48 Renal inflammation hrs of and pyelonephritis catheterization  Practical part Insertion of urinary catheter (male –female) Care and removal of catheter Urinary catheter Irrigation  Equipment (Insertion of urinary catheter): 1. Catheter kit containing the following sterile items:  Catheter of correct size and type.  Drapes (one fenestrated—has an opening in the center)  Sterile gloves  Lubricant Antiseptic cleaning solution such as chlorhexidine or povidone iodine incorporated in an applicator or to be added to cotton balls (forceps to pick up cotton balls)  Con,,,,  Specimen container  Prefilled syringe with sterile water for balloon inflation of an indwelling catheter  Sterile drainage tubing and collection bag (Some kits come preconnected; others do not, and a separate package is required).  Con,,, 2. Sterile drainage tubing and bag (if not included in the kit) 3. Device to secure catheter (i.e., strap) 4. Extra sterile gloves and catheter (optional) 5. Bath blanket 6. Waterproof absorbent pad 7. Clean gloves; basin with warm water, soap washcloth; and towel for perineal care 8. Additional lighting as needed 9. Measuring container for urine Tip points during procedure: Male Female position position supine with legs -Dorsal recumbent position extended and thighs (on back with knees flexed) slightly abducted - sims, position (side-lying position with upper leg flexed at knee and hip. Lubricate catheter tip 5-7 inches 1-2 inches Insertion of catheter 7-9 inches 2-3 inches Cleanse urethral using circular strokes clitoris toward anus( top to meatus bottom) Secure catheter tubing upper thigh or lower inner thigh abdomen Alternate female position: Position patient in side-lying (Sims’) Routine Urinary Catheter Care and Removal Delegation Considerations to nursing assistive personnel (NAP). The nurse instructs NAP to:  Report characteristics of the urine output from the catheter, including (color, odor, and amount).  Report the condition of the patient‘s perineum (color, discharge, contamination from fecal incontinence).  Check the size of the balloon and the size of the syringe needed to deflate the balloon, and to report if balloon does not deflate and/ or if there is bleeding or excessive burning. Unexpected Outcomes of Catheterization: 1. Catheter goes into vagina 1-Leave catheter in vagina. 2- Clean urinary meatus again. 3- Using another catheter kit, reinsert sterile catheter into meatus 4- Remove catheter in vagina once functional catheter is inserted. 2.Sterility is broken during catheterization by nurse or patient.  Replace gloves if contaminated and start over.  If patient touches sterile field but equipment and supplies remain sterile, avoid touching that part of sterile field. If equipment and/ or supplies become contaminated, replace with sterile items or start over with new sterile kit  3. Patient complains of bladder discomfort, and catheter is patent as evidenced by adequate urine flow.  Check catheter to ensure that there is no traction on it.  Notify health care provider. Patient may be experiencing bladder spasms or symptoms of UTI.  Monitor catheter output for color, clarity, odor, and amount. 4.Urethral or perineal irritation is present.  Observe for leaking from around catheter; catheter may need replacement. Make sure catheter (if not removed) is anchored and secured appropriately. 5. Patient has fever and/or urine is malodorous; patient has small, frequent voiding, or bleeding or burning occurs with urination after catheter is removed.  Monitor vital signs and urine. Report findings to prescriber, because any of these symptoms/signs indicates a UTI. 6. Patient is unable to void after catheter removal or voids in small, frequent amounts.  Assess for bladder distention.  Assist to a normal position for voiding.  Provide privacy.  Perform bladder ultrasonography to assess for residual urine. Notify prescriber if residual volume is greater than 150 mL. Catheterization may be indicated. If patient is unable to void within 6 to 8 hours of catheter removal, notify prescriber. Urinary Catheter Irrigation Urinary Catheter Irrigation Bladder irrigation is a procedure used to clear the bladder and urinary catheter of mucus and debris. People who use urinary catheters may collect mucus, stone, or bacteria in their bladder. This buildup can result in bladder infections and bladder stones Indications of Urinary Catheter Irrigation  Maintain patency of urinary catheter To clean bladder from excess mucus, stone crystals, or bacteria  To prevent or remove blood clots after surgery in the urinary system Administer medication to the bladder. Dissolve bladder stones. Soothe an irritated, infected or inflamed bladder lining. Delegation Considerations: The skill of catheter irrigation can be delegated to nursing assistive personnel NAP: The nurse directs the NAP to: Pre & post catheter irrigation Report if the patient complains of pain, discomfort, or leakage of fluid around the catheter. Monitor and record intake and output (I&O); report immediately any decrease in urine output. Report any change in the color of the urine, especially the presence of blood clots.  Catheter irrigation types 1- Closed Continuous Irrigation 2- Closed Intermittent Irrigation Catheter irrigation types Open Intermittent Irrigation  Equipment  Sterile irrigation solution at room temperature (as prescribed)  Antiseptic swabs  Clean gloves Closed Intermittent Irrigation  Sterile container  Sterile 30- to 60-mL irrigation syringe (piston type)  Syringe to access system (Luer-Lok syringe without needle for needleless access port per manufacturer‘s directions)  Screw clamp or rubber band (used to temporarily occlude catheter while irrigant is instilled) Closed Continuous Irrigation  Irrigation tubing with clamp to regulate irrigation flow rate  Y connector (optional) to connect irrigation tubing to double- lumen catheter  Intravenous (IV) pole (closed continuous or intermittent) Open Intermittent Irrigation  Disposable sterile irrigation kit that contains solution container, collection basin, drape, sterile gloves, 30- to 60-mL irrigation syringe(piston type)  Sterile catheter plug  Sterile gloves (optional)  Urinary Catheter Irrigation Procedure Pre Procedure 1. Provide for privacy and explain procedure to client. 2. Assess for pain and bladder fullness 3. Perform hand hygiene. 4. Raise bed to appropriate working height. Lower side rail on working side. 5. Verify in medical record: a. Order for irrigation method (continuous or intermittent), type (sterile saline or medicated solution), and amount of irrigant. 6- Observe urine for color, amount, clarity, and presence of mucus, clots, or sediment. 7- Monitor Intake &Output. If continuous bladder irrigation used, amount of fluid draining from bladder should exceed amount of fluid infused into bladder.  Closed continuous irrigation: 1- Close clamp on new irrigation tubing, and hang bag of irrigating solution on IV pole 2. Insert tip of sterile irrigation tubing into designated port of irrigation solution bag using aseptic technique. 3.open clamp and allow solution to flow (prime) through tubing. 4- Once fluid has completely filled tubing, close clamp and recap end of tubing. 5-Using aseptic technique, connect tubing securely to drainage port of Y connector on double/ triple-lumen catheter. 6- Adjust clamp on irrigation tubing to begin flow of solution into bladder 7- If urine is bright red or has clots, increase irrigation rate until drainage appears pink (according to ordered rate or agency protocol). 8- Observe for outflow of fluid into drainage bag 9- Empty catheter drainage bag as needed  Closed intermittent irrigation: 1- Pour prescribed sterile irrigating solution in sterile container.. 2. Draw prescribed volume of irrigant (usually 30 to 50 mL) into syringe. Place sterile cap on tip of needleless syringe 3- Clamp catheter tubing below soft injection port with screw clamp 4- Using circular motion, clean catheter port (specimen port) with antiseptic swab. 5-Insert tip of needleless syringe using twisting motion into port. 6-Inject solution using slow, even pressure. 7- Remove syringe and remove clamp (or rubber band), allowing solution to drain into urinary drainage bag. NOTE : Some medicated irrigants (solution) may need to dwell in bladder for prescribed period, requiring catheter to be clamped temporarily before being allowed to drain  Post Procedure 11. Help patient to safe and comfortable position. Lower bed and place side rails accordingly. 12. Inspect urine for blood clots and sediment, and ensure that tubing is not kinked or occluded. 13. Remove gloves, dispose of equipment, and wash hands. 14. Help client adjust position. 15. Observe time the patient urinates, and measure the urine; assess urine characteristics. 6- Evaluate and document the patient for dysuria; small, frequent voiding or bleeding during urination  Record irrigation method, amount and type of irrigation solution, characteristics of output, urine output, and patient tolerance to procedure in nurses’ notes.  Report catheter occlusion, sudden bleeding, infection, or increased pain to health care provider.  Record I &O on appropriate flow sheet.  Unexpected Outcomes of urinary catheter irrigation: 1. Irrigating solution does not return (intermittent irrigation) or is not flowing at prescribed rate (CBI).  Examine tubing for clots, sediment, and kinks. Notify health care provider if irrigant does not flow freely from the bladder, patient complains of pain, or bladder distention occurs.  2. Drainage output is less than amount of irrigation solution infused.  Examine drainage tubing for clots, sediment, or kinks.  Inspect urine for presence of or increase in blood clots and sediment.  Evaluate patient for pain and distended bladder. Notify health care provider. 3. Bright-red bleeding with the irrigation (CBI) infusion wide open.  Assess for hypovolemic shock (vital signs, skin color and moisture, anxiety level). Leave irrigation infusion wide open and notify health care provider.  4. Patient experiences pain with irrigation.  Examine drainage tubing for clots, sediment, or kinks.  Evaluate urine for presence of or increase in blood clots and sediment.  Evaluate for distended bladder. Notify health care provider. 5. Signs of possible infection: fever; cloudy, foul- smelling urine; abdominal pain; change in mental status.  Notify health care provider. Monitor vital signs and character of urine.