Urinary Catheterization

Catheters•A hollow tube for instilling and removing fluid

•general term•many types and uses

Urinary Catheterization

•Intro of cath through urethra into bladder

•aseptic procedure•sterile technique

DANGERS

•INJURY•INFECTION

Role of the nurse

•Use infrequently•Not for convenience of nursing staff

•Advocate early removal

Reasons for Urinary Catheterization

•Sterile specimen•Before surgery•Inability to void•Check residual

Reasons for Urinary Caths (continued)

•Remove urine if greatly distended

•Last resort for incontinence

•Accurate I & O

Reasons for Urinary Caths (even more!)

•Keep sutures clean•Dilate/splint urethra•Drainage / Irrigation•Instillation of meds

Types of Urinary Caths

•Most common are plastic or latex

•Rounded tip•Lubricated with water soluble gel

Catheter Sizes•Measure of diameter•Listed as “FR” which stands for “French”

•Size depends on age and sex

Male patients•Urethra is longer•Potential prostrate obstruction

•Use larger FR if trouble•Reposition foreskin

How to select size:

•Adult : 14 or 16 or 18•Child: 8 or 10•Female: 16•Male: 18 (stiffer to pass thru prostate)

Retention or Indwelling Caths

•Temporary or permanent drainage

•attached to urinary collection bag

•most common – Foley

Foley catheter•Has double lumen•Balloon (at tip) inflated once in place

•prevents slipping out of bladder

•Use sterile water/saline

Foley (continued)•Note the balloon size•if c/o pain when you inflate:

- probably in urethra - deflate & advance

Figure 20-17

Drainage system must be below the level of the bladder.

(From Potter, P.A., Perry, A.G. [2003]. Basic nursing: essentials for practice. [5th ed.]. St. Louis: Mosby.)

Catheter Lumen•Space within a tube•Single (straight cath)

– #1 urine

•Double (Foley cath) - #1 plus #2 balloon

Catheter Lumen•Triple (3 way Foley) - #1 and # 2 plus #3 to add irrigation/med

- often used with CBI. (Continuous Bladder Irrigation)

Bladder irrigation

•May be continuous or intermittent

•If continuous–Will be triple lumen–Use solution ordered

Bladder irrigationIf intermittent:– Use urine lumen – Primarily use sterile NSS - new kit q time

– allow gravity return– Check P & P manual

Why Irrigate a cath?

•To cleanse the lumen•To increase the cath patency

•To break up blood clotting

Straight caths•To drain urine•single lumen•intended to insert, drain, and withdrawal

Other cath types:

•Suprapubic cath - cystocath•Texas cath - condom cath

Figure 20-15

A, Condom catheter. B, Condom catheter attached to leg bag.

(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)

Catheter insertion

•Position patient in dorsal recumbent

•700 - 1000 cc max. removed - prevents shock

Nursing care•Closed, sterile system•prevent pulling•no kinks in tubing•tubing over leg on unaffected side

Nursing care (cont)

•Wash hands•Wear gloves•Never disconnect•Never irrigate without an order

Nursing care (cont)

•Cleanse daily•No dependent loops•Bag below bladder•Measure/record I & O•Check volume frequent

Nursing care (cont)

•Check: - color - consistency - odor - any c/o of pain

Nursing measures to promote voiding

•Provide privacy / relax•Female - sitting •Male - standing•Warm bedpan / urinal•Offer fluids

More nursing measures

•Power of imagery•Place hands in water•Water over Perineal areaOnly when these fail can we obtain cath order!

Potential problems after removal

•Inability to void - give 8-10 hours•Frequency, urgency, burning - s/s of UTI

•Incontinence

Related procedures

•Bladder retraining•Bladder scanning

A woman, calling Mount Sinai Hospital, said, "Hello, I want to know if a patient is getting better."The voice on the other end of the line said, "Do you know the patient's name and room number?"She said, "Yes, darling! She's Sarah Finkel, in Room 302."He said, "Oh, yes. Mrs. Finkel is doing very well. In fact, she's had two full meals, her blood pressure is fine, she's going to be taken off the heart monitor in a couple of hours and if she continues this improvement, Dr. Cohen is going to send her home Tuesday."The woman said, "Thank God! That's wonderful! Oh! That's fantastic! That's wonderful news!"The man on the phone said, "From your enthusiasm, I take it you must be a close family member or a very close friend!"She said, "I'm Sarah Finkel in 302! Cohen, my doctor, doesn't tell me a word!"