Urinary Catheterization Click on highlighted Click on highlighted

underlined words to get to underlined words to get to informative links !informative links !

Updated Spring 2010Updated Spring 2010

Recommended video:Recommended video:“Assessing Urinary Care”“Assessing Urinary Care”

Available on Blackboard:Available on Blackboard:Professor Hidle’s skills video on Professor Hidle’s skills video on

Foley Catheter insertionFoley Catheter insertion

Intermittent/straight Intermittent/straight cathetervs

Indwelling Foley catheter

Indications/PurposeIndications/Purpose To relieve discomfort due to bladder distention To relieve discomfort due to bladder distention

(decompression)(decompression) To assess residual urine from incomplete bladder To assess residual urine from incomplete bladder

emptying (emptying (retention)) To obtain a urine specimenTo obtain a urine specimen To empty the bladder completely prior to surgery To empty the bladder completely prior to surgery

((Maintained up to 12 hours in C/S.).) For accurate urine output (hourly) For accurate urine output (hourly) To provide for intermittent or continuous bladder To provide for intermittent or continuous bladder

drainage and irrigationdrainage and irrigation To prevent urine from contacting an incision after To prevent urine from contacting an incision after

perineal surgeryperineal surgery To manage incontinence when other measures To manage incontinence when other measures

have failed (i.e. neurogenic bladder)have failed (i.e. neurogenic bladder)

Contraindication: Signs of Contraindication: Signs of Urethral traumaUrethral trauma

If trauma, perform If trauma, perform genital and rectal exam genital and rectal exam first first

Blood at meatus Blood at meatus Scrotal hematoma Scrotal hematoma Prostate problems

Diagnostic TestsDiagnostic Tests Post-void residualPost-void residual Urine CultureUrine Culture Cystoscopy and Cystoscopy and

Ureteroscopy Ureteroscopy Intravenous PylogramIntravenous Pylogram

Interpretation of Interpretation of Post-Void ResidualPost-Void Residual

PVR < 50ccPVR < 50cc - Adequate bladder - Adequate bladder emptying emptying

PVR > 150ccPVR > 150cc - Avoid bladder - Avoid bladder relaxing drugs relaxing drugs

PVR > 200ccPVR > 200cc - Outlet obstruction - Outlet obstruction likely likely

PVR > 400ccPVR > 400cc - Overflow UTI likely- Overflow UTI likely

Types of CathetersTypes of CathetersThe first catheter from the top is called a Foley catheter or retention or indwelling catheter (continuous). Foley catheters have an inflatable bulb at the end that can be filled with H2O (~5-10 ml) to retain the tip of the catheter within the bladder. A suprapubic catheter is basically an indwelling catheter that is placed directly into the bladder through the abdomen.

The bottom catheter is a intermittent or straight catheter, usually red rubber.

Suprapubic cathetersSuprapubic catheters Indwelling catheter that is placed directly into the Indwelling catheter that is placed directly into the

bladder through the abdomen (above the pubic bladder through the abdomen (above the pubic bone)bone)

Placed by a urologistPlaced by a urologist Changed by qualified medical personnelChanged by qualified medical personnel May be recommended in people who require long May be recommended in people who require long

term catheterization, after some gynecological term catheterization, after some gynecological surgeries, and in people with urethral injury or surgeries, and in people with urethral injury or obstructionobstruction

Possible complications are similar to cathetersPossible complications are similar to catheters

Catheter careCatheter care With initial catheterization of a distended bladder, With initial catheterization of a distended bladder,

never allow more than 750cc to drain at one timenever allow more than 750cc to drain at one time. . Clamp for 20-30 minutes and continue drainage Clamp for 20-30 minutes and continue drainage (prevents patient from going into simulated (prevents patient from going into simulated hypovolemic shock).hypovolemic shock).

Catheter tubing should be over the patient's leg, not Catheter tubing should be over the patient's leg, not under.under.

Catheter Catheter must alwaysmust always be stabilized by taping or using be stabilized by taping or using company prepared velcro leg straps to attach to leg. company prepared velcro leg straps to attach to leg. In male may also be attached to abdomen In male may also be attached to abdomen

FOR MALE, REMBEMBER TO CONSIDER POSSIBLE FOR MALE, REMBEMBER TO CONSIDER POSSIBLE REFLEX ERECTION THAT MAY PULL ON CATHETER – REFLEX ERECTION THAT MAY PULL ON CATHETER – LEAVE ADDITIONAL LENGTH BEFORE TAPING. LEAVE ADDITIONAL LENGTH BEFORE TAPING.

Change catheter according to Change catheter according to hospital policy or specific MD/NP hospital policy or specific MD/NP orders (i.e each week)orders (i.e each week)

The catheter may need immediate The catheter may need immediate removal &/or replacement if it is removal &/or replacement if it is obstructed/clogged, painful or obstructed/clogged, painful or infected (some facilities teach infected (some facilities teach intermittent bladder irrigation which intermittent bladder irrigation which requires an MD order) or continuous requires an MD order) or continuous bladder irrigation may be ordered.bladder irrigation may be ordered.

Routine care of the indwelling catheter Routine care of the indwelling catheter must include daily cleansing of the must include daily cleansing of the urethral area and the catheter itself urethral area and the catheter itself with with soap and water soap and water (some hospital (some hospital policies may vary in agent used)policies may vary in agent used)

The area should also be thoroughly The area should also be thoroughly cleansed after all bowel movements to cleansed after all bowel movements to prevent infectionprevent infection

Antimicrobial ointments are no longer Antimicrobial ointments are no longer usedused

Catheter MaterialsCatheter Materials

LatexLatex: : Long-term catheterization Long-term catheterization Silastic or TeflonSilastic or Teflon: Short-term : Short-term

catheterization or Latex Allergy catheterization or Latex Allergy Minocycline and RifampinMinocycline and Rifampin

impregnated catheters may reduce impregnated catheters may reduce bacteriuria for up to 2 weeksbacteriuria for up to 2 weeks

Catheter sizeCatheter size

Use the narrowest, softest Urinary Use the narrowest, softest Urinary catheters are sized using French (F) units. catheters are sized using French (F) units. The French number divided by 3 is the The French number divided by 3 is the outer diameter of the catheter in outer diameter of the catheter in millimeters. millimeters.

RangesRanges: : – InfantInfant: 8F: 8F– Child/adolescentChild/adolescent: 10-12: 10-12– Adult and large adolescentAdult and large adolescent: 14-18F : 14-18F

(female/male)(female/male) Most common: Most common: 14F to 16F14F to 16F used in large, older used in large, older

adolescents and adultsadolescents and adults

In some cases a larger catheter may In some cases a larger catheter may be required to control leakage of be required to control leakage of urine around the catheter of if the urine around the catheter of if the urine is thick and bloody or contains urine is thick and bloody or contains large amounts of sediment.large amounts of sediment.

Balloon size:Balloon size: 5 – 10 ml balloon 5 – 10 ml balloon usually with fluid to inflate (15-30cc usually with fluid to inflate (15-30cc balloons may be used in patients balloons may be used in patients with prostate surgery)with prostate surgery)

The urethra is about The urethra is about 1.5 inches long in the female1.5 inches long in the female and and 8 inches long in the male8 inches long in the male so the catheter so the catheter must be placed beyond this point to ensure entry must be placed beyond this point to ensure entry into the bladder. into the bladder.

In female, gently insert lubricated catheter into In female, gently insert lubricated catheter into urethra until urine begins to flow. Then another 2-urethra until urine begins to flow. Then another 2-3 inches. 3 inches.

In the male patient, advance almost to the In the male patient, advance almost to the catheter’s bifurcation. catheter’s bifurcation.

Most recent literature suggests that advancing Most recent literature suggests that advancing until the bifurcation should be done in both male until the bifurcation should be done in both male and female to ensure entry into the bladder and female to ensure entry into the bladder before balloon is inflated.before balloon is inflated.

Indwelling cathetersIndwelling catheters Long term (indwelling, Long term (indwelling,

continuous) urethral catheters, continuous) urethral catheters, is frequently left in place for a is frequently left in place for a period of time.period of time.

The tube is attached to a gravity The tube is attached to a gravity drainage bag to collect the drainage bag to collect the urine.urine.

The drainage bag may be either The drainage bag may be either a a leg bagleg bag, which is a smaller , which is a smaller drainage device that attached by drainage device that attached by elastic bands to the leg. elastic bands to the leg. Intended for use in males, this is Intended for use in males, this is used during the day since it fits used during the day since it fits under clothes. under clothes.

A larger gravity collection bag A larger gravity collection bag ((down draindown drain) may be used during ) may be used during the night or in females or the night or in females or bedridden patients and is hung bedridden patients and is hung at the bedside, below bladder at the bedside, below bladder but off floor. but off floor.

Stabilizing catheterStabilizing catheter

To abdomen in male

To leg in female or male

Foley Catheter (Foley Catheter (indwellingindwelling))

Straight CatheterStraight Catheter

Courtesy of http://www.vetmed.wsu.edu/courses_samDX/urinary.htm

The rounded tip of this intermittent catheter reduces urethral trauma as the catheter is passed. Urine enters the lumen of the catheter through two "eye" holes.

Other CathetersOther Catheters

Coude

is a intermittent catheter with a tapered

curved tip that is designed to be easier to

insert when enlargement of the

prostate is suspected.

Mushroom (Pezzer)The mushroom-shaped tip this continuous catheter secures it in the patient's bladder after

percutaneous placement. It may be sutured to your patient's

abdomen or flank, or you may need to tape it in place.

Other Urinary EquipmentOther Urinary Equipment

Catheter Clamp

Three-way Foley for

Continuous Bladder Irrigation

Continuous

Bladder

Irrigation

Home CareHome Care Clean technique is used by patient.Clean technique is used by patient. Drainage bags may be cleaned Drainage bags may be cleaned

periodically (especially for “periodically (especially for “clean clean cathetercatheter”): ”):

Use 2 parts of vinegar and 3 Use 2 parts of vinegar and 3 parts of water to cleanse the parts of water to cleanse the drainage bag. Chlorine bleach drainage bag. Chlorine bleach can be substituted for the can be substituted for the vinegar and water mixture. vinegar and water mixture.

Let the solution soak for 20 Let the solution soak for 20 minutes and hang to dryminutes and hang to dry

Straight catheter care (“Straight catheter care (“Clean Clean techniquetechnique”):”):

Catheter is transported in anti-Catheter is transported in anti-bacterial solution, i.e. zephrine bacterial solution, i.e. zephrine (clear) or betadine. (clear) or betadine.

Heavy red rubber tubing Heavy red rubber tubing (Robinson) should be boiled daily (Robinson) should be boiled daily to disinfect, or soaked in vinegar to disinfect, or soaked in vinegar and water or chlorine bleach as and water or chlorine bleach as above. above.

Discontinuing an indwellingDiscontinuing an indwelling(will demonstrate)(will demonstrate)

First, place a chux under the tubing and tuck under patient hips. First, place a chux under the tubing and tuck under patient hips. Deflate the balloon on the end of the catheter (usually 5-10cc Deflate the balloon on the end of the catheter (usually 5-10cc

which can be determined from catheter connection tip).which can be determined from catheter connection tip). (Not doing so can injure the bladder and urethra.) (Not doing so can injure the bladder and urethra.)

To deflate balloon:To deflate balloon:– Attach a 10cc syringe without a needle to the unattached end Attach a 10cc syringe without a needle to the unattached end

of the tubing's Y-shaped portion (inflating port).of the tubing's Y-shaped portion (inflating port).– Push the syringe tip firmly into the outlet. Push the syringe tip firmly into the outlet. – Gently pull back on the plunger. The water in the balloon will Gently pull back on the plunger. The water in the balloon will

flow into the syringe, deflating the balloon.flow into the syringe, deflating the balloon.– DO NOT DEFLATE THE BALLOON BY CUTTING THE CATHETER DO NOT DEFLATE THE BALLOON BY CUTTING THE CATHETER

TIP ABOVE THE INFLATION PORT UNLESS FLUID CANNOT BE TIP ABOVE THE INFLATION PORT UNLESS FLUID CANNOT BE REMOVED WITH SYRINGEREMOVED WITH SYRINGE !! This may result in water left in This may result in water left in balloon which when removed will cause injury to bladder or balloon which when removed will cause injury to bladder or urethra.urethra.

Be sure that tubing is not adhering to patients Be sure that tubing is not adhering to patients pubic hair.pubic hair.

Tell the patient to take deep breaths and steadily Tell the patient to take deep breaths and steadily withdraw the catheter onto the chux (expect withdraw the catheter onto the chux (expect leaking). leaking).

Wrap catheter in chux to discard, measure Wrap catheter in chux to discard, measure amount of urine in drainage bag and discard. amount of urine in drainage bag and discard. Position client for comfort until you return to Position client for comfort until you return to assist with pericare. assist with pericare.

Chart time of discontinuation of Foley, amount on Chart time of discontinuation of Foley, amount on I&O flow sheet and color and consistency (i.e. I&O flow sheet and color and consistency (i.e. blood, mucus, etc.) along with time in nurses blood, mucus, etc.) along with time in nurses note.note.

External Urinary DeviceExternal Urinary Device

Condom or Texas CatheterCondom or Texas Catheter is an external urinary is an external urinary incontinence device worn incontinence device worn collect urine and protect the collect urine and protect the skin from the constant leakage.skin from the constant leakage.

Female external Urinary Female external Urinary Collection systemCollection system is an odor-is an odor-barrier plastic pouch that barrier plastic pouch that funnels urine into a collection funnels urine into a collection bag and utilizes a comfortable bag and utilizes a comfortable hydrocolloid skin barrier that hydrocolloid skin barrier that protects the skin from protects the skin from irritation. irritation. ((In infants/young children; In infants/young children; referred to as urine collection referred to as urine collection bagbag))

Complications of long-term Complications of long-term catheterizationcatheterization

Last resort r/t possibility of complications:Last resort r/t possibility of complications:

UTI, septicemia, urethral injury, skin breakdown, UTI, septicemia, urethral injury, skin breakdown, bladder stones and hematuriabladder stones and hematuria

BacteriuriaBacteriuria Chronic renal inflammation Chronic renal inflammation Pyelonephritis Pyelonephritis Nephrolithiasis Nephrolithiasis Cystolithiasis Cystolithiasis Bladder cancer may also develop after many Bladder cancer may also develop after many

years of catheter useyears of catheter use

Nursing Implications: Nursing Implications: Monitor for ComplicationsMonitor for Complications

Foul smelling urine Foul smelling urine Thick, cloudy urine with or without Thick, cloudy urine with or without

sediment sediment Painful urination (dysuria)Painful urination (dysuria) Fever, chillsFever, chills Urethral swelling around the catheterUrethral swelling around the catheter Bleeding into or around the catheterBleeding into or around the catheter Catheter draining little or no urine despite Catheter draining little or no urine despite

adequate fluid intakeadequate fluid intake Leakage of large amounts of urine around Leakage of large amounts of urine around

the catheterthe catheter

Troubleshooting a leaking catheter Troubleshooting a leaking catheter

May be caused by incorrect size of catheter (too May be caused by incorrect size of catheter (too small), improper balloon size, or bladder spasmssmall), improper balloon size, or bladder spasms

If bladder spasms occur, check that the catheter If bladder spasms occur, check that the catheter is draining properly. If no urine is detected in the is draining properly. If no urine is detected in the drainage bag, the catheter may be obstructed by drainage bag, the catheter may be obstructed by blood or thick sediment, or kinking of the catheter blood or thick sediment, or kinking of the catheter or drainage tube.or drainage tube.

Irrigation or the catheter may be indicatedIrrigation or the catheter may be indicated Other caused of urine leakage around the Other caused of urine leakage around the

catheter include constipation or impaction of catheter include constipation or impaction of stool, or UTIstool, or UTI

THE END!THE END!