URINARY ELIMINATION & CATHETERS

Objectives

Demonstrate correct technique for inserting indwelling and straight catheters

Recognizes signs and symptoms of infection related to urinary catheters

Demonstrate aseptic routine care of a patient with an indwelling catheter

Demonstrate correct technique for removing an indwelling catheter.

Demonstrate correct procedure for application of condom catheter

Document and report to RN care related to urinary drainage

Urinary Elimination System

Anatomy

Kidney - Urine p ro duc tio n

Ureters - Tube s which c o nne c t the kidne y s to the bla dd e r.

Bladder - Re s e rvo ir fo r urine until the urg e to vo id ta ke s p la c e .

Urethra - Tube fro m the bla dd e r to the o uts id e o f the bo d y in no rm a l a na to m y . Male = 20 cm long

Female = 4 cm long

Anatomy Facts

A continuous layer of mucous membrane lines the kidney pelvis, ureters, urethra & bladder

Because there is no break in this lining, bacteria introduced into this normally sterile environment can quickly spread throughout the entire system

When the bladder is empty it falls into folds which provide pockets where bacteria can multiply

Because this membrane layer is highly vascular, bacteria can easily enter the blood stream & cause septicemia

Catheterization - Reasons

Collect a sterile specimen Check residual urine Inability to void related to post-op complications Before, during or after surgery to empty bladder Temporary/Permanent Incontinence: a. Total- c o ntinuo us lo s s o f urine fro m bla dd e r b. Stress- le a ka g e o f s m a ll a m o unts o f urine with p hys ic a l s tre s s i. e . c o ug hing o r s ne e z ing

Catheterization - Reasons

Urge - Invo lunta ry p a s s a g e o f urine a fte r fe e ling s tro ng ne e d to vo id . Una ble to s to p urina ting a nd c a n’ t g e t to ba thro o m o n tim e . Se e n in the e ld e rly , with UTIs a nd tum o rs .

Functional - Invo lunta ry , unp re d ic ta ble p a s s a g e o f urine re la te d to no c a ll lig ht o r im m o bility , e tc .

Alternative to Catheterization

Bladder Scan Estimates residual urine Increased use over straight catheterization 90% accuracy Decreases risk of infection and discomfort to patient

PRIOR to Catheterization

Know and ConfirmKnow and Confirm Doctor’s order Last void Patient’s level of consciousness and understanding Mobility, physical limitations, ability to cooperate Sex, age, catheter size

Kids 6-10 Female 14-16 Male 16-18)

Allergies to antiseptics, tape, rubber, latex Adverse conditions Impaired passage such as enlarge prostate

Catheter Types - Condom

Condom Catheter Condom Catheter (External, Texas, Urinary Sheath)

Incontinent men Soft rubber, latex, silicone Slides over Penis Tubing connects to tip of condom and flows into

collection bag.

Catheter Types - Condom

Remove for thirty minutes each day, clean and dry penis, re-apply new catheter. Elastic tape may be used to secure catheter in

place. This tape will expand when the penis changes size.

Never use adhesive tape- cuts off blood flow which causes injury.

Straight CatheterStraight Catheter Removes urine from bladder aseptically due to 1. Incontinence 2. Post void residuals 3. Sterile specimen Do e s no t a tta ch to a c o lle c tio n ba g Co ns id e re d a s te rile p ro c e dure

Catheter Types - Straight

Catheter Types - Indwelling

Indwelling Catheter (Foley)Indwelling Catheter (Foley) To remove urine aseptically Sterile procedure Has urinary collection bag May be used for extended periods of time

SuprapubicSuprapubic Catheter inserted into the bladder through an

opening in the lower abdomen (a bo ut 1 inch a bo ve the s ym p hys is p ubis )

Placed under anesthesia May be left in place for long periods of time Sutured into place.

Catheter Types - Suprapubic

Rules for Catheterization

1. Wash hands, use gloves2. Tubing without kinks/obstructions3. Drainage bag below bladder4. Attach to non-movable bed part5. Secure with leg strap6. Check system for leaks7. Perform perineal care BID, after all BMs &with cath care8. Watch I&O closely9. Report complaints of discomfort to nurse (pain, burning,

irritation) 10. Record amount, color, clarity, odor, particles

Insertion/Application - Condom

Condom Catheter Clean gloves to remove old catheter Wash and dry penis Apply skin prep to penis shaft Remove protective backing from condom

exposing adhesive strip

Insertion/Application - Condom

Hold penis firmly. Roll condom onto penis leaving 1inch space between penis and end of catheter.

Secure condom with elastic strip in spiral manner not completely on penis Connect condom to drainage bag Check penis for redness and excoriation

Have patient relax by taking slow deep breaths Lubricate catheter well To find female meatus

Look for the wink Betadine pools in the meatus Ask patient to bear down as if to void

If catheter enters the vagina, leave it

Insertion Tips – Straight/Foley

Insertion of Indwelling Catheter

If indwelling catheter, GENTLY tug on catheter until resistance is met to insure placement in bladder

Do peri care and apply leg band to secure catheter to patient’s leg

Remove gloves and discard supplies properly

Other Considerations

When performing straight cath Know policy & procedure for maximum amount

of urine allowed to be withdrawn.To place catheter in an uncircumcised man Carefully pull back foreskin before cleansing

Documentation

DocumentDocument Type of procedure Size of catheter and balloon Amount of fluid actually instilled into balloon Amount of urine returned Characteristics of urine (color, odor, sediment) Specimen sent if applicable How patient tolerated procedure

Problems During Insertion

Catheter inserted into VaginaCatheter inserted into Vagina 1. Leave in place 2. Reposition fingers to re-visualize meatus 3. Use new catheter 4. Repeat procedure

Problems During Insertion

Unable to insert into femaleUnable to insert into female 1. Ask patient or other team member to hold legs

apart 2. Observe urethral opening (before cleansing) for

movement when pressure is applied 3. Improve lighting 4. Repeat insertion procedure

Unable to insert catheter into maleUnable to insert catheter into male 1. Notify nurse 2. Repeat procedure but change the angle of the

penis 3. Try an a coude catheter

Problems During Insertion

Problems During Insertion

Catheter comes out with balloon inflatedCatheter comes out with balloon inflated 1. Check with nurse 2. Check for urethral trauma (pain, bleeding) 3. Monitor urine output for bleeding 4. Obtain new catheter kit & reinsert with 10 ml balloon per nurse’s instruction

Care of Patient with a Catheter

1. Keep catheter bag below level of bladder2. Attach drainage bag to bed frame (not side rails)3. Secure tubing onto bed – urine should flow freely

from catheter to bag (coil tubing on bed) 4. Empty catheter bag every 8 hours or prn5. Provide catheter care & pericare as needed6. Do not allow the drain on the bag to touch any

surface7. Keep drainage bag off the floor

Catheter Removal

1. Physician’s order2. Gather supplies- 10cc syringe, gloves, chux3. Deflate balloon- note amount withdrawn4. Avoid pubic hair5. Pinch catheter; pull out on exhalation steadily &

gently6. Measure output7. Discard catheter bag properly8. Provide peri care9. Monitor patient for output10. If not voided in 4-6 hours, notify nurse

Following Catheter Removal

1. Patient to void within 4-6 hours2. Urine amount 120-240 ml (or per policy)3. Observe bladder for distention4. Monitor patient for any complaints of painful

urination5. Monitor patient for hematuria

Catheter Removal DocumentationDocument :

Size of catheter removed Size and amount of fluid in balloon Patient tolerance Output in catheter bag Description of urine Peri care Time of removal

Voiding Following Catheter RemovalHints to assist patient to void after catheter Hints to assist patient to void after catheter

removalremoval Encourage oral fluids Proper position to urinate Sound of running water Sitz bath

Catheter Specimen - Syringe

Urinary Diversions

DefinitionDefinitionRemoval of bladder (cancer, bladder injuries) and making a new pathway for urine to exit the body.Two Ca te g o rie s

1. Continent2. Noncontinent (incontinent)

Continent Urinary Diversions

Surgery creates an internal pouch where urine is stored (Kock or Indiana Pouch) Do not need to wear an appliance Taught to insert catheter into the stoma several times a day to drain the urine

Noncontinent Urinary Diversions

Patient cannot control urine Must wear an external urinary ostomy pouch

Types of non-continent urinary diversionsTypes of non-continent urinary diversions 1. Ureterostomy

Ureterostomy

UreterostomyThe s urg ic a l c re a tio n o f a n a rtific ia l o p e ning be twe e n the ure te r a nd the a bd o m e n.

Both ureters may be brought through the skin onto the abdomen Drains urine

Ileal Conduit

A small section of the ileum is resected from the intestine One end is sutured closed Ureters are implanted in the other endOpen end of the ileum becomes the stomaDrains urine

Ureterostomies