Download presentation
Presentation is loading. Please wait.
1
Principles of Catheterisation
November 2004 Richard Lake
2
Indications for catheterisation
Procedure, complications and contraindications for: Female Male Intermittent self catheterisation Suprapubic November 2004 Richard Lake
3
Catheterisation Is it a new procedure?
3000BC river reeds and onion stems were used to drain the bladder Gold, tin, lead and silver tubes were then developed and used 1920’s first vulcanised rubber tubes were produced November 2004 Richard Lake
4
1934 – Fredrick Foley developed first self retaining catheter
This had separate channels for draining the bladder and a self retaining balloon Foley style catheters are the design in use today for indwelling bladder drainage Difference between 1934 and modern catheters are the materials their made from November 2004 Richard Lake
5
Important prior knowledge
Anatomy and physiology of urinary system Rationale for procedure Necessary equipment Competence in performing skill November 2004 Richard Lake
6
Anatomy November 2004 Richard Lake
7
November 2004 Richard Lake
8
November 2004 Richard Lake
9
Indications for catheterisation
Bladder drainage Acute urinary retention Residual volume bladder drainage Bladder irrigation following surgery Urodynamic flow rate studies Accurate fluid balance Instillation of drugs November 2004 Richard Lake
10
Indications for catheterisation summarised
Prophylaxis Diagnosis Therapy November 2004 Richard Lake
11
Equipment required Sterile catheterisation pack containing gallipots, receiver, swabs, disposable towel Disposable under pad for patient Sterile gloves and disposable plastic apron Appropriate catheter Sterile anaesthetic lubricating jelly Water for injections to inflate catheter ballon Universal specimen container Antiseptic solution Drainage bag and stand November 2004 Richard Lake
12
Catheter types short term
Catheter material Duration Comments PVC 14 days Rigid, painful Latex Can cause discomfort and tissue trauma due to high surface friction Teflon-coated latex 28 days Smoother, resistance to encrustations November 2004 Richard Lake
13
Catheter types longer term
Catheter material Duration Comments Silicone elastomer-coated latex 12 weeks Resistance to bacterial adherence Silicone Smooth, resistance to encrustations, non-inflammatory Hydrogel-coated latex Resistance to bacterial adherence, improved patient comfort, non-inflammatory November 2004 Richard Lake
14
Catheter sizes Catheters are available in both different sizes and lengths Variation in length is due to the difference in length of the male and female urethra Male catheters are cm in length Female catheters are cm in length The size is the measure of the internal lumen of the catheter and is measured in Charriere (Ch) November 2004 Richard Lake
15
Fe-male catheterisation
The procedure will be covered in more detail in the small group work Remember to use the smallest size catheter possible for the purpose it is needed for If anaesthetic gel is used this should be placed into the urethra 5 minutes prior to catheterisation Two pairs of sterile gloves should be used to avoid cross contamination when cleansing and instilling gel. The outer pair is removed after cleansing and prior to catheter insertion November 2004 Richard Lake
16
If the catheter is accidentally inserted into the vagina, leave it in place to prevent it happening again Use a new catheter Once this is successfully in place remove the first catheter from the vagina November 2004 Richard Lake
17
Procedure (female) Explain the procedure to the patient and gain informed consent Take the pre prepared trolley to the bedside and place on left or right depending on nurses dominant hand Raise the bed to an appropriate height and ensure a good light source Expose the genital area with consideration for patient dignity and place a disposable pad beneath the patient Wash and dry hands November 2004 Richard Lake
18
Pour an appropriate cleanser into the galipot
Ensure asepsis is maintained and open packs and equipment onto the trolley Open the catheter but do not remove it from the internal wrapper and place it in the sterile receiver on the trolley Pour an appropriate cleanser into the galipot Open the catheter bag and arrange it on the side of the bed, ensuring the attachment tip is accessible and remains sterile Squeeze small amount of lubricant or anaesthetic gel onto a gauze swab Draw up the amount of sterile water to inflate the balloon Wash hands again and put on two pairs of sterile gloves November 2004 Richard Lake
19
Place the sterile dressing towel between the patients legs and over the patients thighs
Using a gauze swab and the non dominant hand retract the labia minora to expose the urethral meatus. This hand is used to maintain labial separation until procedure is completed Clean the perineal area using a new gauze swab for each stroke cleansing from the front towards the anus Place the receiver holding the catheter on the sterile towel between the patients legs November 2004 Richard Lake
20
Lubricate the catheter tip with anaesthetic or lubricating gel
Expose the tip of the catheter by pulling off the top of the wrapper at the serrated edge Lubricate the catheter tip with anaesthetic or lubricating gel Hold the catheter so the distal end remains in the receiver Gradually advance it out of the wrapper into the urethra in an upward and backward direction for approximately 5-7cm or until urine flows Advance a further 5 cm, do not force the catheter Inflate the balloon with the correct amount of water Attach the catheter drainage bag and position so there is no pulling on the catheter November 2004 Richard Lake
21
Male catheterisation The procedure will be discussed fully in the practical sessions Ensure the patient has no history of prostatic hypertrophy Assess any risk factors such as anti coagulant therapy It is important to hold the penis at 60 to 90 degrees to the body, this reduces the risk of strictures November 2004 Richard Lake
22
Anaesthetic lubricating jelly should be placed into the urethra and the practitioner must wait 5 minutes for this to be effective If the patient complains of any severe discomfort during the procedure then the procedure should be stopped immediately If resistance is felt increasing the traction on the penis may reduce the spasm of the external sphincter Encouraging the patient to cough may also ease the passage of the catheter November 2004 Richard Lake
23
Procedure (male) Explain the procedure to the patient and gain informed consent Take the pre prepared trolley to the bedside and place on left or right depending on nurses dominant hand Raise the bed to an appropriate height and ensure a good light source Expose the genital area with consideration for patient dignity and place a disposable pad beneath the patient Wash and dry hands November 2004 Richard Lake
24
Pour an appropriate cleanser into the galipot
Ensure asepsis is maintained and open packs and equipment onto the trolley Open the catheter but do not remove it from the internal wrapper and place it in the sterile receiver on the trolley Pour an appropriate cleanser into the galipot Open the catheter bag and arrange it on the side of the bed, ensuring the attachment tip is accessible and remains sterile Prepare the anaesthetic lubricating gel and remove end tip Draw up the amount of sterile water to inflate the balloon Wash hands again and put on two pairs of sterile gloves November 2004 Richard Lake
25
Clean the area using a new gauze swab for each stroke
Place the sterile dressing towel between the patients legs and over the patients thighs Using a gauze swab and the non dominant hand retract the fore skin to expose the urethral meatus. Clean the area using a new gauze swab for each stroke Hold the penis at degrees to the body Warn the patient the anaesthetic gel may sting and instil the gel via the urethral meatus Place a finger over the meatus and hold penis at same angle for 5 minutes to allow the gel to work Place the receiver holding the catheter on the sterile towel between the patients legs November 2004 Richard Lake
26
Hold the catheter so the distal end remains in the receiver
Expose the tip of the catheter by pulling off the top of the wrapper at the serrated edge Hold the catheter so the distal end remains in the receiver Gradually advance it out of the wrapper into the urethra until urine flows Advance a further 5 cm, do not force the catheter Inflate the balloon with the correct amount of water Attach the catheter drainage bag and position so there is no pulling on the catheter November 2004 Richard Lake
27
Points for consideration
Catheter valves can be used instead of urine drainage bags for bladder training purposes Catheter retention balloons should not be over filled so as to avoid urinary bypassing Leg bags can be used in mobile patients Following male catheterisation always roll the fore skin back over the glans penis to prevent a paraphimosis occurring November 2004 Richard Lake
28
Complications associated with urethral catheterisation
Urinary tract infection Encrustation and blockage Bypassing Tissue damage Patient discomfort November 2004 Richard Lake
29
Intermittent self catheterisation
This is a socially clean and not aseptic technique for the patient If a health care professional performs the procedure then it is aseptic Procedure is commonly used by patients requiring intravesical medication instillation, or patients with neurogenic voiding problems Self lubricating PVC or silicone catheters are often used for the procedure November 2004 Richard Lake
30
Procedure (female) Patient should attempt to void urine
Hands should be washed with soap and water Soak catheter (if coated) according to manufacturers instructions Wash genitals with a wet wipe The patient will choose a comfortable position over a toilet or suitable container One hand is used to spread the labia apart and find the urethral opening above the vagina. A mirror is often used initially but with practice is found by touch November 2004 Richard Lake
31
Dispose of catheter and wash hands
The catheter is gently inserted into the urethra with care taken not to touch the part entering the body Catheter is slid slowly and smoothly into urethra until urine starts to drain into toilet When urine stops flowing, catheter is withdrawn slowly and smoothly. Often more urine drains as the catheter is removed Dispose of catheter and wash hands November 2004 Richard Lake
32
Procedure (male) Patient should attempt to void urine
Hands should be washed with soap and water Soak catheter (if coated) according to manufacturers instructions Wash genitals with a wet wipe The patient will choose a comfortable position over a toilet or suitable container Gently pull back the foreskin (if present), hold the penis at 60 to 90 degrees November 2004 Richard Lake
33
Dispose of catheter and wash hands
The catheter is gently inserted into the urethra with care taken not to touch the part entering the body Catheter is slid slowly and smoothly into urethra until urine starts to drain into toilet When urine stops flowing, catheter is withdrawn slowly and smoothly. Often more urine drains as the catheter is removed The foreskin should be rolled back into position to prevent a paraphimosis occurring Dispose of catheter and wash hands November 2004 Richard Lake
34
Procedure has several advantages over urethral catheterisation:
Allows more patient independence Decreased impact upon patient body image Less discomfort Can allow the patient to continue with their sexual relationships November 2004 Richard Lake
35
Suprapubic catheterisation
Procedure involves insertion of specially designed catheter into the bladder via the abdominal wall Procedure is performed under either local or general anaesthesia November 2004 Richard Lake
36
Indications Urinary retention or voiding problems caused by prostatic obstruction or infection Urethral stricture When urethral catheterisation is not possible If trauma present to pelvis or urinary tract Patients undergoing surgery to pelvis or urinary tract November 2004 Richard Lake
37
Contraindications Patients with haematuria Known bladder tumour
Small fibrotic bladders Prosthetic devices in the lower abdomen November 2004 Richard Lake
38
Risk factors of procedure
Bowel perforation/ haemorrhage at cystostomy formation Cystostomy complications, e.g. localised infection Pain, discomfort, irritation Some evidence suggests risk of long term squamous cell carcinoma Bladder stones Urethral leakage especially in females November 2004 Richard Lake
39
Procedure Surgical procedure performed in some hospitals by urology clinical nurse specialists Local or general anaesthesia Cystostomy (surgical opening) is formed between internal bladder and external abdominal wall Specially designed self retaining catheter is inserted which forms a complete seal Catheter is connected to urine drainage bag as normal November 2004 Richard Lake
40
Conclusion Catheterisation is a commonly performed procedure in clinical practice Urethral catheterisation of both male and female patients is a nursing procedure The nurse needs an awareness of the anatomy and physiology of the urinary system The steps of the procedure including the rationale and potential complications November 2004 Richard Lake
41
Patients who perform intermittent self catheterisation require good health education
The nurse needs a good awareness of the procedure to promote this health education Suprapubic catheters may also be used but performed as a minor surgical procedure possibly by a urology clinical nurse specialist or doctor November 2004 Richard Lake
42
Any Questions? November 2004 Richard Lake
43
For a copy of the notes E-mail – r.a.lake@swan.ac.uk
Make sure you put in the header catheterisation notes November 2004 Richard Lake
Similar presentations
