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November 2004Richard Lake1 Principles of Catheterisation.

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Presentation on theme: "November 2004Richard Lake1 Principles of Catheterisation."— Presentation transcript:

1 November 2004Richard Lake1 Principles of Catheterisation

2 November 2004Richard Lake2 Indications for catheterisation Indications for catheterisation Procedure, complications and contraindications for: Procedure, complications and contraindications for: Female Female Male Male Intermittent self catheterisation Intermittent self catheterisation Suprapubic Suprapubic

3 November 2004Richard Lake3 Catheterisation Is it a new procedure? N0 N0 3000BC river reeds and onion stems were used to drain the bladder 3000BC river reeds and onion stems were used to drain the bladder Gold, tin, lead and silver tubes were then developed and used Gold, tin, lead and silver tubes were then developed and used 1920’s first vulcanised rubber tubes were produced 1920’s first vulcanised rubber tubes were produced

4 November 2004Richard Lake – Fredrick Foley developed first self retaining catheter 1934 – Fredrick Foley developed first self retaining catheter This had separate channels for draining the bladder and a self retaining balloon 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 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 Difference between 1934 and modern catheters are the materials their made from

5 November 2004Richard Lake5 Important prior knowledge Anatomy and physiology of urinary system Anatomy and physiology of urinary system Rationale for procedure Rationale for procedure Necessary equipment Necessary equipment Competence in performing skill Competence in performing skill

6 November 2004Richard Lake6Anatomy

7 November 2004Richard Lake7

8 November 2004Richard Lake8

9 November 2004Richard Lake9 Indications for catheterisation Bladder drainage Bladder drainage Acute urinary retention Acute urinary retention Residual volume bladder drainage Residual volume bladder drainage Bladder irrigation following surgery Bladder irrigation following surgery Urodynamic flow rate studies Urodynamic flow rate studies Accurate fluid balance Accurate fluid balance Instillation of drugs Instillation of drugs

10 November 2004Richard Lake10 Indications for catheterisation summarised Prophylaxis Prophylaxis Diagnosis Diagnosis Therapy Therapy

11 November 2004Richard Lake11 Equipment required Sterile catheterisation pack containing gallipots, receiver, swabs, disposable towel Sterile catheterisation pack containing gallipots, receiver, swabs, disposable towel Disposable under pad for patient Disposable under pad for patient Sterile gloves and disposable plastic apron Sterile gloves and disposable plastic apron Appropriate catheter Appropriate catheter Sterile anaesthetic lubricating jelly Sterile anaesthetic lubricating jelly Water for injections to inflate catheter ballon Water for injections to inflate catheter ballon Universal specimen container Universal specimen container Antiseptic solution Antiseptic solution Drainage bag and stand Drainage bag and stand

12 November 2004Richard Lake12 Catheter types short term Catheter material DurationComments PVC 14 days Rigid, painful Latex 14 days Can cause discomfort and tissue trauma due to high surface friction Teflon-coated latex 28 days Smoother, resistance to encrustations

13 November 2004Richard Lake13 Catheter types longer term Catheter material DurationComments Silicone elastomer- coated latex 12 weeks Resistance to bacterial adherence Silicone 12 weeks Smooth, resistance to encrustations, non- inflammatory Hydrogel- coated latex 12 weeks Resistance to bacterial adherence, improved patient comfort, non- inflammatory

14 November 2004Richard Lake14 Catheter sizes Catheters are available in both different sizes and lengths 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 Variation in length is due to the difference in length of the male and female urethra Male catheters are cm in length Male catheters are cm in length Female 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) The size is the measure of the internal lumen of the catheter and is measured in Charriere (Ch)

15 November 2004Richard Lake15 Fe-male catheterisation The procedure will be covered in more detail in the small group work 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 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 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 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

16 November 2004Richard Lake16 If the catheter is accidentally inserted into the vagina, leave it in place to prevent it happening again If the catheter is accidentally inserted into the vagina, leave it in place to prevent it happening again Use a new catheter Use a new catheter Once this is successfully in place remove the first catheter from the vagina Once this is successfully in place remove the first catheter from the vagina

17 November 2004Richard Lake17 Procedure (female) Explain the procedure to the patient and gain informed consent 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 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 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 Expose the genital area with consideration for patient dignity and place a disposable pad beneath the patient Wash and dry hands Wash and dry hands

18 November 2004Richard Lake18 Ensure asepsis is maintained and open packs and equipment onto the trolley 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 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 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 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 Squeeze small amount of lubricant or anaesthetic gel onto a gauze swab Draw up the amount of sterile water to inflate the balloon Draw up the amount of sterile water to inflate the balloon Wash hands again and put on two pairs of sterile gloves Wash hands again and put on two pairs of sterile gloves

19 November 2004Richard Lake19 Place the sterile dressing towel between the patients legs and over the patients thighs 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 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 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 Place the receiver holding the catheter on the sterile towel between the patients legs

20 November 2004Richard Lake20 Expose the tip of the catheter by pulling off the top of the wrapper at the serrated edge 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 Lubricate the catheter tip with anaesthetic or lubricating gel Hold the catheter so the distal end remains in the receiver 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 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 Advance a further 5 cm, do not force the catheter Inflate the balloon with the correct amount of water Inflate the balloon with the correct amount of water Attach the catheter drainage bag and position so there is no pulling on the catheter Attach the catheter drainage bag and position so there is no pulling on the catheter

21 November 2004Richard Lake21 Male catheterisation The procedure will be discussed fully in the practical sessions The procedure will be discussed fully in the practical sessions Ensure the patient has no history of prostatic hypertrophy Ensure the patient has no history of prostatic hypertrophy Assess any risk factors such as anti coagulant therapy 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 It is important to hold the penis at 60 to 90 degrees to the body, this reduces the risk of strictures

22 November 2004Richard Lake22 Anaesthetic lubricating jelly should be placed into the urethra and the practitioner must wait 5 minutes for this to be effective 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 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 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 Encouraging the patient to cough may also ease the passage of the catheter

23 November 2004Richard Lake23 Procedure (male) Explain the procedure to the patient and gain informed consent 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 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 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 Expose the genital area with consideration for patient dignity and place a disposable pad beneath the patient Wash and dry hands Wash and dry hands

24 November 2004Richard Lake24 Ensure asepsis is maintained and open packs and equipment onto the trolley 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 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 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 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 Prepare the anaesthetic lubricating gel and remove end tip Draw up the amount of sterile water to inflate the balloon Draw up the amount of sterile water to inflate the balloon Wash hands again and put on two pairs of sterile gloves Wash hands again and put on two pairs of sterile gloves

25 November 2004Richard Lake25 Place the sterile dressing towel between the patients legs and over the patients thighs 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. 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 Clean the area using a new gauze swab for each stroke Hold the penis at degrees to the body Hold the penis at degrees to the body Warn the patient the anaesthetic gel may sting and instil the gel via the urethral meatus 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 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 Place the receiver holding the catheter on the sterile towel between the patients legs

26 November 2004Richard Lake26 Expose the tip of the catheter by pulling off the top of the wrapper at the serrated edge 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 Hold the catheter so the distal end remains in the receiver Gradually advance it out of the wrapper into the urethra until urine flows Gradually advance it out of the wrapper into the urethra until urine flows Advance a further 5 cm, do not force the catheter Advance a further 5 cm, do not force the catheter Inflate the balloon with the correct amount of water Inflate the balloon with the correct amount of water Attach the catheter drainage bag and position so there is no pulling on the catheter Attach the catheter drainage bag and position so there is no pulling on the catheter

27 November 2004Richard Lake27 Points for consideration Catheter valves can be used instead of urine drainage bags for bladder training purposes 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 Catheter retention balloons should not be over filled so as to avoid urinary bypassing Leg bags can be used in mobile patients 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 Following male catheterisation always roll the fore skin back over the glans penis to prevent a paraphimosis occurring

28 November 2004Richard Lake28 Complications associated with urethral catheterisation Urinary tract infection Urinary tract infection Encrustation and blockage Encrustation and blockage Bypassing Bypassing Tissue damage Tissue damage Patient discomfort Patient discomfort

29 November 2004Richard Lake29 Intermittent self catheterisation This is a socially clean and not aseptic technique for the patient This is a socially clean and not aseptic technique for the patient If a health care professional performs the procedure then it is aseptic 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 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 Self lubricating PVC or silicone catheters are often used for the procedure

30 November 2004Richard Lake30 Procedure (female) Patient should attempt to void urine Patient should attempt to void urine Hands should be washed with soap and water Hands should be washed with soap and water Soak catheter (if coated) according to manufacturers instructions Soak catheter (if coated) according to manufacturers instructions Wash genitals with a wet wipe Wash genitals with a wet wipe The patient will choose a comfortable position over a toilet or suitable container 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 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

31 November 2004Richard Lake31 The catheter is gently inserted into the urethra with care taken not to touch the part entering the body 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 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 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 Dispose of catheter and wash hands

32 November 2004Richard Lake32 Procedure (male) Patient should attempt to void urine Patient should attempt to void urine Hands should be washed with soap and water Hands should be washed with soap and water Soak catheter (if coated) according to manufacturers instructions Soak catheter (if coated) according to manufacturers instructions Wash genitals with a wet wipe Wash genitals with a wet wipe The patient will choose a comfortable position over a toilet or suitable container 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 Gently pull back the foreskin (if present), hold the penis at 60 to 90 degrees

33 November 2004Richard Lake33 The catheter is gently inserted into the urethra with care taken not to touch the part entering the body 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 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 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 The foreskin should be rolled back into position to prevent a paraphimosis occurring Dispose of catheter and wash hands Dispose of catheter and wash hands

34 November 2004Richard Lake34 Procedure has several advantages over urethral catheterisation: Procedure has several advantages over urethral catheterisation: Allows more patient independence Allows more patient independence Decreased impact upon patient body image Decreased impact upon patient body image Less discomfort Less discomfort Can allow the patient to continue with their sexual relationships Can allow the patient to continue with their sexual relationships

35 November 2004Richard Lake35 Suprapubic catheterisation Procedure involves insertion of specially designed catheter into the bladder via the abdominal wall Procedure involves insertion of specially designed catheter into the bladder via the abdominal wall Procedure is performed under either local or general anaesthesia Procedure is performed under either local or general anaesthesia

36 November 2004Richard Lake36 Indications Urinary retention or voiding problems caused by prostatic obstruction or infection Urinary retention or voiding problems caused by prostatic obstruction or infection Urethral stricture Urethral stricture When urethral catheterisation is not possible When urethral catheterisation is not possible If trauma present to pelvis or urinary tract If trauma present to pelvis or urinary tract Patients undergoing surgery to pelvis or urinary tract Patients undergoing surgery to pelvis or urinary tract

37 November 2004Richard Lake37 Contraindications Patients with haematuria Patients with haematuria Known bladder tumour Known bladder tumour Small fibrotic bladders Small fibrotic bladders Prosthetic devices in the lower abdomen Prosthetic devices in the lower abdomen

38 November 2004Richard Lake38 Risk factors of procedure Bowel perforation/ haemorrhage at cystostomy formation Bowel perforation/ haemorrhage at cystostomy formation Cystostomy complications, e.g. localised infection Cystostomy complications, e.g. localised infection Pain, discomfort, irritation Pain, discomfort, irritation Some evidence suggests risk of long term squamous cell carcinoma Some evidence suggests risk of long term squamous cell carcinoma Bladder stones Bladder stones Urethral leakage especially in females Urethral leakage especially in females

39 November 2004Richard Lake39 Procedure Surgical procedure performed in some hospitals by urology clinical nurse specialists Surgical procedure performed in some hospitals by urology clinical nurse specialists Local or general anaesthesia Local or general anaesthesia Cystostomy (surgical opening) is formed between internal bladder and external abdominal wall Cystostomy (surgical opening) is formed between internal bladder and external abdominal wall Specially designed self retaining catheter is inserted which forms a complete seal Specially designed self retaining catheter is inserted which forms a complete seal Catheter is connected to urine drainage bag as normal Catheter is connected to urine drainage bag as normal

40 November 2004Richard Lake40 Conclusion Catheterisation is a commonly performed procedure in clinical practice Catheterisation is a commonly performed procedure in clinical practice Urethral catheterisation of both male and female patients is a nursing procedure 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 nurse needs an awareness of the anatomy and physiology of the urinary system The steps of the procedure including the rationale and potential complications The steps of the procedure including the rationale and potential complications

41 November 2004Richard Lake41 Patients who perform intermittent self catheterisation require good health education Patients who perform intermittent self catheterisation require good health education The nurse needs a good awareness of the procedure to promote this 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 Suprapubic catheters may also be used but performed as a minor surgical procedure possibly by a urology clinical nurse specialist or doctor

42 November 2004Richard Lake42 Any Questions?

43 November 2004Richard Lake43 For a copy of the notes – – Make sure you put in the header catheterisation notes Make sure you put in the header catheterisation notes


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