1. Surgical Technology Lecture Series 2000©
Power-Point®

2. Content Outline Laboratory Values of Urine
Indications for Catheterization
Catheterization Considerations
Necessary Supplies
Insertion Procedure
Output Monitoring

3. Quantity Normal urine output per day 1000 to 1500 ml
Approximately 95% is H2O
Output can vary greatly according to
Intake of fluid
Type and amount of food
Exercise
Kidney function

4. Quantity (continued) Abnormalities and indications
Polyuria: diabetes (mellitus or insipidus), nephritis, intake of diuretics such as caffeine
Oliguria: nephritis, heart disease, fever, diarrhea, vomiting, low fluid intake
Anuria: uremia, acute nephritis, complete obstruction of ureters or urethral opening from bladder

5. Color Normal: yellow to amber Abnormalities and indications
Depends on concentration of the pigment urochrome
Abnormalities and indications
Milky or cloudy: pus or fat globules indicating a GU infection, bacterial sediment due to GU infection

6. Color (continued) Red: Pale: diabetes insipidus
Hematuria: urinary obstruction, renal calculi, tumor, renal failure
drugs or dyes used for x-ray purposes
food dyes
Pale: diabetes insipidus
Greenish-brown: bile pigment due to jaundice
Black: poisoning, hemorrhage

7. Odor Normal Abnormalities and indications
Faintly sweet, but not too strong
Abnormalities and indications
Strong sweet smell: acetone present associated with diabetes mellitus
Unpleasant smell: ingestion of a drug or certain types of food

8. Composition

9. Proteinuria Albumin and globulin Abnormalities and indications
Normal: mg excreted in the urine in each 24 hour period
Abnormalities and indications
Albumin: renal disease, diabetes mellitus
Globulin: renal disease, pyelonephritis

10. Sugar Normal Abnormalities and indications
Abnormalities and indications
Glycosuria: diabetes mellitus, high intake of sugar

11. Ketones Normal Abnormalities and indications
Abnormalities and indications
Ketonuria: diabetic ketoacidosis, starvation, eating disorders

12. Red Blood Cells Normal Abnormalities and indications 0 - 4
Hematuria due to injury to kidney

13. White Blood Cells
Normal
0-5
Abnormalities and indications
UTI

14. Specific Gravity Definition Normal Abbreviation sp gr
Weight of a substance as compared to the equal volume of water
Water is the standard and has a sp gr of 1
Normal

15. Specific Gravity (continued)
Abnormalities and indications
Low: dilution of urine, renal disease such as nephritis, pituitary disease is suspected due to decreased ADH
High: acute nephritis, diabetes mellitus if urine is light yellow in color

16. pH Review of pH scale Neutral: 7 Less than 7: acid
More than 7: alkaline
Maximum acidity (acidosis): 0
Maximum alkalinity: 14

17. pH (continued) Normal Abnormalities and indications 4.6 - 8.0
average is 6.0
Abnormalities and indications
High acidity: acidosis, diabetes mellitus, fever, starvation
Alkaline: vegetarian diet, infection, ingestion of alkaline compounds/products

18. Indications for Catheterization
Specimen (typically done through clean catch)
A sterile specimen is needed for laboratory analysis
Decompression of bladder
Decompress bladder to avoid injury to the bladder during abdominal or pelvic surgery
Monitor output
Measure urine output pre-, intra-, and postoperatively

19. Indications (continued)
Incontinence
Placed in surgical patient who has incontinence prior to surgical procedure
Placed in surgical patient who will possibly have temporary incontinence after surgical procedure
Placed in surgical patient who will possibly have permanent incontinence due to trauma

20. Indications (continued)
Facilitate hemostasis
Large balloon on indwelling catheter compresses against bladder wall
Aids in hemostasis after a TURP or other surgery on GU tract structures
Facilitate output and healing
Facilitates output of urine after surgery on GU tract structures
Allows structures time to heal and regain strength

21. Physician’s Order Know the physician’s order
straight catheter vs. indwelling catheter
how long should catheter be left in place
size of catheter
type of catheter

22. Know the Anatomy Male anatomy
Due to length of urethra, it may curve on its path from the bladder to the urethral meatus
Curves may make catheter insertion difficult
Lift penis vertically and hold taught to straighten any curves when inserting catheter

23. Know the Anatomy (continued)
Female anatomy
Urethra much shorter than male
Urethral meatus difficult to locate
Must retract labia to locate the urethra
Due to shorter urethra, females are more prone to contracting a UTI than a male

24. Positioning Male Female
Supine
Female
Frog-leg(modified recumbent) position
Place pillows under knees for support
Note: Catheterization is accomplished before the patient is placed in the surgical position
Exception - lithotomy position

25. Lighting
Recommended to have surgical lights turned on and in position before placement of catheter
Aids in visualization of urethra, especially the female

26. Sterile Technique Urinary catheterization is a sterile procedure
Strict sterile technique must be followed to prevent the patient from experiencing a UTI
Sterile gloves are worn
Sterile, disposable catheterization tray is used

27. Size of Catheter Review of French scale Abbreviation Fr
System of measurement used to indicate the outer diameter of catheters, dilators, and sounds
Each unit of the Fr scale is equal to approximately 1/3 mm
Example: 21 Fr = 7 mm

28. Size of Catheter (continued)
Adult
Female
Usually 14 Fr or 16 Fr
Male
Usually 16 Fr or 18 Fr
Pediatric
According to size of infant/child
Smallest size available is 8 Fr

29. Types of Catheters Robinson catheter
Also called red Robinson, red rob, or straight cath
Non-retaining
1 or 2 holes at tip
May be lubricated (K-Y Jelly®)

30. Types of Catheters (continued)
Foley catheter
Indwelling catheter
5 ml or 30 ml balloon used to retain catheter in bladder
5 ml used most frequently; 10 ml of sterile H20 required to inflate 5 ml balloon
30 ml used postoperatively to aid in achieving bladder hemostasis

31. Types of Catheters (continued)
Foley catheter (continued)
2-way Foley
Lumen for filling and emptying the balloon
Lumen for drainage (outflow)
3-way Foley
Lumen for irrigation (inflow)

32. Foley Catheter Tray Sterile Foley catheter kit may contain Drapes
Gloves
Lubricant (K-Y Jelly®) may be in a small packet or syringe
Cotton balls or gauze
Forceps
Antiseptic solution (Betadine®)

33. Foley Catheter Tray (continued)
Kit contents (continued)
Foley catheter
Drainage bag (may be pre-connected to catheter)
Sterile specimen cup with label
10 cc syringe prefilled with water
Tape

34. Coude Catheter Non-retaining or ballooned style Firm curved tip
Used when urethra is distorted (eg BPH)

35. Insertion Procedure
The following are the procedural steps for the placement of an indwelling catheter in a female
Wash hands
Position and expose patient
Provide illumination
Open catheter tray in a sterile manner
Tray may be placed between the patient’s legs

36. Insertion Procedure (continued)
Don sterile gloves using the open glove technique
Organize supplies within sterile field
Attach syringe and inflate balloon with water to check the integrity of the balloon
Lubricate tip of catheter
Prepare antiseptic solution and applicators
Prepare specimen container (if needed)
Connect catheter to drainage bag (if needed)

37. Insertion Procedure (continued)
Use nondominant hand to retract the labia
Cleanse meatus
Antiseptic soaked applicator is grasped with forceps in dominant hand
Meatus is cleaned in an anterior to posterior motion - applicator is discarded after use
Repeat x 2

38. Insertion Procedure (continued)
Insert catheter
Grasp lubricated catheter near tip
Insert catheter appropriate distance
Observe urine flow
May require application of external pressure

39. Insertion Procedure (continued)
Inflate balloon
DO NOT INFLATE BALLOON UNTIL URINE FLOW IS CONFIRMED!!!
If balloon is inflated before urine flow is confirmed, it is possible that the catheter has not entered the bladder and the balloon may damage the urethra

40. Insertion Procedure (continued)
Position catheter
Position catheter within bladder by gently retracting any redundant tubing
Position and secure the external tubing
Tape to inner aspect of patient’s thigh
Position drainage bag below the level of the bladder to facilitate drainage

41. Insertion Procedure (continued)
Care for patient and supplies as needed
Dry patient
Remove and discard unnecessary items
Remove soiled gloves
Reposition patient (if necessary)
Care for specimen (if necessary)
Wash hands
Document procedure

42. Insertion Procedure (continued)
CAUTION
DO NOT raise the drainage bag above the level of the bladder
If drainage bag must be raised be sure to kink or clamp tubing to prevent retrograde flow of urine and prevent a UTI
Care must be taken when moving the patient to protect the catheter and drainage bag to avoid injury to the urethra and avoid retrograde flow

43. Drainage Bag Graduated in ml’s to estimate output
Empty urine from bag into graduated pitcher for more accurate measurement
Make sure all urine has passed from drainage tube into the bag prior to measurement

44. Urometer® Plastic container attached to bag Graduated in ml’s
Allows for more accurate measurement than bag
Back of container has opening to allow excess urine to flow into the bag

45. General Information
Urine collection unit is emptied as needed or just prior to transport to PACU
Amount of urine excreted during surgery is recorded prior to patient transported to PACU
Bag is again emptied and the amount recorded prior to transport from PACU