Health science college Department of nursing Assosa University By: Birhanu A1 For: 2 nd YEAR PHO students By: Birhanu A

Chapter 6 Urinary Catheterization By: Birhanu A2

Learning Objectives  At the end of this chapter students will be able to know :  Explain purpose of catheterization  Identify different types of catheters  Describe indication of catheterization  Demonstrate sterility technique through out the catheterization.  Intervene the procedure for those in need of it with understanding of both male and female patient By: Birhanu A3

Urinary Catheterization  Urinary Catheterization is a sterile procedure that accomplished by inserting a catheter (a hollow tube, often with inflatable balloon tip) into the urinary bladder  An invasive procedure that should only be carried out by a qualified competent health care professional using aseptic technique because Catheterization is considered as the most prominent cause of nosocomial infections By: Birhanu A4

Indications Catheterization of the urinary tract should only be done when if there is a specific and adequate clinical indication( purpose )are there. A. Diagnosis purposes Urine collection (sterile specimen) Post void residual (PVR) Instillation of contrast By: Birhanu A5

B. Therapy purposes 1. Relief of obstruction Clots (3-way catheter used) Strictures BPH 2. Monitor U/O 3. Management of neurogenic bladder 4. To empty the bladder before, during and after surgery 5.unconscious patients By: Birhanu A6

Contraindications  Urethral trauma  Pelvic fracture  Urethral obstruction  Bladder neck masses By: Birhanu A7

Types of Catheter Birhanua20152gamil.com By: Birhanu A 8  Type of catheter Based on route  Urethral, and  Super-pubic  Type of urethral catheter:  Straight (plain/Robinson)  Retention (Foley/indwelling)  Coude (elbowed)

Types of Catheters By: Birhanu A9 Suprapubic Indwelling CondomStraight

Straight Catheter Also called a red-rubber catheter or plain catheter.  It is a single lumen and do not have a balloon near the tip.  Straight catheter is inserted only for as much time as it takes to drain the bladder or obtain urine specimen so, placed into the bladder for short periods of time(5- 10min) By: Birhanu A10

Straight Catheter By: Birhanu A11

purpose  To relieve discomfort due to bladder distention  To assess the residual urine  To obtain a urine specimen  To empty the bladder prior to surgery By: Birhanu A12

Indwelling Catheter Also called foley or retention catheter.  are those placed into the bladder for extended periods of times.  these catheters have a balloon at the distal end that is inflated after insertion but not for straight catheter N.B: The balloon holds the catheter in place for a duration of time By: Braun A13

This Indwelling Catheter have 2 or 3 lumen, one lumen use for the urine drainage by connecting with urine collection bag the 2 nd lumen is used for inflation of the balloon near the tip N.B: The most commonly indicated balloon size is 10ml. But we need always inflate the balloon as the manufacturers recommended volume if the catheter have 3 rd lumen The 3rd lumen used for irrigation By: Birhanu A14

Two Way and three way Foley Catheter By: Birhanu A15

Urinary Drainage Bag By: Birhanu A16

purpose To manage incontinence To provide for intermittent or continuous bladder drainage and irrigation To prevent urine from contacting an incision after perennial surgery (prevent infection) To measure urine output needs to be monitored hourly By: Birhanu A17

Coude catheter Also known as elbowed catheter:- used for elderly men who have benign prostate hyperplasia (BPH)- which is curved tip By: Birhanu A18 Coude Catheter

Supra-pubic catheter Suprapubic - means the area just above your pubic bone, above the level of your pubic hair. This type of catheter is inserted through a small incision above the pubic area directly into the urinary bladder through the abdominal wall. Used for continuous drainage. More hygienic than ureteral, as it is away from the genital area where infection has an easy passage to the bladder By: Birhanu A19

Indications Suprapubic catheterization is indicated when urethral catheterization is contraindicated or technically not possible to relieve urinary retention due to the following conditions: Urethral injuries Urethral obstruction Bladder neck masses Benign prosthetic hypertrophy (BPH) Prostate cancer By: Birhanu A20

By: Birhanu A21

Condom Catheter It is soft, flexible device made of plastic or rubber material which is applied externally to the penis. Condom catheter is not inserted into the urethra. Purpose  When voluntary control of urination is not possible for male clients.  If there is urinary incontinence  Alternative solution after trail of indwelling catheter or straight catheter By: Birhanu A22

Condom Catheter By: Birhanu A23

Procedure Male client Position: supine with leg abducted slightly, pines pull upward and forward 90 0 Cline the genital: clean the penis with circular motion center to outward Insert: around 20cm Lubricant : use water soluble jelly Female client Position: dorsal recumbent Cline the genital: clean from front (above the urethral opening ) to back Insert: insert around 5 cm Lubricant :use water soluble jelly By: Birhanu A24

Special Considerations  Check the doctor’s order.  Provide privacy. Invasive procedure elicit anxiety and feeling of embarrassment.  Use a calm, straight forward, professional manner to relieve the patient’s anxiety.  Practice aseptic technique. Urinary bladder is a sterile cavity.  Provide perineal care before catheterization.  Facilitate insertion of the catheter, prevent pain By: Birhanu A25

We need identify the urethral orifice for female client By: Birhanu A26

Urinary Catheterization equipment  Sterile gloves  Droplight  Sterile cotton swabs  Povidone iodine solution  Sterile pick-up forceps  Water soluble lubricant  Sterile 4x4 gauze Additional equipment for indwelling catheters Drainage tubing and collecting bag Sterile syringe and needle with 5 ml or 30 ml Adhesive tape Bed pan By: Birhanu A27

Procedure  Prepare the client and equipment for perennial wash  Position the patient – dorsal recumbent  Wash the perennial area with warm water and soap  Rinse and dry the area  Prepare the equipment  Create a sterile field  Clean the area with antiseptic solution.  Lubricate the insertion tip of the catheter (5-7 cm in females) 4/10/2019Prepared by birhanu a28

Con’t  Expose the urinary meatus adequately by retracting the tissue or the labia minora.  Retract the fore skin of uncircumcised male.  Grasp the penis firmly behind the glans and hold straighten.  Insert the catheter into the urethral orifice.  Insert 5 cm in females and 20 cm in males or until urine comes.  Collect the urine – for specimen (about 30 ml)  Empty or drain the bladder and remove the catheter 4/10/2019Prepared by birhanu a29

Note:  If resistance is encountered during insertion, do not force it – forceful pressure can cause trauma.  Ask the client to take deep breaths - relaxes the external sphincter (slight resistance is normal).  Dorsal Recumbent position is better: – Female- for a better view of the urinary meatus and reduce the risk of catheter contaminate. – Male- allows greater relaxation of the abdominal and perennial muscles and permits easier insertion of the tube. 4/10/2019Prepared by birhanu a30

procedure  Gather the necessary equipment & explain the procedure to the client: 1.Retention catheter 2.Syringe 3.Sterile water 4.Adhesive tape 5.Urine collection bag 4/10/2019Prepared by birhanu a31

Con’t  Explain the procedure to the patient  Position the client in supine position with legs spread and feet together  Open catheterization kit  Prepare sterile field, done sterile gloves  Check balloon for patency  Apply lubricant to 5cm of the distal part of the catheter  Apply sterile drape & bed protection materials (rubber sheet). 4/10/2019Prepared by birhanu a32

Con’t  In female separate the labia, & in male hold the penis straight with non-dominant hand.  Cleanse perennial & urethral mucosa with cleansing solution.  Pick the catheter identify the urethral meatus and gently insert until 2-5 inches beyond where the urine started flowing.  Inflate balloon with 10cc of sterile liquid/ water. 4/10/2019Prepared by birhanu a33

Con’t  After catheter insertion, the balloon is inflated to hold the catheter in place within the bladder.  The outside end of the catheter has two openings, one to drain the urine, the other to inflate the balloon.  The balloon of the catheter is located behind the opening at the insertion tip.  This ensures that the balloon is inflated inside the bladder and not in the urethra (cause trauma). 4/10/2019Prepared by birhanu a34

Con’t  Apply slight tension on the catheter until you feel resistance:  Resistance indicates that the catheter balloon is inflated appropriately and that the catheter is well attached in the bladder  Connect the catheter to the drainage system & Secure it to thigh or abdomen. 4/10/2019Prepared by birhanu a35

Con’t  Place drainage bag below level of the bladder.  Evaluate catheter function & amount, color, odor and quality of urine.  Remove gloves & wash your hands.  Document what you have done. 4/10/2019Prepared by birhanu a36

Removal Withdraw the solution or air from the balloon using a syringe. And remove gently 4/10/2019Prepared by birhanu a37

Male Catheterization 1.Assess the patient’s need for catheterization and refer patient to the doctor. 2.Verify the doctor’s order for catheterization. 3.Prepare for the necessary materials. 4.Perform handwashing. 5.Identify the right patient By: Birhanu A38

Explain the procedure. Position the patient properly, supine position. Ensure privacy. Practice aseptic technique in the entire procedure. Open the catheterization kit. Add and prepare the materials to be used By: Birhanu A39

Male Catheterization 11.Don first glove and fill the syringe with sterile water. 12.Don second glove and applies sterile drapes for the patient. 13.Grab the penis firmly behind the glans with the non- dominant hand and retracts the foreskin of the uncircumcised male By: Birhanu A40

With the dominant hand, use sterile forcep to pick up swabs. Clean first from the meatus and then wipe the tissue surrounding the meatus in circular motion using a new swab for each stroke. Pick up the catheter and place the drainage end of the catheter in the urine receptacle using the uncontaminated hand. Lubricate the insertion end or tip of the catheter By: Birhanu A41

Male Catheterization 17.Lift the penis to a position of 90 degree angle and insert the catheter until urine flows. 18.Connect the catheter to the urine bag and ensure that the emptying base of the bag is closed. 19.Inflate the balloon by injecting 5 – 10 cc of PNSS and check for anchorage. 20.Tape the catheter into the thigh using non-allergenic tape. 21.Dispose soiled materials properly. 22.Accurately record the procedures done By: Birhanu A42

Female Catheterization 1.Assess the patient’s need for catheterization and refer patient to the doctor. 2.Verify the doctor’s order for catheterization. 3.Prepare for the necessary materials. 4.Perform handwashing. 5.Identify the right patient By: Birhanu A43

Explain the procedure. Position the patient properly, supine position. Ensure privacy. Practice aseptic technique in the entire procedure. Open the catheterization kit. Add and prepare the materials to be used By: Birhanu A44

Female Catheterization 11.Don first glove and fill the syringe with sterile water. 12.Don second glove and applies sterile drapes for the patient. 13.With the non-dominant hand, separate the labia minora with thumb and index finger. Never remove fingers until catheter is inserted. 14.With the dominant hand, use sterile forcep to pick up swabs. Clean first from the meatus and then wipe the tissue surrounding the meatus in circular motion using a new swab for each stroke. 15.Pick up the catheter and place the drainage end of the catheter in the urine receptacle using the uncontaminated hand. 16.Lubricate the insertion end or tip of the catheter By: Birhanu A45

Female Catheterization 17.Lift the penis to a position of 90 degree angle and insert the catheter until urine flows. 18.Connect the catheter to the urine bag and ensure that the emptying base of the bag is closed. 19.Inflate the balloon by injecting 5 – 10 cc of PNSS and check for anchorage. 20.Tape the catheter into the thigh using non-allergenic tape. 21.Dispose soiled materials properly. 22.Accurately record the procedures done By: Birhanu A46

Female Catheterization By: Birhanu A47

Female Catheterization By: Birhanu A48