Urinary Elimination and Care Chapter 31 Urinary Elimination and Care

Urinary Catheter Tube inserted through urinary meatus—passes through urethra—into bladder Rubber, plastic, latex, polyvinyl, or silicone What is the purpose of a balloon on a catheter?

Types of Catheters Straight Single lumen Sterile specimen or one time drainage Sterile procedure

Types of Catheters Indwelling Double lumen Foley Remains in for designated period of time Balloon—dual purpose Drainage bag—position correctly Nursing care associated with indwelling catheter

Male Female

Types of Catheters Three-way Triple lumen Continuous bladder irrigation or medication instillation

Types of Catheters Coude’ Curved tip Stiffer consistency Enlarged prostate Review facility policy

Types of Catheters Suprapubic Trauma or surgery to urethra Unable to insert through urethra Incision through abdominal wall and into the bladder Catheter placed Nursing care associated with suprapubic catheter

Types of Catheters Condom Texas catheter Male Drainage bag—leg or regular Nursing care associated with condom catheter

Catheter Use Reasons for catheter use Precautions with continuous bladder irrigation Catheter size Average adult 14 or 16Fr Average balloon capacity 5 to 10 ml

Catheter Insertion Physician’s order Check allergies Strict aseptic (sterile) technique If you contaminate the catheter, your gloves, your sterile field, or sterile supplies—STOP the procedure and start over with new kit

Catheter Insertion Failure to do so may cause your patient to experience infection, discomfort, added expense, and potentially death from sepsis You may be the only one who knows you contaminated the supplies Be your patient’s advocate

Female Perineal anatomy Urinary meatus normally found between the clitoris and the vagina Usually not obvious unless has had multiple catheterizations Female urinary meatus resembles small dimpling of tissue—tiny slit or crease

Female Elderly women Normal position for female Cleansing technique Atrophy of tissue Drooping May locate at the edge of or slightly inside the vaginal opening Normal position for female Cleansing technique Insertion and lubrication

Male Hypospadias or epispadias Position Cleansing technique Insertion and lubrication Presence of foreskin Foreskin must be retracted throughout procedure Foreskin must be replaced at end of procedure

Male If resistance is meet on catheter insertion Never try to push through resistance Several techniques to try Hold catheter in place—sphincter relaxes Roll catheter between fingers Adjust penis toward patient’s feet or head slightly

Complications Complications of rapid release of urine from the bladder Bladder spasms Shock Drain no more than 800 to 1,000 ml at one time—if excessive drainage, clamp tubing for 30 minutes—than resume draining

Drainage Bag Monitor output collected in bag throughout shift—color, clarity, odor, sediment Empty when full May delegate task—but you are responsible for monitoring output throughout shift

Care of the Urinary Drainage Bag Empty every 8 hours and document amount Do not touch drainage spout to any surface and wipe with alcohol before closing Always empty urine in a graduate to measure it Maintain bag below the level of the bladder Keep tubing free of kinks and coils Hang on bed; do not rest on floor

Troubleshooting Low Output No urine collecting in drainage bag Palpate lower abdomen above pubic bone Check for kinks in tubing Position of tubing Change position of patient Next action?

Intermittent Catheter Irrigation Irrigate with sterile saline to flush out sediment or mucus Sterile technique required Order required

Discontinuing Catheters Order required Review Skill 31-10 Clean technique required Gather supplies Patient education and monitor urine output Measure first void

Health Care vs. Patient Self Insertion Health care urinary catheter insertion Strict sterile technique Hospital, nursing home, home health, hospice, doctor’s office Patient self catheterization at home Clean technique