Urinary Catheterization
Catheters A hollow tube for instilling and removing fluid general term many types and uses
Urinary Catheterization Intro of cath through urethra into bladder aseptic procedure sterile technique
DANGERS INJURY INFECTION
Role of the nurse Use infrequently Not for convenience of nursing staff Advocate early removal
Reasons for Urinary Catheterization Sterile specimen Before surgery Inability to void Check residual
Reasons for Urinary Caths (continued) Remove urine if greatly distended Last resort for incontinence Accurate I & O
Reasons for Urinary Caths (even more!) Keep sutures clean Dilate/splint urethra Drainage / Irrigation Instillation of meds
Types of Urinary Caths Most common are plastic or latex Rounded tip Lubricated with water soluble gel
Catheter Sizes Measure of diameter Listed as “FR” which stands for “French” Size depends on age and sex
Male patients Urethra is longer Potential prostrate obstruction Use larger FR if trouble Reposition foreskin
How to select size: Adult : 14 or 16 or 18 Child: 8 or 10 Female: 16 Male: 18 (stiffer to pass thru prostate)
Retention or Indwelling Caths Temporary or permanent drainage attached to urinary collection bag most common – Foley
Foley catheter Has double lumen Balloon (at tip) inflated once in place prevents slipping out of bladder Use sterile water/saline
Foley (continued) Note the balloon size if c/o pain when you inflate: - probably in urethra - deflate & advance
Drainage system must be below the level of the bladder. Figure 20-17 (From Potter, P.A., Perry, A.G. [2003]. Basic nursing: essentials for practice. [5th ed.]. St. Louis: Mosby.) Drainage system must be below the level of the bladder.
Catheter Lumen Space within a tube Single (straight cath) #1 urine Double (Foley cath) - #1 plus #2 balloon
Catheter Lumen Triple (3 way Foley) - #1 and # 2 plus #3 to add irrigation/med - often used with CBI. (Continuous Bladder Irrigation)
Bladder irrigation May be continuous or intermittent If continuous Will be triple lumen Use solution ordered
Bladder irrigation If intermittent: Use urine lumen Primarily use sterile NSS - new kit q time allow gravity return Check P & P manual
Why Irrigate a cath? To cleanse the lumen To increase the cath patency To break up blood clotting
Straight caths To drain urine single lumen intended to insert, drain, and withdrawal
Other cath types: Suprapubic cath - cystocath Texas cath - condom cath
A, Condom catheter. B, Condom catheter attached to leg bag. Figure 20-15 (From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.) A, Condom catheter. B, Condom catheter attached to leg bag.
Catheter insertion Position patient in dorsal recumbent 700 - 1000 cc max. removed - prevents shock
Nursing care Closed, sterile system prevent pulling no kinks in tubing tubing over leg on unaffected side
Nursing care (cont) Wash hands Wear gloves Never disconnect Never irrigate without an order
Nursing care (cont) Cleanse daily No dependent loops Bag below bladder Measure/record I & O Check volume frequent
Nursing care (cont) Check: - color - consistency - odor - any c/o of pain
Nursing measures to promote voiding Provide privacy / relax Female - sitting Male - standing Warm bedpan / urinal Offer fluids
More nursing measures Power of imagery Place hands in water Water over Perineal area Only when these fail can we obtain cath order!
Potential problems after removal Inability to void - give 8-10 hours Frequency, urgency, burning - s/s of UTI Incontinence
Related procedures Bladder retraining Bladder scanning
A woman, calling Mount Sinai Hospital, said, "Hello, I want to know if a patient is getting better." The voice on the other end of the line said, "Do you know the patient's name and room number?" She said, "Yes, darling! She's Sarah Finkel, in Room 302." He said, "Oh, yes. Mrs. Finkel is doing very well. In fact, she's had two full meals, her blood pressure is fine, she's going to be taken off the heart monitor in a couple of hours and if she continues this improvement, Dr. Cohen is going to send her home Tuesday." The woman said, "Thank God! That's wonderful! Oh! That's fantastic! That's wonderful news!" The man on the phone said, "From your enthusiasm, I take it you must be a close family member or a very close friend!" She said, "I'm Sarah Finkel in 302! Cohen, my doctor, doesn't tell me a word!" The End