Surgical Technology Lecture Series 2000© Power-Point®

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

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

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

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

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

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

Composition

Proteinuria Albumin and globulin Abnormalities and indications Normal: 10-100 mg excreted in the urine in each 24 hour period Abnormalities and indications Albumin: renal disease, diabetes mellitus Globulin: renal disease, pyelonephritis

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

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

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

White Blood Cells Normal 0-5 Abnormalities and indications UTI

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 1.010 - 1.025

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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®)

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

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)

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®)

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

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

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

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)

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

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

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

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

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

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

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

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

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