1. Urinary Elimination and Care
Chapter 31
Urinary Elimination and Care

2. 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?

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

5. 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

7. Male Female

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

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

12. 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

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

16. 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

20. 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

21. 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

22. 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

25. 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

26. 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

31. 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

33. 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

34. 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

35. 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

36. 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?

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

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

39. 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