1. Urinary Catheter
Chapter 32
Perry & Potter

2. Review IV: Order: 4000 ml N/S over 12 hours gtt factor = 15 gtt/ml
a) What is the flow rate? 333 ml/hr
b) What is the drip rate? gtt/min
Answers
a) 4000 ml = ? = 333 ml
12 hr hr hr
b) 333 ml/hr X 15 gtt/ml = gtt/min
60 min

3. Add to 100 ml N/S given over 45 min gtt factor 15 gtt/ml
2. IV med: Order: Gentamycin 100 mg IVPB q4h
Available: 40 mg/ml
Add to 100 ml N/S given over 45 min
gtt factor 15 gtt/ml
How much do you add to the minibag? 2.5 ml
What is the drip rate? gtt/min

4. a) desire X stock = amount 100 mg X 1 ml = 2
a) desire X stock = amount 100 mg X 1 ml = 2.5 ml have 40 mg or 100 mg = 40 mg = 2.5 ml ? 1 ml b) 100 ml = ? = 133 ml 45 min 60 min(1 hr) hr Remember when calculating drip rate (gtt/min) you need to know flow rate (ml/hr) first! 133 ml/hr x 15 gtt/ml = gtt/min 60 min

5. have 5000 units or 3000 units = 5000 units = 0.6 ml ? 1 ml Answer
3. SC: Order: Heparin 3000 units s/c OD
Available 5000 units/ml
a) How many mls do you administer? 0.6 ml
Answer
a) desire X stock = amount units X 1 ml = 0.6 ml
have units or
3000 units = 5000 units = 0.6 ml
? ml

6. or 15 mg = 60 mg = 0.5 ml ? 2 ml Available: 60 mg/2ml
4. IM: Order: Toradol 15 mg IM STAT
Available: 60 mg/2ml
How many mls do you administer?
Answer
a) desire X stock = amount 15 mg X 2 ml = 0.5 ml
have mg or
15 mg = 60 mg = 0.5 ml
? ml

7. Urinary Catheterization
Urinary catheterization is done when a person is unable to urinate using a toilet, bedpan, urinal, bedside commode, or when accurate urinary output is required
A urinary catheter is a tube that is inserted into the bladder through the urethra to allow the urine in the bladder to drain out

8. Situations When a Urinary Catheter is Used
A urinary catheter is used in many different situations:
A urinary catheter may be inserted to drain the bladder before or during a surgical procedure, during recovery from a serious illness or injury, or to collect urine for testing
A urinary catheter may be used for a person who is incontinent of urine, if the person has wounds or pressure ulcers that would be made worse by contact with urine
A urinary catheter is necessary when a person is unable to urinate because of an obstruction in the urethra

9. Types of catheters
A condom catheter, consists of a soft plastic or rubber sheath, tubing, and a collection bag for the urine. The sheath is placed over the penis and the collection bag is attached to the leg. Collects urine when there is no need for catheter insertion.
A straight catheter, is used when the catheter is to be inserted and removed immediately.
An indwelling catheter, also known as Foley catheter, is left inside the bladder to provide continuous urine drainage.
A suprapubic catheter is a type of indwelling catheter. The suprapubic catheter is inserted into the bladder through a surgical incision made in the abdominal wall, right above the pubic bone.
A 3-way catheter for continuous bladder irrigation (CBI) is a type of indwelling catheter. It is inserted to irrigate the bladder to prevent obstruction (i.e bleeding)

10. Catheters
Straight
Condom
Indwelling
Suprapubic

11. 3-way
CBI
Irrigations performed on intermittent or continuous basis to maintain catheter patency. A closed system can provide continuous or intermittent irrigation without disrupting sterility

12. Caring for a Person with an Indwelling Urinary Catheter
Indwelling urinary catheters are connected by a length of tubing to a urine drainage bag
The tubing is secured loosely to the person’s body near the insertion site using a catheter strap or adhesive tape
Securing the tubing to the person’s body prevents the catheter from being accidentally pulled out during repositioning

13. Caring for a Person with an Indwelling Urinary Catheter
A little bit of slack is left in the tubing to prevent the catheter from pulling against the bladder outlet and the urethral opening
The remaining length of tubing is then gently coiled and secured to the bed linens using a plastic clip or safety pin

14. Caring for a Person with an Indwelling Urinary Catheter
Coiling the tubing prevents the tubing from becoming bent or kinked, coiling the tubing and securing it to the bed linens also keeps the weight of the tubing from pulling against the person’s body.
The drainage bag is then secured to the bed frame at a level lower than the person’s bladder.

15. Caring for a Person with an Indwelling Urinary Catheter
If the drainage bag and tubing are higher than the person’s bladder, then gravity could cause old, contaminated urine to run back down the tubing and into the person’s bladder, causing an infection.

16. Providing Catheter Care
Providing good catheter care is important because the presence of the catheter in the urethra provides a pathway for bacteria to travel up from the perineum into the bladder
Having a catheter eliminates the “flushing” action of normal urination, which helps to remove bacteria from the urinary tract naturally.

17. Providing Catheter Care
Bacteria can be introduced into the body both when a catheter is inserted and after it is in place, urinary tract infections (UTIs) in catheterized people are one of the most common nosocomial infections.

18. Urinary Catheterization - Emptying Urine Drainage Bags
Urine drainage bags are routinely emptied and the urine measured at the end of each shift.
Urine drainage bags should also be emptied if they are full.
Leg bags need to be emptied frequently because they are smaller, and hold less urine.

19. Be sure to monitor urine output
Amount
Characteristics (color, clarity, sediment, hematuria, odor)
less than 30 ml/hr of urine indicates a problem

20. Catheter Insertion Equipment: (check packages and expiry dates)
Catheter tray (with drapes, fenestrated drape, cotton balls, forceps)
Catheter (14-16 Fr (for women) 12 Fr for young girls
(16-18 Fr (for men)
Sterile drainage tubing with collection bag
Correct size syringe (check catheter balloon)
Sterile water
Cleansing solution
Lubricant
Sterile gloves
Specimen container
Tape to anchor tubing
Gloves
Bath blanket

21. Assess
Review physician’s order and understand purpose of inserting catheter
Assess client (last urination, level of awareness, understanding)
Palpate bladder
Identify meatus and assess skin integrity
Identify potential difficulties (i.e enlarged prostate)

22. Implement Wash hands Provide privacy
Raise bed, stand on left side of bed if right handed (right side if left handed)
Arrange equipment
Water proof pad under client
Position & drape client

23. With disposable gloves, wash perineal areas Wash hands
Female: dorsal recumbent (supine with knees flexed) or Sims position (side-lying with upper leg flexed at knee and hip)
Male: supine position
With disposable gloves, wash perineal areas
Wash hands
Open tubing with collection bag (attach to bed frame and
have tubing positioned to easily connect to catheter once inserted
organize sterile field – add catheter, lubricant, syringe and sterile water, test balloon, pour cleaning solution over cotton balls
Apply sterile gloves

24. Lubricate catheter (2. 5 to 5 cm for women) and 12. 5 to 17
Lubricate catheter (2.5 to 5 cm for women) and 12.5 to 17.5 cm for men)
*Note: there may be an order for lubricant containing local anaesthetic*
Apply sterile drapes keep gloves sterile
women: under buttocks and fenestrated over perineum
men: over thighs and fenestrated over penis

25. Place sterile tray and contents between legs
Cleanse meatus:
Women: with nondominant hand, expose meatus, maintain
Position of hand, cleanse with forceps, wipe from front to back,
new cotton ball each swipe, far labial fold, near, and directly
over meatus
Men: retract foreskin, hold penis below glans, maintain position
of hand, with forceps clean in a circular motion from meatus
down to base of glans, repeat three more times

26. Hold end of catheter loosely coiled in dominant hand, place end of catheter in tray
Insert catheter:
Women: ask client to bear down as if to void,
insert 5 to 7.5 cm or until urine flows, then
advance another 2.5 to 5 cm
Men: hold penis perpendicular, ask client to
bear down, insert 17 to 22.5 cm or until urine
flows, then advance to bifurcation

27. Collect specimen if indicated
Allow bladder to empty unless policy restricts (800 to 1000 ml)
Inflate balloon with amount indicated
If client complains of pain, aspirate solution and advance catheter further and inflate
Gently pull to feel resistance
Attach catheter to collection bag and attach to bed frame below bladder
Anchor catheter (thigh if appropriate and coil tubing on bed and attach to mattress)

28. Evaluate Palpate bladder Assess comfort
Characteristics and amount of urine

29. Document Report and record type and size of catheter
Amount of fluid used to inflate balloon
Characteristics of urine, amount, reason for catheter, specimens, client’s response

30. Video Female intermittent catheter Female indwelling catheter
Irrigating using closed system
Unexpected situations

31. Lets Practice!