CHAPTER 48 / Urinary Elimination 1303

(every 3 to 4 hours) may be performed because the risk of urinary tract infection may be less than with an indwelling catheter.

Urinary Catheterization
Urinary catheterization is the introduction of a catheter into the urinary bladder. This is usually performed only when absolutely necessary, because the danger exists of introducing microorganisms into the bladder. Clients who have lowered immune resistance are at the greatest risk. Once an infection is introduced into the bladder, it can ascend the ureters and eventually involve the kidneys. The hazard of infection remains after the catheter is in place because normal defense mechanisms such as intermittent flushing of microorganisms from the urethra through voiding are bypassed. Thus, strict sterile technique is used for catheterization.

CLINICAL ALERT
The insertion of urinary catheters is one of the most common causes of hospital-acquired infections, ffl Figure 48-8 A coude catheter. (Courtesy of Bard Medical Division.)

Another hazard is trauma with urethral catheterization, particularly in the male client, whose urethra is longer and more tortuous. It is important to insert a catheter along the -normal contour of the urethra. Damage to the urethra can occur if the catheter is forced through strictures or at an incorrect angle. In males, the urethra is normally curved, but it can be straightened by elevating the penis to a position perpendicular to the body.

Catheters are commonly made of rubber or plastics although they may be made from latex, silicone, or polyvinyl chloride (PVC). They are sized by the diameter of the lumen using the French (Fr) scale: the larger the number, the larger the lumen. Either straight catheters, inserted to drai n the bladder and then immediately removed, or retention catheters, which remain in the bladder to drain urine, may be used. The straight catheter is a single-lumen tube with a small eye or opening about 1 1/4 cm (1/2 in.) from the insertion tip (Figure 48-7 ) . The coude catheter is a variation of the straight catheter. It is more rigid than other straight catheters and has a tapered, curved tip (Figure 48-8 ). This catheter may be used for men with prostatic hypertrophy because it is more easily controlled and less traumatic on insertion. The retention, or Foley, catheter is a double-lumen catheter. The larger lumen drains urine from the bladder. A second, smaller lumen is used to inflate a balloon near the tip of the catheter to hold the catheter in place within the bladder (Figure 48-9 ). Clients who require continuous or intermittent bladder irrigation may have a three-way Foley catheter (Figure 48-10 ). The three-way

B Figure 48-7 Red-rubber or plastic Robinson straight catheters. (Courtesy of Bard Medical Division.)

Figure 48-9 An indwelling/retention (Foley) catheter with the balloon inflated. (Courtesy of Bard Medical Division.)