URINARY CATHETERIZATION

Equipments: • Flashlight or lamp • Mask, if required by agency policy • Bath blanket • Soap; a basin of warm water, a washcloth and a towel • Disposable gloves • A sterile catheterization kit containing:  Sterile gloves  Drapes, fenestrated (optional)  Antiseptic cleansing solution  Cotton balls or gauze squares  Forceps

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Water soluble lubricant Catheter of appropriate size (either straight or indwelling)  French #14 or #16 for adult women  French #18 or #20 for adult men  French # 8 or # 10 for children Drainage tubing or collection bag Specimen container (if necessary) Receptacle for waste Tape or plaster Rubber draw sheet  

INSERTING A STRAIGHT CATHETER IN FEMALES PROCEDURE 1. Assess the status of the client a. When client last voided b. Level of awareness or developmental stage c. Mobility and physical limitations d. Age-Determines catheter to use e. Pathological condition that may impair passage of catheter such as enlarged prostate f. Allergies RATIONALE 1 2 3 4 5

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PROCEDURE 2. Prepare all equipment and supplies before entering room of the patient. Be sure to wash hands. 3. Explain the procedure. Describe the pressure sensation that will be felt during insertion. 4. Clear bedside table and arrange equipment for convenience. Place materials for cleaning perineum separately. 5. Provide privacy to the client. Have her lie on a firm mattress. Place waterproof pad under the client.

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6. Position the client in dorsal recumbent position with thighs elevated and externally rotated. Pillows may support legs.

7. Drape the client with bath blanket. Place blanket over client one corner at each side corner over arms and sides, last corner over the perineum. Raise gown above hips. 8. Wear disposable gloves. Wash perineal – genital area with warm water and soap. Dry the area. Remove and dispose of gloves.

9. If necessary, position lamp to illuminate perineal area.

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PROCEDURE 10. Open catheterization kit and catheter according to direction. Put on sterile gloves. 11. Organize supplies on the sterile; open sterile package containing catheter, pour antiseptic solution over the cotton balls; open packet containing containing lubricant, remove specimen container. 12. Apply sterile drape. Use first drape as an underpad, and place it under buttocks. Place fenestrated drape over perineal area exposing only the labia. If fenestrated drape is snot available, place two high drapes from side farthest to the side and nearest to you. Place sterile kit between thighs. 13. Lubricate the insertion tip of the catheter about 1-2 inches. Be careful not to clog the opening. 14. With non-dominant hand, carefully retract the labia to fully expose urethral meatus. Maintain position of nondominant hand throughout the remainder of procedure. 15. With nondominant hand, pick up forceps with cotton balls and clean the perineal area wiping from front to back (clitoris to anus). Use one cotton ball for each stroke near the labial field, along far labial field and directly over meatus. 16. Pick up catheter with gloved dominant hand approximately 5 cm from the catheter tip. Hold end of catheter loosely coiled in palm

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PROCEDURE 17. Insert the catheter slowly through the urinary meatus. Advance the catheter approximately 5-7.5 cm in adult (2.5 cm in children) until urine flows out of the catheter. Ask the client to take deep breaths if catheter meets resistance. Release labia and hold catheter securely. 18. If urine specimen is to be collected, pinch the catheter and transfer the drainage end of it into sterile specimen bottle. Cover specimen cup and set aside for labeling. 19. Allow bladder to empty fully or partially depending on agency policy or physician’s order.

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20. When flow of urine begins to decrease withdraw catheter slowly about 1 cm at a time until barely drips, then withdraw the catheter completely.

21. Remove the equipment used. Assist the client to a comfortable position. Dry the client’s perineum with a towel or drape. Proper aftercare of equipment should be done. Send urine specimen to laboratory after proper labeling.

22. Document the catheterization. Include assessment before and after procedure; type and size of catheter inserted: time, character and amount of urine obtained; specimen sent to laboratory and client’s response to procedure.

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INSERTING A STRAIGHT CATHETER IN MALES PROCEDURE 1. Follow techniques 1-5 of female straight catheterization RATIONALE 1 2 3 4 5

2. Assist the client to assume supine position with thighs slightly abducted and knees slightly flexed.

3. Drape the client’s upper trunk with bath blanket and cover lower extremities with bedsheets exposing only the genitalia. 4. Place catheter set next to patient’s legs.

5. Follow technique 8-11 of female straight catheterization.

6. Apply sterile drape over thighs just below the pelvis. Pick-up fenestrated drape, allow it to unfold and drape it over penis, with fenestrated slit resting over penis. 7. Lubricate 7.5 – 12.5 cm (3-5 inches) along side of catheter tip. Be careful not to clog the eye of catheter.

8. With the non-dominant hand, grasp the penis firmly behind the glans while spreading meatus between thumb and forefinger. Retract the foreskin of an uncircumcised male. Maintain non-dominant hand in this position throughout catheter insertion.

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PROCEDURE 9. With dominant hand, pick up cotton ball with forceps and clean penis. Clean the meatus first, and then wipe the tissue surrounding the meatus in a circular motion. Discard each swab after each stroke. 10. Pick up the catheter with dominant hand holding it about 8-10 inches from the insertion tip. Place drainage end in the urine receptacle. 11. Lift the penis to a position perpendicular to the body (90 angle) and exert slight traction (pulling or tension upward). Insert catheter steadily about about 20 cm (8 inches) or until urine flows. If resistance is met, twist the catheter or ask the client to take deep breaths or try to void. 12. While urine flows, lower the penis and hold the catheter securely with dominant hand.

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13. Follow technique 18-22 for female catheterization for remainder of the procedure.

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INSERTING A RETENTION CATHETER PROCEDURE 1. Test catheter balloon by injecting fluid from pre-filled syringe into balloon valve. The balloon should inflate without leakage. Withdraw fluid and leave syringe on port of catheter. 2. Follow steps as of straight catheterization. • Lubricate insertion tip of catheter • • • Remove sterile cap of specimen container if urine specimen is needed Clean urinary meatus and surrounding tissues Insert the catheter RATIONALE 1 2 3 4 5

• Collect urine specimen if required 3. Insert the catheter an additional of 2.5 cm (1-2 inches) beyond the part at which urine began to flow.

4. Slowly inject total amount of solution (5-10 ml. sterile water). If client complain of sudden pain, aspirate back solution and advance catheter further. Inject no more fluid than the balloon size indicates. 5. When the balloon is safely inflated, apply slight tension on catheter until resistance is felt. Move catheter slightly back in bladder. Remove the syringe. 6. Attached end of catheter to collecting tube of drainage system. Place bag in dependent position. PROCEDURE RATIONALE 1 2 3 4 5

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7. Tape the catheter to the inside of female thigh or abdomen of a male client.

8. Hang the drainage bad on the frame of the bed below the level of the bladder.

9. Document pertinent data • Time and date of catheterization • • • • • • Reason for catheterization Amount of sterile water to inflate balloon Character and amount of urine obtained Specimen sent to laboratory Other pertinent information before and after procedure Client’s response

PROVIDING CATHETER CARE

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Equipments: • Soap • Washcloth and towel • Bath basin • Warm water PROCEDURE 1. See Standard Protocol.

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Disposable glove Bath blanket Waterproof pad

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2. Position client comfortably and cover with bath blanket, exposing only perineal area.

3. Place waterproof pad under client.

4. Provide routine perineal care, making sure all perineal folds are cleansed thoroughly. 5. Hold catheter securely near the meatus with the gloved nondominant hand. Using a clean washcloth, soaps and water, take the dominant hand and wipe in a circular motion along the length of the catheter for about 100 10cm (4 inches). Avoid placing tension on or pulling on the exposed catheter tubing. 6. Replace as necessary the anchor device used to secure the catheter tubing to the client’s leg or abdomen.

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PROCEDURE 7. Check drainage tubing and bag.

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8. Empty collection bag as necessary or at least every 8 hours.

9. See Completion Protocol.

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REMOVAL OF RETENTION CATHETER Equipments: • 10-ml syringe without a needle or larger depending upon volume of solution used to inflate the • Waterproof pad • Clean disposable gloves • Urine “hat” PROCEDURE 1. See Standard Protocol. 2. Position the client supine, and place a water-proof pad under the catheter. Females will need to abduct the legs with the drape between thighs. Drape can lay on male’s thighs. 3. Insert hub of syringe into inflation valve (balloon port). Aspirate until tubing collapses, indicating that entire contents of balloon has been removed. 4. Remove catheter smoothly and steadily. 5. Wrap catheter on waterproof pad. Unhook collection bag and drainage tubing from bed. 6. Measure urine, and empty the drainage bag. Record output. 7. Cleanse the perineum with soap and water, and dry area thoroughly. 8. Place the urine “hat” on the toilet seat. RATIONALE

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PROCEDURE 9. See Completion Protocol 10. Evaluation: • Observe time and amount of first voided specimen. • • Monitor I & O. Ask client to list the signs and symptoms or urinary tract infection.

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11. Documentation: a. Record and report time catheter was removed. b. Record teaching relating to increasing fluid intake and signs and symptoms or urinary tract infection. c. Record and report time, amount, and characteristics of first voiding. d. Record I & O.

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APPLYING AND REMOVING A DRAINAGE CONDOM Equipments: • Leg drainage bag with tubing or urinary drainage bag with tubing • Condom sheath • Bath blanket or similar drape • Clean gloves • Basin of warm water and soap • Washcloth and towel • Elastic tape or Velcro strap PROCEDURE 1. Review the client record to determine a pattern to voiding and other pertinent data. 2. Apply clean gloves and examine the client’s penis for swelling or excoriation that would contraindicate the use of the condom 3. Assemble the leg drainage bag or urinary drainage bag for attachment to the condom sheath. 4. Roll the condom outward onto itself to facilitate easier application. On some models, the inner flap will be exposed. This flap is applied around the urinary meatus to prevent the reflux of urine. 5. Position the client in either a supine or a sitting position. 6. Explain to the client what you are going to do, why it is necessary, and how he can cooperate. RATIONALE 1 2 3 4 5

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7. Discuss if using a condom catheter will impact further care treatments. 8. Wash hands, apply clean gloves, and observe appropriate infection control procedures.

9. Provide for client privacy. • Drape the client appropriately with the bath blanket, exposing only the penis. 10. Inspect and clean the penis. • Clean the genital area and dry it thoroughly. 11. Apply and secure the condom. • Roll the condom smoothly over the penis, leaving 2.5 cm (1 inch) between the end of the penis and the rubber or plastic connecting tube • Secure the condom firmly, but not too tightly, to the penis. Some condoms have an adhesive inside the proximal end that adheres to the skin of the base of the penis. Many condoms are packaged with special tape. If neither is present, use a strip of elastic tape or Velcro around the base of the penis over the condom. Ordinary tape is contraindicated because it is not flexible and can stop blood flow.

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PROCEDURE 12. Securely attach the urinary drainage system. • Make sure that the tip of the penis is not touching the condom and that the condom is not twisted. • • • Attach the urinary drainage system to the condom. Remove the gloves and wash your hands. If the client is to remain in bed, attach the urinary drainage bag to the bed frame. If the client is ambulatory, attach the bag to the client’s leg.

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13. Teach the client about the drainage system. • Instruct the client to keep the drainage bag below the level of the condom and to avoid loops or kinks in the tubing.

14. Inspect the penis 30 minutes following condom application, and check urine flow. Document these findings. • Assess the penis for swelling and discoloration, which indicates that the condom is too tight. • Assess urine flow if the client has voided. Normally, some urine is present in the tube if the flow is not obstructed.

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PROCEDURE 15. Change the condom daily and provide skin care. • Remove the elastic or Velcro strip, apply clean gloves, and roll off the condom. • • • Wash the penis with soapy water, rinse, and dry it thoroughly. Assess the foreskin for signs of irritation, swelling, and discoloration. Reapply a new condom.

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16. Document in the client record using forms or checklists supplemented by narrative notes when appropriate. Record the application of the condom, the time, and pertinent observations, such as irritated areas on penis

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