Urinary Catheterization

Prepared by
Nilam Gurung
Roll no 23
PBBN 3rd year
Urinary Catheterization
Definition
Catheterization is a process of drawing urine from the
urinary bladder by means of catheter by using aseptic
technique for the purpose of empting the bladder.
Types
1.External Cathetererization
Condom Catheterization
2.Urethreal Catheterization
Intermittent Catheterization
Indwelling Catheterization
3.Suprapubic Catheterization
1.External Catheterization
External catheterization is a
rare type of catheterization
in which device called
condom catheter remains
outside of the body in the
form of a urinary pouch or a
penile sheath catheter.
External catheters are an
effective way to collect urine
but are not indicated for
management of urinary
obstruction. It is used in
incontinence male
Purposes
• To drain urine incase of an incontinent patient
• To permit patient’s normal physical activity without
fear of embarrassment caused by incontinence
2.Urethral Catheterization
Urethral catheter are more invasive
because the device is inserted
transurethrally. It includes;
• Intermittent catheterization
It is a safe and effective method to
empty the bladder in patients with
voiding disorders where patient need
either short term catheter or as a daily
habit for life. IC involves the use of a
short, flexible catheter that is inserted
through the urethra into the bladder
to drain urine.
Purposes
 To relieve bladder distension
 To assess for residual urine after voiding
 To obtain a sterile specimen
 To empty bladder prior to delivery or abdominal
surgery
• Indwelling Catheterization

A urinary catheter is inserted

into the urethra and
advanced into the bladder
allowing for the continuous,
passive drainage of urine
from the bladder. A balloon
at the proximal end of the
catheter is inflated with
sterile water to hold the
catheter in place .
Cont..
 Short-Term Versus Long-Term Catheterization
Short-term catheterization has been described
differently by varying sources as a catheter that is
expected to be removed after the bladder is emptied
or within 1 to 14 days of use or the catheter is used
less than 30 days
Long-term catheterization is referred to as catheter use
for more than 30 days. It is used to manage urinary
retention and incontinence when other methods are
not effective
Purposes
 To facilitate urinary elimination in incontinent patient
 To relieve acute or chronic urinary retention
 To splint urethra to promote healing after urological
surgery
 To prevent urine from contacting an incision after
perineal surgery
 To facilitate continuous bladder drainage after injury/
surgery on urinary tract or other major surgeries
3.Suprapubic Catheterization

Suprapubic catheterization,
a urinary catheter is passed
percutaneously through the
anterior abdominal wall
into the bladder, and is
usually sited
approximately 2 cm above
the pubic bone
Purposes
 To manage acute urinary retention when other types
of catheterization is not possible for example urethral
closure.
 To allow instruments to pass into the bladder for
some urological procedures eg cystoscopy
 Temporary diversion of urine for some
gynecological, abdominal, or urological surgeries
 To prevent persistent problems due to urethral
catheters for examples, irritation, blocking, or leakage
around a urethral catheter
 Chronic bladder drainage when no other alternative
therapy is possible.
Nursing Management of Patient
Undergoing Urinary Catheterization
In caring for a patient with catheter, the main goal
includes;
• To prevent urinary tract infection
• To prevent ascending infection
• To make free flow of urine
• To make comfort to the patient
Cont..
• Pre procedure care
 Explain the procedure, purposes and importance of
procedure to the patient
 Take informed consent
 Take vital signs
 Maintain privacy
 Provide psychological support
 Positioning the patient
 Keep ready specimen collection container if needed
Cont..
 Ask the patient regarding any allergy to anesthesia,
latex, Urinary tract infection and clotting disorders
Cont..
• During procedure
 Assess the patient’s condition continuously
 Encourage the patient to be patience and take deep breath
 Collect the urine specimen properly if ordered
 Assess color, odour, consistency and amount of urine
 Ensure that the patient feel comfort or not
 Circulate the articles as needed
 Do not force the catheter during insertion that may cause
lower urinary tract injury
 Perform procedure by following principles and aseptic
techniques
Cont..
• Post procedure care
 Replace the all articles properly
 Keep the patient in comfortable position
 Fix the urinary catheter properly
 Assess the any bleeding on incision site
 Documentation should be done about date and time of
procedure, types of catheter used, amount,
color,ordour and consistency of urine,any
abnormalities and condition of patient after procedure
 Recheck the catheter for proper draining of urine
General Care
• Encourage the patient to take plenty of fluids atleast
2.5 to 3litre per day or according to patient conditon
• Maintain closed drainage system and do not open the
drainage system at connection points to obtain
specimen or to measure urine
• If the drainage tube becomes disconnected do not
touch the ends of the catheter. Wipe the ends with
antiseptic solution before reconnecting it
• Avoid prolonged clamping or kinking of tubing
• Remind the patient never to lie on the tubing and to
check it tomake sure there are no bends in the tube
Cont..
• Never leave the urinary bag lying on the floor
• Empty the drainage bag at 3 to 4 hours
• Give perineal care twice a day and after defecation if
possible
• Prevent pooling and reflux of urine into the bladder by
following measures;
o Avoid raising the drainage bag above the level of
patient’s bladder. It is needed clamp the catheter
o Not allow to full up drainage bag
o Drain all urine from the tubing to the bag before the
client exercises or ambulates
Cont..
o While changing position or in bed making drainage bag
should be clamped
• If sedement gathers in the tubing or drainage bag or if there
is a leak, need to change the tube and bag
• Remove the condom once a day to clean the area and assess
the skin for any signs of infection, impaired skin integrity
• Do not reattach the condom catheter if it falls off. It will not
stick any better in second try. Apply a new catheter and strip
• Client may have latex allergy and may require latex free
condoms
Cont..
• Patients at risk for UTI may be treated with an
antibiotic prior to the catheter exchange
• During a catheter exchange, insert the catheter within
10 minutes of removing the existing catheter because
the catheter tract will close quickly
• Determine the proper length/depth to insert the new
catheter. Mark the length of the existing catheter at
the skin level where it exits; mark the corresponding
length on the new replacement catheter to ensure it is
placed at the correct depth; lubricate the tip of the
catheter with water soluble gel and reinsert the
catheter to the same length; and inflate the balloon
Cont..
• When removing a Supra Pubic catheter, Do not
withdraw water out of the balloon, but attach a syringe
and allow the water to flow out by gravity
• Consider clamping the catheter, prior to removal, to
ensure there is a sufficient volume of urine in the
bladder to drain with the insertion of the new catheter,
and avoid a prolonged wait to confirm the placement
• Have the patient take deep breaths and relax the
abdominal muscles during removal and reinsertion of
the catheter.
Cont..
• Monitor the stoma daily for irritation, erosion, urine
leakage, and assess the skin integrity under the
securement device
• Observe for urine output from the catheter to make
sure it is patent.
• Perform catheter irrigations only with a physician’s
order. Routine bladder irrigations are not beneficial,
but may be recommended in special circumstances,
such as for management of blood clots or calculi
blocking the catheter
Cont..
• Keep dressings in place for the first month until the
stoma site is healed and then dressings can be
discontinued. Application of anti-microbial agents at
the stoma site is not recommended.
• Secure the catheter to the lower abdomen to prevent
traction and trauma to the anterior bladder wall or
skin at the insertion site, and prevent dislodgement
• The new suprapubic tract matures in approximately 2
weeks, but the catheter should not be changed for 6 to
12 weeks
Complications
• Catheter associated urinary tract infection (CAUTI)
• Urethral injury
• Bladder cancer (usually only with long term use of
indwelling catheter
• Urinary bladder perforation
• Kidney damage
• Haemorrhage
Cont..
• Urinary catheter obstruction due to bladder stone
• Bypass leakage
• Catheter related bladder discomfort
• Skin breakdown
• Allergy or sensitivity to latex