Urinary catheterization

Urinary Catheterization

Urinary catheterization is the insertion of a specially designed

tube into the bladder using aseptic technique

Purposes of catheterization:
• draining urine
• the removal of clots/debris
• the instillation of medication
 Indications
• To empty the contents of the bladder
• To determine residual urine
• To allow irrigation of the bladder
• To bypass an obstruction
• To relieve retention of urine
• To enable bladder function tests to be performed
• To measure urinary output accurately
• To relieve incontinence when no other means is practicable
• Imaging study of the lower urinary tract
• To avoid complications during the insertion of radioactive material into the
cervix/uterus, brachytherapy for the prostate
 Considerations
• It is an invasive procedure and should not be undertaken without full
consideration of the benefits and risks
• Catheterization carries an infection risk. Catheter-associated
infections are the most common hospital-acquired infection,
accounting for 40% of all hospital infections
• The presence of a catheter can be a traumatic experience for patients
• Indwelling catheters are the primary source of urinary tract infections
within acute care
It is essential that they are only used if clinically necessary
 Contraindications

• Traumatic injury
• Suspicion on urethral laceration
• Acute bacterial prostatitis
• Refusal by patient to be catheterized
• Failed attempt during catheterization
 Alternative Types of Catheters
• Suprapubic catheter – catheter inserted through the anterior
abdominal wall into the dome of the bladder
• Intermittent catheter - or straight catheters is used to drain
the bladder for shorter periods (5 to 10 minutes)
• External condom catheter – is used when voluntary control
of urination is not possible for male patients, it represents an
alternative to an indwelling catheter
Suprapubic Catheter
Straight Catheter
External Condom Catheter
Types of Straight Catheter
Urine drainage bags are available in a wide selection of sizes ranging from the large
2 liter bag, which is used more commonly in non-ambulatory patients and
overnight, to 350–750 mL leg bags
 Drainage bags
1. Urine drainage bags should only be changed
according to clinical need: when that catheter is
changed or if the bag is leaking, or at times
dictated by the manufacturer’s instructions, for
example every 5–7 days
2. Therefore bags should always be positioned below
the level of the bladder to maintain an
unobstructed flow, appropriate empting, avoiding
urine reflux and associated with it infection
Urinary catheterization: male
 Essential equipment
• Sterile pack containing gallipots, receiver, gauze swabs, disposable towels
• Disposable pad
• 0.9% sodium chloride
• Bactericidal alcohol handrub
• Hypoallergenic tape or leg strap for tethering
• Sterile gloves
• Sterile water
• Selection of appropriate catheters
• Syringe and needle (as required to obtain a urine sample)
• Sterile anaesthetic lubricating jelly
• Disposable plastic apron
• Universal specimen container
• Drainage bag and stand or holder
• Clean towel or similar cover
 Pre-procedure
• Explain and discuss the procedure with the patient and screen the
bed
• Prepare the trolley, placing all equipment required on the bottom
shelf
• Take the trolley to the patient’s bedside
• Assist the patient to get into the supine position with the legs
extended on the bed
• Remove underpants or pyjama trousers and use a towel to cover the
patient’s thighs and genital area
• Sanitize hands
• Put on a disposable plastic apron
 Procedure
• Open the outer cover of the catheterization pack and slide the pack
onto the top shelf of the trolley
• Using an aseptic technique, open the sterile/catheter pack. Pour 0.9%
sodium chloride into gallipot. Open an appropriately sized catheter
onto the sterile field
• Remove cover from the patient’s genital area, maintaining the
patient’s privacy, and position a disposable pad under the patient’s
buttocks and thighs
• Clean hands with a bactericidal alcohol handrub and put on sterile
gloves
• On the sterile field, place the catheter into the sterile receiver
 Procedure
• Place a sterile towel across the patient’s thighs
• With one hand, wrap a sterile topical swab around the penis. Use this to
retract the foreskin, if necessary, and with the other hand clean the
glans penis with 0.9% sodium chloride or sterile water in circular spiral
motion from glans toward the shaft
• Insert the nozzle of the lubricating jelly into the urethra. Squeeze the gel
into the urethra, remove the nozzle and discard the tube. Massage the
gel along the urethra using the barrel of the syringe
• Squeeze the penis and wait approximately 5 minutes
• With non dominant hand hold the penis firmly behind the glans, raising
it until it is almost totally extended. Maintain this hold of the penis
until the catheter is inserted and urine flowing
 Procedure
• With the dominant hand, place the receiver containing the catheter between
the patient’s legs. Take the catheter and insert it into the penis for 15–25 cm
until urine flows
• If resistance is felt at the external sphincter, increase the traction on the penis
slightly and apply steady, gentle pressure on the catheter. Ask the patient to
cough gently
• When urine begins to flow, advance the catheter to its bifurcation
• Gently inflate the balloon according to the manufacturer’s direction
• Withdraw the catheter slightly and attach it to the drainage system
• Support the catheter either by using a specially designed support or by taping
the catheter to the patient’s leg
• Ensure that the glans penis is clean and dry and then extend the foreskin
 Post Procedure
• Assist the patient to replace underwear and pyjama and replace bed cover
Ensure that the area is dry
• Measure the amount of urine
• If required, take a urine specimen for laboratory examination
• Dispose of equipment including apron and gloves in an orange plastic clinical
waste bag and seal the bag before moving the trolley
• Draw back the curtains
• Dispose of clinical waste bag in a larger bin
• Wash hands thoroughly with bactericidal soap and water
• Record information in relevant documents
 Record
Record includes the following information:
• reasons for catheterization
• date and time of catheterization
• catheter type, length and size
• amount of water instilled into the balloon
• batch number
• manufacturer
• any problems negotiated during the procedure
• a review date to assess the need for continued catheterization or date of
change of catheter
Urinary catheterization: Female
 Essential equipment
• Sterile pack containing gallipots, receiver, gauze swabs, disposable towels
• Disposable pad
• 0.9% sodium chloride
• Bactericidal alcohol handrub
• Hypoallergenic tape or leg strap for tethering
• Sterile gloves
• Sterile water
• Selection of appropriate catheters
• Syringe and needle (as required to obtain a urine sample)
• Sterile anaesthetic lubricating jelly
• Disposable plastic apron
• Universal specimen container
• Drainage bag and stand or holder
• Clean towel or similar cover
 Pre-procedure
• Explain and discuss the procedure with the patient and screen the bed
• Prepare the trolley, placing all equipment required on the bottom shelf
• Take the trolley to the patient’s bedside
• Assist patient to get into the supine position with knees bent, hips flexed
and feet resting about 60 cm apart (lithotomy position)
• Remove underpants or pyjama trousers and use a towel to cover the
patient’s thighs and genital area
• Ensure that a good light source is available
• Sanitize hands
• Put on a disposable plastic apron
 Procedure
• Open the outer cover of the catheterization pack and slide the pack
onto the top shelf of the trolley
• Using an aseptic technique, open the sterile/catheter pack. Pour 0.9%
sodium chloride into gallipot. Open an appropriately sized catheter
onto the sterile field
• Remove cover from the patient’s genital area, maintaining the
patient’s privacy, and position a disposable pad under the patient’s
buttocks and buttocks
• Clean hands with a bactericidal alcohol handrub and put on sterile
gloves
• Place sterile towels under the patient’s buttocks
 Procedure
• Using gauze swabs, with non dominant hand separate the labia minora
so that the urethral meatus is seen. One hand should be used to
maintain labial separation until catheter is inserted and urine flowing
• Clean around the urethral orifice with 0.9% sodium chloride using
single downward strokes
• Place a small amount of the lubricating jelly/anaesthetic gel onto the
tip of the catheter
• Place the catheter, in the sterile receiver, between the patient’s legs
• Introduce the tip of the catheter into the urethral orifice in an upward
and backward direction. Advance the catheter until 5–6 cm has been
inserted
 Procedure
• If there is no urine present, remove the catheter gently and start
procedure again. If urine is present, advance the catheter 6–8 cm
• Inflate the balloon according to the manufacturer’s directions, having
ensured that the catheter is draining adequately
• Withdraw the catheter slightly and connect it to the drainage system
• Support the catheter either by using a specially designed support or
by taping the catheter to the patient’s leg
 Post Procedure
• Assist the patient to replace underwear and pyjama and replace bed cover
Ensure that the area is dry
• Measure the amount of urine
• If required, take a urine specimen for laboratory examination
• Dispose of equipment including apron and gloves in an orange plastic clinical
waste bag and seal the bag before moving the trolley
• Draw back the curtains
• Dispose of clinical waste bag in a larger bin
• Wash hands thoroughly with bactericidal soap and water
• Record information in relevant documents
 Record
Record includes the following information:
• reasons for catheterization
• date and time of catheterization
• catheter type, length and size
• amount of water instilled into the balloon
• batch number
• manufacturer
• any problems negotiated during the procedure
• a review date to assess the need for continued catheterization or date of
change of catheter
 Thank you for attention!

This presentation does not represent the studying

material

Reading:
The Royal Marsden Manual of
Clinical Nursing Procedures. Part Two. Chapter 5. p.147