URINARY

C A T H E T E R IZ T ION
MEMBERS:
Agudo, Brananola, Bernas, Laurente, Parrilla, Sobrado, Sulla,
Tolentino
 A R Y C A T HE T E R I Z A T I
U R I N O N
A ft e r 5 h o u r s of c l a s s ro o m d i s c u s s i o n and demonatrati on, the L e v e l I
n u rs i n g students will b e able to:
1. D E F I N E T E R M S R E L AT E D T O C AT H E T E R I Z AT I O N : 7. D I S C U S S C AT H E T E R I Z AT I O N IN R E L AT I O N TO :
A. C AT HE T E R A. P R I N C I P L E S I N V O LV E D
B . MIC T U R IT IO N B. P U R P O S E O R I M P O R TA N C E
C . U R IN A R Y R E T E N T IO N
C. I N D I C AT I O N S A N D C O N T R A I N D I C AT I O N S
D . U R IN A R Y C A T H E T E R IZ A T IO N
8. S T A T E T H E T Y P E S O F C A T H E T E R A N D M E T H O D S O F C AT H E T E R I Z AT I O N
E . U R G E N C Y IN U R IN A T IO N
9. D E S C R I B E T H E M A L E A N D F E M A L E M E T H O D S O F C AT H E T E R I Z AT I O N IN R E L AT I O N TO :
F . U R IN A R Y IN C O N T IN E N C E
G . R E S ID U A L V O L U ME A. S I Z E O F T H E C A T H E T E R
2. R E V I E W T H O R O U G H LY T H E A N AT O M Y A N D B. P O S I T I O N O F T H E PAT I E N T D U R I N G C AT H E T E R I Z AT I O N
P H Y S I O L O G Y O F T H E U R I N A R Y S Y S T E M IN C. L E N G T H /A R E A O F L U B R I C AT I O N A P P L I E D O N T H E C A T H E T E R
MALES AND FEM ALES D. L E N G T H O F C AT H E T E R I N S E R T I O N
3. E X P L A I N T H E P H Y S I O L O G Y O F U R I N E F O R M AT I O N
E. M E T H O D O F C AT H E T E R I Z AT I O N
4. D E S C R I B E T H E C H A R A C T E R I S T I C S O F A N O R M A L
10. D E T E R M I N E H O W T O S E L E C T A N A P P R O P R I AT E C A T H E T E R
URINE
11.L I S T D O W N T H E M AT E R I A L S N E E D E D F O R C AT H E T E R I Z AT I O N
5. E N U M E R AT E T H E D I F F E R E N T F A C T O R S
T H AT A F F E C T VOIDING 12. I D E N T I F Y G U I D E L I N E S T O B E O B S E R V E D D U R I N G A N D B E F O R E C AT H E T E R I Z AT I O N

6. D I F F E R E N T I AT E T H E VA R I O U S T Y P E S 13.I D E N T I F Y T H E N U R S I N G R E S P O N S I B I L I T I E S B E F O R E , D U R I N G A N D A F T E R
O F A LT E R AT I O N S IN U R I N A R Y C AT H E T E R I Z AT I O N
E L I M I N AT I O N
D E F INIT ION
OF TERMS
CAT HET ER
provides a continuous flow of urine
in patients unable to control
micturition or those with
obstructions.
a hollow flexible tube that C a n be
inserted into a vessel/cavity of the
body to withdraw or to instill fluids,
directly monitor various types of
information and visualize a vessel or
cavity.
MICTURITION
the process of emptying the
bladder; also called
micturition or voiding
 URINARY RETENTION
the accumulation of urine in
the bladder and inability of the
bladder to empty itself
U R I N A R Y C AT H E T E R I Z AT I O N
U rinary catheterization is the
introduction of a catheter into
the
urinary This is usually
bladder.
performed onlywhen absolutely
necessary, because the danger exists
of introducing microorganisms into the
bladder.
U R G E N C Y I N U R I N AT I O N

the feeling that one must

urinate
URINARY INCONTINENCE
a temporary or permanent inability of
the external sphincter muscles to
control the flow of urine from the
bladder
involuntary leakage of urine or loss of
bladder control, is a health
symptom, not a disease. It is normal
in infants. the inability to control
urination or defecation
RESIDUAL VOLUME
the amount of urine remaining in
the bladder after a person voids
Postvoid residual (PVR) (urine remaining
in the bladder following voiding) is
normally 5 0 to 100 mL.
P V R is measured to assess the amount
of
retained urine after voiding and
determine the need for interventions
A N AT O M Y A N D
PHYSIOLOGY
Urinary System in
Males and Females
 URINARY STEM
is one of the excretory systems of the body.
plays a vital part in maintaining homeostasis of
H 2 O and electrolyte concentration within the
body.
it consist of the following structures:
2 Kidneys, which secretes urine.
2 Ureters, which convey the urine
from the
kidneys to the urinary bladder.
1 U rinary B ladder, where the urine collects
and temporarily stored,
1 U rethra, throug h which the urine is
discharge from the urinary bladder to the
exterior.
KIDNEYS
are paired organs that are reddish in color and resemble kidney
bean in shape. They are about the size of a closed fist. They are
located above the waist between the parietal peritoneum and
the posterior wall of the abdomen. The right kidney is slightly
lower than the left because of the large area occupied by the
liver.
Average adult kidney measures about 11.25 cm (4 inches long),
2.0 - 7.5 cm (2-3 inches wide), and 2.5 cm (1 inch thick).
produces urine that contains metaboilic waste products,
including the nitrogenous compounds urea and uric acid, excess
ions and some drugs.
The main functions of the kidneys are:
1.Formati on and secretions of urine.
2. Producti on and secretion of erythropoietin, the hormone for
controlling the rate of formation of red blood cells.
3. Producti on and secretions of renin and important enzyme in
the
control of blood pressure.
URETERS
is basically an extension of the pelvis of the kidney and extends
about 25 - 3 0 cm (10 – 12 inches) with the diameter of about
3mm down to the urinary bladder. Each begins as the funnel-
shaped renal pelvis and descends parallel on each side of the
vertebral column to the bladder. They connect to the urinary
bladder posteriorly. The ureters are lined with the mucous coat
of transitional epithelium that can stretch Connecti ve tissue
binds the epithelium to a layer of smooth muscle.
Functi on:
The ureters propel the urine from the kidneys into the bladder by
peristaltic contraction of the smooth muscle layer. This is an
intrinsic property of the smooth muscle and is not under calyces.
Peristaltic waves several times, increasing in frequency with the
volume of urine produced, and send little spurts of urine into the
bladder.
URINARY BLADDER
it is a hollow muscular organ located in
the pelvic cavity posterior to the pubic
symphysis. It consists of the same tissue
layer as the ureters. It is a movable
organ held in position by folds of
peritoneum.
When empty, it resembles a deflated
balloon. It assumes a spherical shape
when slightly full of urine. As urine
volume increases, it becomes pear-
shaped and ascends into the
abdominal cavity.
 UR E T H R A
is a small thin-walled tube, leading from the floor of the
urinary bladder to the outside of the body. It transports urine
by peristalsis. Its position in two sexes differs slightly as does
it functions.
Females – it lies directly posterior to the pubic symphysis and is
located in the wall of the vagina in an anterior position just above
the vaginal opening. Its length is about 3.8 cm or 1.5 inches. Its
opening to the outside is called the urethral orifice and is
located between the clitoris and the vaginal opening.
Males - the urethra is 2 0 cm (8inches long). Directly below the
bladder, it passes vertically through the prostate gland. It then
passes through the urogenital diaphragm and enters the penis. It
opens at the tip of the penis at the urethral orifice. In the male,
the urethra has a dual function as part of both the urinary and
reproductive systems. It carries urine out of the body and
functions as a passageway for semen to be discharged from the
body
PHYSIOLOGY OF
URINE
F O R M AT I O N
Urine is formed in the nephrons through a complex
three step process.
1st step: Glomerular Filtrati on
Water, salts, nutrient molecules, and waste
molecules move from the glomerulus to the inside
of the glomerular capsule. These small molecules
are called the G L O M E R U L A R FILTRATION.
2nd step: Tubular Reabsorpti on
Nutrient and salt molecules are actively reabsorbed
from the proximal convoluted tubule into the
peritubular capillary network, and water flows
passively.
3rd step: Tubular Secreti on
Certain molecules are actively secreted from the
peritubular capillary network into the distal
convoluted tubule.
CHARACTERISTICS
OF A NORMAL
URINE
D IF F E R E NT
FA C TO R S
T H AT
AFFECT
VOIDING
 D E V E L O P M E N TA L FA C T O R S
I N FA N T S
Urine output varies according to fluid intake but gradually increases to 2 5 0
to 5 0 0 m L a day during the first year. An infant may urinate as often as 2 0
times a day. The urine of the neonate is colorless and odorless and has a
specific gravity of 1.008. Because newborns and infants have immature
kidneys, they are unable to concentrate urine very effectively.

PRESCHOOLER
The preschooler is able to take responsibility for independent toileting.
Parents need to realize that accidents do occur and the child should
never be punished or disciplined for this.Girls should be taught to wipe
from front to back to prevent contamination of the urinary tract by
feces.
 D E V E L O P M E N TA L FA C T O R S
SCHOOL-AGE CHILDREN
During this period, the child urinates six to eight times a day. Enuresis,
which is defined as the involuntary passing of urine

O L D E R A D U LT S
The excretory function of the kidney diminishes with age, but usually
not significantly below normal levels unless a disease process
intervenes.
 P SYC H O S O C I A L FA C TO R S
The person is unable to relax abdominal and perineal muscles and the external urethral sphincter;
thus, voiding is inhibited. People also may voluntarily suppress urination because of perceived time
pressures; for example, nurses often ignore the urge to void until they are able to take a break. This
behavior can increase the risk of UTIs.

F L U I D A N D F O O D I N TA K E
The healthy body maintains a balance between the amount of fluid ingested and the amount of fluid
eliminated. When the amount of fluid intake increases, therefore, the output normally increases.

M E D I C AT I O N S
Many medications, particularly those affecting the autonomic nervous system, interfere with the
normal urination process and may cause retention . Some medications may alter the color of the urine.

MUSCLE TONE
Good muscle tone is important to maintain the stretch and contractility of thedetrusor muscle so the
bladder can fill adequately and empty completely.
PAT H O L O G I C C O N D I T I O N S
Some diseases and pathologies can affect the formation and excretion of urine. Diseases of the
kidneys may affect the ability of the nephrons to produce urine.

SURGICAL AND DIAGNOSTIC PROCEDURES

Some surgical and diagnostic procedures affect the passage of urine and the urine itself.
 VA R I O U S
T Y P ES OF
A LT E R AT I O N S IN
URINARY
E L I M I N AT I O N
C A T H E T E R IZ A T ION
IN R E L AT I O N TO:
P R I N C I P L E S I N V O LV E D
P U R P O S E O R I M P O R TA N C E
I N D I C AT I O N S A N D
C O N T R A I N D I C AT I O N S
 A N AT O M Y A N D
PRINCIPLES PHYSIOLOGY
I N V O LV E D I N One has to know the different
URINARY parts and functions of the

C A T H E T E R IZ A T ION reproductive system in order

to minimize error in inserting
catheter to the patient.

TIME AND E N E RGY MICROBIOLOGY

Do medical handwashing
The nurse should be fast but
before and after the procedure,
gently and accurate to save
instrument should be sterile.
time.
P U R P O S E O F U R I N A R Y C AT H E T E R I Z AT I O N

•To relieve discomfort due to bladder distention or to provide gradual

decompression of a distended bladder
• To assess the amount of residual urine if the bladder empti es
incompletely
• To obtain a sterile urine specimen
• To empty the bladder completely prior to surgery
•To facilitate accurate measurement of urinary output for critically ill clients whose
output needs to be monitored hourly
• To provide for intermittent or conti nuous bladder drainage and/ or irrigation
• To prevent urine from contacti ng an incision after perineal surgery
I N D I C AT I O N S O F U R I N A R Y
C AT H E T E R I Z AT I O N
INTERMITTENT

C A T H E R IZ A T IO N
• Relieving discomfort of bladder distention,
providing decompression
• Obtaining sterile urine specimen when
clean- catch specimen is unobtainable
• Assessing residual urine after urination
•Managing patients with spinal cord injuries,
neuromuscular degeneration, or incompetent
bladders long term
I N D I C AT I O N S O F U R I N A R Y
C AT H E T E R I Z AT I O N
S H O R T- T E R M I N D W E L L I N G
C AT H E R I Z AT I O N
•Obstructi on to urine outflow (e.g., prostate
enlargement)
•Surgical repair of bladder, urethra, and
surrounding structures
•Preventi on of urethral obstruction from blood
clots after genitourinary surgery
•Measurement of urinary output in critically ill
patients
• Conti nuous or intermittent bladder
irrigations
 I N D I C AT I O N S O F U R I N A R Y
C AT H E T E R I Z AT I O N
LONG-TERM INDWELLING
C AT H E R I Z AT I O N

• Severe urinary retention with recurrent

episodes of UTI
• Skin rashes, ulcers, or wounds irritated by
contact with urine
• Terminal illness when bed linen changes are painful
for patient
 C ONT R A IND IC A T IONS
OF URINARY
C AT H E T E R I Z AT I O N

• Traumatic urethral injury

• Colonic Obstructi on
• Following gastrointestinal and gynecological
surgery
• Bowel inflammation and ulcerative conditions
of the large colon
T Y P E S OF C AT H E T E R
AND
METHODS OF
C A T H E T E R IZ A T ION
STRAIGHT

C•isAaTsingle-lumen
H E T E Rtube with a
small eye or opening about 1.25
cm (0.5 in.) from the insertion tip.
-a catheter that is used to drain
urine temporarily or to obtain a
urine specimen.
IND W E L L ING
C AT H E T E R
if the catheter remains in place for
conti nuous drainage. It is also called
retention or foley catheter. It is designed
so that it does not slip out of the
bladder. A balloon is inflated to ensure
that the catheter remains in the bladder
O nc e it is inserted. It is used for the
gradual decompression of an
overdistended
bladder for intermittent bladder
drainag e and irrig ation,and for
conti nuous bladder drainage.
THREE WAY
C AT H E T E R
a catheter with three ports: one for the
inflation of the retention balloon, one
for urine drainage, and one for infusing
irrigant.
a three-way Foley catheter. The three-
way catheter has a third lumen through
which sterile irrigating fluid can flow
into the bladder. The fluid then exits
the bladder through the drainage
lumen, along with the urine.
S UP R A P UBIC
C AT H E T E R
is occasionally used for conti nuous
drainage. This type of catheter is
surgically inserted through a small
incision above the pubic area. Supra
pubic bladder drainage patients urine
from the urethra when injury,
structure, prostatic obstruction or
gynecologic or abdominal surgery has
compromised the flow Of urine
through the urethra.
COUDÉ
CAT HET ER
is used on male client who may have
enlarged/hypertrophied prostates that
partly obstruct the urethra. Lessen
trauma during insertion because it is
stiffer and easier to control than the
straight tip catheter.
CONDOM
CAT HET ER
also referred to as a “urinary sheath” or
“external catheter”. Att ached to a urinary
drainage system is commonly prescribed
for incontinent males. Use of a condom
appliance is preferable to insertion of a
retention catheter because it avoids
entrance into the urethra and bladder and
minimizes the risk of urethral or bladder
infection. Some clients may require a
condom appliance at night only, others
continuously.
M E T H O D S O F U R I N A R Y I R R I G AT I O N
CLOSED METHOD
is performed without disruption of the close drainage system using a triple-
lumen indwelling urethral catheter. O n e lumen is used to inflate the
balloon of the catheter to keep secured inside the bladder. Another lumen
is used for the removal of the urine into a close drainage system. A third
lumen is connected to a container of sterile irrigation solution. The catheter
and drainage tube remains connected to decrease the risk of entry of
microorganisms into the system which could cause infection.

OPEN METHOD
is performed with the double lumen indwelling catheter. It is rarely
performed in acute care setti ngs and is associated with an increased risk of
UTI related to disconnecti on of the catheter and drainage tubing.
 MALE AND FEMALE
METHODS
O F C AT H E T E R I Z AT I O N
IN R E L AT I O N TO:
SIZE OF THE CATHETER
POSITION OF THE LUBRICATION
APPLIED ON THE CATHETER
LENGTH/AREA OF LUBRICATION
APPLIED ON THE CATHETER
LENGTH OF CATHETER
INSERTION METHOD OF
CATHETERIZATION
S E L E C T I N G A N A P P R O P R I AT E C A T H E T E R

S elect the type of material on accordance with the estimated leng th of the
catheterization period.
U se plastic catheter for short periods only (e.g , a week or less) because they are
flexible.
U se a rubber or elastic catheter for periods of 2 or 3 weeks. L atex may be used
for clients with no known latex allergy.
U sed silicon catheter for long term they create less encrustation at the
urethral meatus. However, they are very expensive.
Use P V C catheter for 4-6 weeks period.
S E L E C T I N G A N A P P R O P R I AT E C A T H E T E R
Determine the appropriate catheter length by the client’s gender. For adult female
clients use a 22-cm catheter; for adult male clients, a 40-cm catheter.
Determine appropriate catheter size by the size of the urethral canal. Use sizes such as
# 8 or #10 for children, #14 or #16 for adults. Men frequently require a larger size than
women, for example, #18. The lumen of a silicone catheter is slightly larger than that
of a same-sized latex catheter.
Select the appropriate balloon size. For adults, use a 5-mL balloon to facilitate optimal
urine drainage. The smaller balloons allow more complete bladder emptying because
the catheter tip is closer to the urethral opening in the bladder. However, a 3 0 - m L
balloon is commonly used to achieve hemostasis of the prostatic area following a
prostatectomy. Use 3-mL balloons for children.
M AT E R I A L S N E E D E D F O R C AT H E R I Z AT I O N

Sterile gloves Sterile drapes Anti septi c solution) Lubricant Cott on Balls or Gauze squares

Forceps Straight or Indwelling Catheter

Kidney Basin Specimen Collector
(according to order)

Urine Collecti on Bag and Velcro leg Disposable bag Water proof pad or
Drainage Tubing
Urine receptacle
strap or tape chux
M AT E R I A L S N E E D E D F O R C AT H E R I Z AT I O N

For an indwelling catheter:

S yring e prefilled with sterile water in amount specified by
catheter manufacturer
Collecti on bag and tubing
5–10 mL 2% X ylocaine g el or water-soluble lubricant for male
urethral injection (if agency permits)
Clean gloves
Supplies for performing perineal
cleansing Bath blanket or sheet for
draping the client
Adequate lighting (Obtain a flashlight or
 GUIDELINES TO BE OBSERVED DURING AND
B E F O R E U R I N A R Y C AT H E T E R I Z AT I O N
During:
Before:
Use hand hygiene and standard precautions
Catheters should only be inserted during any manipulation of the catheter or
by trained individuals. collecti ng system.
Use aseptic technique and sterile Maintain a sterile, closed drainage system.
equipment. Maintain unobstructed urine flow; keep catheter
Catheter kit should include a and tubing from kinking.
catheter and all necessary items in Keep the collection bag below the level of the
one place. bladder at all times, but do not rest the bag
Use the smallest catheter possible on the floor.
Empty the collection bag regularly with a
that allows for proper drainage
separate, clean collecti ng container for each
and decreases urethral trauma.
client; and prevent contact of the drainage
spigot with the nonsterile collecti ng container.
NURSING
C O N S I D E R AT I O N S
BEFORE, DURING
AND AFTER
C AT H E T E R I Z AT I O N
B E F OR E
• Verify doctor's Order and identify client.
•Explain to the client what you are going to do, why it is necessary, and how he/she
can cooperate.
• Provide privacy for client.
•Place the client in the appropriate position and drag all areas except the perineum
Male: Supine, legs abducted and extended
Female: Dorsal Recumbent position
• Wash hands and observe appropriate infection control procedures.
• Do perineal care/flushing before the procedure.
•Establish adequate lighting. Stands on the client's right if you are right handed, on
the client's left if you are left handed.
•Use appropriate size of catheter.
Male: Fr 16 or 18
F emale: F r 14 or 16
B E F OR E
•If using a collecti ng bag and it is not contained in the
catheterization kit, open the drainage package and place the
end of tubing within reach.
•If agency permits, apply clean gloves and inject 10 — 15 ml of
xylocaine gel into the urethra in the male. Wipe the
underside Of the shaft to distribute the gel up to the
urethra. Wait at least 5 min for the gel to take effect before
inserting the catheter.
•Open the catheterization kit. Place a waterproof drape under
the buttocks (female) or penis (male) without contaminating
the center of the drape with your hands.
D UR ING
• Apply sterile gloves.
• Organize the remaining supplies.
• Saturate the cleansing balls with antiseptic solution.
• Open the lubricant package.
• Remove the specimen container and place it nearby with the lid loosely O n top.
• Att ach the prefilled syringe to the indwelling catheter inflation hub and test the balloon.
•Lubricate the catheter (l — 2 inches for females; 5 — 7 inches for males) and place it with
the drainage end inside the collection container
• If desired, place the fenestrated drape over the perineum. exposing the urinary meatus
• Cleanse the meatus.
•Locate the urinary meatus properly:
Male: at the tip of the plans penis
Female: between the clitoris and
the vaginal orifice
 D UR ING
•Insert the catheter
Male: hold the penis at 90° angle perpendicular to the body
Female: with the nondominant hand, separate the labia majora with the two fingers.
•Grasp the catheter firmly 2 — 3 inches from the tip. Ask the client to take a slow deep breath and insert
the catheter as the client exhales.
•Advance the catheter 2 inches further after the urine begins to flow through it to be sure it is fully in
the bladder.
•If the catheter accidentally contacts the labia or slips into the vagina, it is considered contaminated and a
new catheter must be used.
•For the indwelling catheter, innate the retention balloon with the designated volume.
•Collect the urine specimen if needed. Allow 2 0 — 3 0 ml to flow into the bottle without touching
the catheter to the bottle.
•Allow the straight catheter to continue draining. If necessary, attach the drainage end of an indwelling
catheter to the collecting tubing and bag.
• Anchor the catheter properly.
•Male: Laterally or upward over the lower abdomen to prevent penoscrotal pressure.
•Female: Inner aspects of the thigh, providing enough "give" so it will not pull when the legs move.
 AFT ER
• Examine and measure the urine.
• Remove the straight catheter when urine now stops.
•Wipe the perineal area of any remaining antiseptic or lubricant.
Return the client to a comfortable position.
•Discard all used supplies in appropriate receptacles and wash your
hands.
•Document the catheterization procedure including catheter size
and results in the client record using forms or checklists
supplemented by narrative notes when appropriate.
T H A N K YOU FOR
LISTENING!
Don't hesitate to ask any questions!