Urinary Catheterization

Urinary Catheterization

Catheterization of the urinary bladder is the insertion of a hollow tube through the urethra into the bladder for removing urine. It is an aseptic procedure for which sterile equipment is required.

Catheter-A flexible tube inserted through a narrow opening into a body cavity, particularly the bladder, for removing fluid.


Purpose Of Urinary Catheterization

  1. Relieve Urinary Retention.
  2. Obtain a Sterile Urine Specimen from a Female Patient.
  3. Measure Residual Urine.
  4. Empty the Bladder Before, During, or After Surgery.
  5. Allows accurate measurement of urine output.
  6. To relieve urinary Incontinence.

Urinary Catheter Size

  • The French scale (Fr.) is used to denote the size of catheters. Each unit is roughly equivalent to 0.33 mm in diameter (that is, 18 Fr. indicates a diameter of 6 mm).
  • The smaller the number, the smaller the catheter. A larger sized catheter is used for a male because it is stiffer, thus easier to push the distance of the male urethra.

Catheters come in several sizes-

  • Number 5 Fr. and 10 Fr. are used for children.  
  • Number 14 Fr. and 16 Fr. are used for female adults.
  • Number 20 Fr. and 22 Fr. are usually used for male adults.

Types Of Urinary Catheters

  1. Intermittent Catheter-
  • An intermittent catheter is used to drain the bladder for short periods (5-10 minutes). It may be inserted by the patient.
  • Intermittent Catheterization is defined as a procedure performed medically in a situation when a patient is in need of catheterization, but for a shorter period of time.

2. Retention/Indwelling Catheter-

  • This type of catheter is placed into the bladder and secured there for a period of time.
  • Indwelling catheter, also called Foley's catheter is defined as a device, which helps in the drainage of urinary bladder. The catheter that is inserted inside is sterile in nature. The indwelling catheter consists of a catheter and a balloon that retains the catheter inside the Bladder.

Parts of Foley's Catheter

  • Balloon inflation port- It has an inscription of the amount to be instilled in balloon.
  • Uro Bag connector- From this port urine will drain.
  • Balloon- It keeps the catheter in place.

3. Supra Pubic Catheter- This type of catheter is inserted into the bladder through a small incision above the pubic area. It is used for continuous drainage.

Indications for Suprapubic Catheterization

  • Urinary retention when urethral catheterization is not feasible.
  • When the urethra is damaged or injured.
  • If the pelvic floor muscles are weakened,causing a urethral catheter to fall out.
  • After surgeries that involve the bladder, uterus, prostate, or nearby organs.

Contraindications for Suprapubic Catheterization

  • Nondistended bladder and bladder malignancy.
  • Active skin infection, coagulopathy, osteomyelitis of the pubis.

4. Condom catheter-A condom catheter is a rubber sheath that is put over your penis. The condom is attached to a tube. Urine drains through the tube and into a drainage bag. A condom catheter drains your urine without putting a catheter into your bladder through your penis.

5. Silicon catheter-Silicone catheters are catheters that are made out of 100% silicone. They have absolutely no traces of latex in them, which is ideal for those who have latex allergies or are sensitive to the material. Silicone catheters are made for several different styles of catheters and are most commonly used for intermittent and Foley catheterization.


Gather All Equipment

  • Sterile dressing set (two bowls, artery forcep thumb forceps, sponge holder, cotton and gauz piece, kidney tray
  • Catheter
  • 10cc syringe
  • Sterile water
  • Cotton balls with betadine
  • Lubricant
  • Sterile gloves.
  • Flashlight or lamp.
  • Urine collection bag.
  • Velcro leg strap or anchoring tape.

Procedure of Introducing an Indwelling Catheter

Procedure  Rational 
The nurse has to introduce herself before beginning the procedure. verify the patrient. To develop rapport and prevent error.

Eplain the procedure to the patient and family.

Explain why the procedure is necessary, and its indications.

 To gain consent and cooperation
Wash the hands properly. To prevent contamination
Provide screen for privacy. To maintain privacy of the patient

Position the patient Appropriately cover the patient and allow only the perineum  to be exposed.

  
Open the catheterization tray and wear sterile gloves to perform the procedure. Spread sterile hole sheet on the perineal area. To create and maintain sterile area and aseptic technique

Clean the perineal area starting from outer to the inner area (labia majora - labia minora-last stroke at center from top to bottom).

For last center stroke, with nondominant hand separate the labia majora, minora and clean center from top to bottom extending the stroke to anal opening.

 More clean to less clean principle
Open catheter and lubricate the catheter. For easy insertion
Place the drainage end into the kidney tray. Prevents soiling of the linen

Insert the catheter, it is worth considering that slight resistance can be expected.

Once the catheter enters bladder stream of urine will be observed from distal end of catheter in kidney tray.

 Due to the sphincter control

If accidentally, the catheter is inserted in the vagina and misses the urethral opening, the catheter is considered to be contaminated.

The nurse must use a new catheter. But, before removing the catheter from the vagina, insert the new catheter in the urethra to avoid inserting the catheter in the vagina again.                              
  • To avoid confusion between the vaginal and urethral opening, plug the vaginal opening with cotton and separate the labia for proper visualization of the urethra.
  • Another important aspect-in vagina resistance is not felt.
In males-hold the penis(Grasp the patient's penis between your thumb and forefinger of your nondominant hand) and retract the prepuce if patient is not circumcised, clean the tip of the penis using the center to periphery stroke in a circular motion.  
After cleaning lubricate the catheter and hold the penis upright( Hold the penis at a 90-degree angle.) with nondominant hand To straighten the urethral duct
Insert the lubricated catheter  

Distal end is kept in the kidney tray.

Watch for the urine output

 It confirms the position of catheter in bladder

After the catheter is inserted, urine will flow in the drainage bag. The retention balloon has to be inflated without releasing the catheter.

Hold catheter in nondominant hand, the balloon has to be inflated using dominant hand.

 As the urine flow comes, still insert the catheter almost half length so that while balloon inflation urethral injury doesn't occur.
 
if urine sample is needed, collect it. It can be collected through the drainage bag as well. Note that the urine sample can be collected from the drainage bag only for the initial time.  
Secure the catheter using tape. To prevent the misplacement
Remove the gloves and discard them.  
Wash hands and perform hand hygiene. To prevent the cross contamination
Observe the urine and note down the output, by taking the measurements from the collecting bag.  
Document the procedure in the record book.  
Report to the physician if any changes in the urine are seen.  


 NOTE- Never force the catheter to advance. Discontinue the procedure if the catheter will not advance or the patient has unusual discomfort. Get assistance from the charge nurse or physician.


Complications

Acute phase

  1. Urinary Tract Infection.
  2. Creation of false passages.
  3. Urethral strictures.
  4. Urethral perforation.
  5. Bleeding

For long period use-

  1. Prostatitis.
  2. Cystitis.
  3. Urethritis.
  4. Pyelonephritis.
  5. Sepsis

REMOVING AN INDWELLING CATHETER

  •  Assemble all supplies and equipment.
  1. 10 cc syringe.
  2. Washcloth and towel.
  3. Exam gloves.
  4. Soap and water.
  • Identify the patient and explain the procedure to him. Advise him that there will be a slight burning during removal of the catheter.
  • Provide privacy and assist the female patient into a dorsal recumbent position. The male should be in a supine position.
  • Wash your hands and put on exam gloves.
  • Empty the balloon by inserting the barrel of the syringe and withdrawing the amount of fluid used during inflation.
  • Pinch off and gently pull on the catheter near the point where it exits from the meatus.
  • Clean the perineum or penis with soap and water. Dry the area well.
  • Inspect the catheter to be sure no remnants remained in the bladder. If the catheter is not totally intact, report this promptly and save the catheter for further inspection.
  • Empty the drainage bag. Measure the amount of urine and record on the intake and output (I&O) sheet.
  •  Remove the gloves and wash your hands.
  • Discard disposable supplies and return reusable supplies and equipment to the appropriate area.
  • Record that the catheter was removed, the time and date and by whom. Note the amount, color, and clarity of the urine in the drainage bag. Also document all patient teaching done and the patient's level of understanding.
  • After removal of the catheter, assess the patient for 24 hours for patterns of urinary elimination. Note the time and amount of the first voided urine.

Report any of the following-

  1. Inability to void within 8 to 10 hours.
  2. Frequency, burning, dribbling, or hesitation in starting the stream of urine.
  3. Cloudiness or any other unusual color or characteristic of the urine.
  4. Provide a level of fluids similar to the intake when the catheter was in place.
  5. Record that the catheter was removed, the date and time, and by whom.

 

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