Urinary Catheterization

Purposes: To relieve bladder distention or to provide

gradual decompression of a distended bladder To instill medication into the bladder To irrigate the bladder To measure hourly urine output accurately To collect urine specimen To measure residual urine Residual Urine, is the

amount of urine retained in the bladder after forceful voiding

To maintain continence among incontinent clients

To prevent urine from contracting an incision after perineal surgery

To promote healing of the genito-urinary structures postoperatively

Equipment:

Indwelling

Straight

Urinary Catheterization

Is the introduction of catheter through the urethra into the bladder in order to withdraw urine.

Tube commonly made of rubber(good for 1wk), plastic(2-3wks), latex(1-2mons).

Normal length of urethra:o Female – 3 to 4 inches

o Male – 6 to 9 inches

Appropriate size:o Female – Fr 12-14

o Male - Fr 16 to 18

Assessment Determine the most appropriate method of catheterization based on the purpose and any criteria specified in the order such as total amount of urine to be removed or size of catheter to be used:

Straight Catheter - use for a spot urine specimen - amount of residual urine is being measured - temporary decompression / emptying of the bladder is required.

Indwelling/Retention Catheter - if the bladder must remain empty or continuous urine measurement and collection is needed:

Determine if the client is able to cooperate and hold still during the procedure and if the client can be positioned supine with head relatively flat.

Determine when the client last voided or was last catheterized.

Percuss the bladder to check for fullness or distention.

ProcedureVerify doctor’s order

Identify and inform the client and explain, why it is necessary and how he/she can cooperate.

To allay anxiety

Provide privacy To prevent feeling of embarrassment

Wash hands and observe appropriate infection control procedures

To prevent ascending UTI

Perform routine perineal care before the procedure

To minimize microorganism at the external genitals

Have adequate lighting To visualize urethral meatus properly

Place the client in appropriate position:

Male: Supine, legs abducted and extended Female: Dorsal recumbent Don sterile gloves Inflate the balloon of catheter with air to check that it is intact then deflate. Locate the urinary meatus properly:

Male: at the tip of the glans penis Female: between the clitoris and vaginal orifice

Cleanse urinary meatus with antiseptic solution Note: The nondominant hand is considered contaminated once it touches the client skin.

Male: - Use your nondominant hand to grasp the penis just below the glans. - Hold the penis firmly upright with slight tension - Pick up a cleansing ball with the forceps and wipe from the center of the meatus in circular motion Note: The foreskin must not be allowed to return over the cleanse meatus nor the penis be dropped

Female: - Use your nondominant hand to spread the labia

Pick up a cleansing ball with the forceps in your dominant hand and wipe one side of the labia in an anteroposterior direction.

When cleansing the urinary meatus, move the swab downward

Lifting the penis firmly and upright prevents possible erection and helps strengthen the urethra

Lubricate catheter with water soluble lubricant before insertion Male: 6 – 7 inches Female: 1 – 2 inches

To prevent friction and prevent trauma

Insert catheter gently in rotating motion. Instruct the client to take slow deep breaths to relax sphincter or strain as if attempting to void to opens urinary meatus.

During insertion of catheter in male, hold the penis at 90 degree angle or perpendicular to the body

To straighten the urethra and facilitate insertion

For indwelling or retention catheter, inflate the balloon with 5 – 10 ml. of PNSS

Placement of indwelling / retention catheter and inflated balloon

Gently pull on the catheter. If resistance is felt, the catheter balloon is properly inflated in the bladder. Anchor catheter properly: Male: laterally or upward over the lower abdomen / upper thigh Female: inner aspect of the thigh

To prevent penoscrotal pressure

Attach drainage bag to the bed frame, ensuring that tubing should fall below the top of the bag. Keep client comfortable Do after-care Do relevant documentation

Note: If the purpose of catheterization is to relieve bladder distention, practice GRADUAL DECOMPRESSION, to prevent shock, hemorrhage or bladder atony.

Gradual Decompression may be done by the following actions:

Empty the bladder slowly by pinching the catheter to reduce the size of the lumen.

Elevate urine receptacle at the level of symphysis pubis to slow down expulsion of urine.

Do not remove more than 1000 ml of urine at a time

Nursing Interventions for Client with Indwelling/Retention Catheter

Practice asepsis. Proper handwashing should be done before and after manipulating the device. To prevent infection

Increase fluid intake. To enhance excretion of microorganism and body wastes

Acidify urine ( diet: meat,fish.eggs and cereals) Acidic urine inhibits proliferation of microorganism.

Maintained closed drainage system. Do not detach catheter from the connecting tubing, unnecessarily.

Meticulous perineal care. To prevent ascending UTI

Ensure patency of urinary catheter. Avoid kinks. Irrigate with sterile PNSS as ordered.

Ensure that gravity drainage of urine is maintained. Hold the urinary drainage bag below the level of bladder when ambulating

Monitor I & O Change urinary catheter, tubing and bag when

sediments accumulates, if leakage is present or if a strong odor is evident.

Removal of Indwelling / Retention Catheter Check doctor’s order Wash hands. Remove the tape that secured the

catheter to the client’s body Don clean disposable gloves. Handwashing and

gloving prevent transfer of microorganism Insert hub of the syringe into balloon inflation

port and draw out all the liquid. The balloon must be completely deflated to prevent trauma to the urethra as the catheter is remove.

Instruct the client to inhale and then pinch and remove the catheter slowly and carefully as the clients exhales. Breathing provides distraction and exhalation prevents tightening of abdominal

and perineal muscles as the catheter is withdraw. Pinching catheter prevents urine from dribbling onto the bed linens.

After removal of catheter, allow the urine to drain into collection bag. Measure and record the amount of urine remaining in the collection bag.

Assess client’s perineum and meatus for any signs of redness or irritation.

Assist client to do perineal care and dry genitals. To ensure client comfort.

Discard contaminated equipment and articles in appropriate containers. To prevent contamination of the environment.

Make relevant document

NOTE: Voiding should be expected within 6 – 8 hours

from the time of removal of catheter. Some dribbling of urine may be experienced.

Continue to assess I & O If the client has not voided in 8 hours, assess for

urinary retention If the client has difficulty establishing voluntary

control of voiding, notify the physician. It may be necessary to reinsert the catheter or to perform in and out ( intermittent ) catheterization

Nursing Interventions for Clients with Urinary Incontenence

Bladder Retraining Program. Determine the client’s voiding pattern or establish a regular voiding time.

Lengthen the intervals of voiding once the client’s voiding can be controlled.

Regulate fluid intake Avoid large amounts of fruit juices and

carbonated beverages. Avoid stimulants at bedtime Schedule diuretics in the morning. Adequate fluid intake in the morning. Kegel’s Exercise ( alternating tension and

relaxation of the pubococcygeal muscles )

Nursing Interventions to Induce Voiding/Urination Provide privacy Provide fluids to drink Assist the patient in the anatomical position of

voiding Serve clean, warm and dry bedpan (female) or

urinal (male) Allow the client to listen to the sound of running

water Dangle fingers in warm water Pour warm water over the perineum Promote relaxation Provide adequate time for voiding Perform Crede’s Maneuver as ordered ( this is

done by applying pressure on the suprapubic area)

Administer cholinergics as ordered Last resort: URINARY CATHETERIZATION