catherisation 1 Flashcards
Indications for Indwelling Catheter
Relief of urinary tract obstruction
Promote urinary drainage in patients with neurogenic
bladder dysfunction or urine retention
Postoperatively for urological or other surgeries
Facilitation of surgical repair of urethra
Prevent contamination of stage III and IV pressure ulcers
Accurate measurement of urine output for critically ill
Complications of Long Term Use
30 days
- UTIs
- Pain
- Bladder spasms
- Periurethral abscess
- Urethral trauma or erosion
- Fistula or urethral stricture
- Pressure necrosis
- Stones
Unacceptable Reasons
Routine collection of urine specimen
Convenience of nursing staff or patient’s family
▪ Incontinence
▪ mobility limitations
Risk of CAUTIs is too high to use for these reasons.
Nursing Care to Prevent CAUTIs
Avoid unnecessary insertion Correct insertion practices Catheter care Patient and family education Early removal
Assessing Need for Catheterisation
Needs to be clinically indicated
Assess alternatives and discuss with patient
Document clinical indication for catheterisation
Assess reasons for catheterisation every day
Removed when no longer clinically indicated
Select smallest gauge that will allow urine to flow out
Selection of Catheters
• Materials – latex, plastic, silicone
• Tip shape – normal, coude, whistle tip
• Size of lumen - according to French scale
• Size varies with patient size and purpose
• If too large - tissue erosion from excessive
pressure on meatus or urethra
Catheter Types and Sizes
pediatric - 6 to 10 FR
adult female- 12-14
adult male - 14-18 Fr
clot retention - 20-22 Fr
Correct Catheter Insertion Practices
Appropriately trained staff Procedural handwash ▪ 1 min with green solution Aseptic technique ▪ Sterile gloves ▪ Catheter pack chlorhexidine 0.1% solution ▪ clean meatus Lignocaine 2% gel for males Lubricant gel for females Insert far enough into bladder Secure catheter to leg ▪ Prevent urethral tension
Catheter Care
Connect to sterile closed drainage system
Do not break the connection unless clinically indicated
Avoid contamination when emptying drainage bag
Keep drainage bag below level of the bladder
Hand hygiene - gloves for catheter care
Use separate, clean jug for each patient
Aseptic technique for collecting urine sample from port
Catheter Care
Assess drainage system Accurate FBC Monitor urine output Stabilised properly Assess urethral orifice Daily personal hygiene for meatal cleansing Do not let bag > ¾ full. Use a new overnight bag each night when in hospital Flip flow valves, leg bags and overnight bags changed weekly when D/C home. Pts wash O/N bags and reuse daily
Catheter Education
Ensure patients, relatives or carers are given information:
▪ Manage catheter and drainage system
▪ Clean and connect overnight bag
▪ Minimise risk of urinary tract infection
▪ Drink plenty of fluids
▪ Obtain supplies suitable for individual needs
▪ Know when catheter is to be removed – early as possible
Indications for Suprapubic Catheters
ST for bladder, prostate and ureteral surgery LT for selected patients ▪ neurological ▪ unable to urinate, empty bladder or leaking
Care for SPC
Under general anaesthetic or local at bedside
May be sutured in to place to prevent dislodgement
Protect skin around insertion site from breakdown
Prone to poor drainage blocked by bladder wall,
sediment or clots.
Milk tube and prevent kinking
SPC Catheter Care
Bladder spasms cause urinary leakage Oxybutynin or other antispasmodics Wound needs to be cleaned SPC changed 4 – 6 weekly
Indications for In-Out Cathete
• For urodynamic testing
• Collection of sterile urine sample in selected situations (Hx
complicated UTI)
• Instillation of medications into the bladder
• Intermittent catheterisation – postop or spinal injury
• Clean intermittent Catheterisation (CISC) education
• Lower risk of UTI than indwelling catheters
