Catherterization Flashcards
(17 cards)
What is bladder catherterization?
the insertion of a catheter into a patient’s bladder
- performed for both therapeutic and diagnostic purposes
- the urinary catheter can be either intermittent (short-term) or
indwelling (long-term)
- It can be performed by external, urethral, and suprapubic techniques
Describe the 3 types of catheters?
- External catheters
- adhere to the external genitalia in men or pubic area in women to collect the urine. - Urethral catheters
- inserted through the urethra, with the tip advanced into the base of the bladder. - Suprapubic catheters
- inserted into the bladder surgically via a suprapubic approach.
What are the indications for urethral catherterisation?
- a pre operative procedure,
- Relieve urinary retention
- For unwell patients to help measure their fluid input and output.
- Neurogenic bladder dysfunction
- Urinary incontinence
- Social and hygiene reasons
- Acutely ill patients requiring close urinary output measurement
- Chemotherapy drug delivery
- Bladder irrigation
What are the potential causes of urinary retention?
- Obstructive
e.g BPH, stones, strictures, stenosis, or tumors. - Infectious & Inflammatory
e.g. Cystitis, urethritis, prostatitis, and vulvovaginitis. - Pharmacologic
Drugs with anticholinergic or alpha-adrenergic agonist properties. - Neurologic
Brain or spinal cord injury, cerebrovascular accident, multiple sclerosis, Parkinson disease, and dementia. - Others: Trauma, psychogenic, Fowler syndrome in women
What are the diagnostic reasons for catheterizartion?
- Measurement of urodynamics
- Sample collection for urinalysis
- Radiographic studies (cystogram)
What are the contraindications to bladder catheterization?
- Blood at the meatus
- Insertion of the catheter can worsen an underlying injury - Gross hematuria
- Evidence of urethral infection
- Urethral pain or discomfort
- Patient refusal
What is the procedure for cathaterisation?
Note: A chaperone is required for this procedure.
- Begin by introducing yourself to the patient and clarify his identity.
- Explaining what you are going to do and obtain consent.
- Gather equipment
What equipment is necessary for catheterisation?
Sterile gloves Sterile water Single-use lubricant and anesthetic gel Catheter Catheter bag Waterproof pad (disposable)
What equipment can be found in a catheter pack?
2 pairs of sterile gloves Large disposable pad Sterile drapes Sterile cotton gauze swabs Sterile cotton wool swabs 12 – 20 Fr male Foley catheter catheter bag a 10ml saline-filled syringe antiseptic solution Sterile bowl Sterile water
Describe the structure of a catheter?
- Composition: Silicone, latex, and PVC.
- Coating: Teflon, hydrogel, and antimicrobial or latex with a silicone elastomer coat
- Most catheters have dual-lumen tubes with one lumen draining the catheter and the other delivering water to the balloon.
How do you prepare for a catheterisation?
- Review indications and contraindications for the procedure.
- Give clear instructions to the patient about the procedure.
- Allow appropriate time to respond to the queries of the patient.
- A proper light source should be present.
- Maintain patient’s privacy during the procedure.
- The patient should lie down on a firm flat surface with the head resting on a pillow.
- Appropriate positioning of the patient
- Supine position for men
- frog-leg position for women is recommended - Place a disposable pad beneath the patient’s buttocks.
- Perform hand hygiene.
- Wear sterile gloves.
- Appropriately drape the patient.
- Prepare the external genitalia:
- men: prepare the glans penis and the urethral meatus using a sterile technique
- women: use the non-dominant hand to expose the urethral meatus by separating the labia and prepare the meatus with an antiseptic solution.
Describe the procedure to clean the male glans before catheterisation?
- Using an aseptic technique open the catheter pack and pour antiseptic solution into the receiver
- Open the rest of your equipment onto the sterile field.
- Pour antiseptic solution into the receiver
- Wash and dry your hands, then put on the sterile gloves
- Clean the glans using gauze swabs soaked in an antiseptic solution.
- Hold the penis with your left hand and clean the glans thoroughly
- Remember to retract the foreskin and clean around the urethral meatus
- Remove the gloves/ or maintain the same first pair.
- Wash your hands and apply the second pair of gloves
- Drape the patient with sterile drapes and place a collecting vessel between the patients legs
Describe the procedure to clean the female genitalia?
- Using an aseptic technique open the catheter pack and pour antiseptic solution into the receiver
- Open the rest of your equipment onto the sterile field.
- Pour antiseptic solution into the receiver
- Wash and dry your hands, then put on the sterile gloves
- use your left hand, part the labia
- Using saline soaked gauze balls, clean the urinary meatus with your right hand.
- Remember to use single downward movements with each gauze.
- Remove the gloves/ or maintain the same first pair.
- Wash your hands and apply the second pair of gloves
- Drape the patient with sterile drapes and place a collecting vessel between the patients legs
Describe the procedure to insert the catheter in a male?
- Hold the penis vertically with the left hand and with the other hold the catheter by its sleeve.
- Apply lubricant/water the catheter tip.
- Advance catheter tip from its sleeve and insert into the urethra
- Progressively insert the catheter, ensuring that neither your hand nor the sleeve touch the penis until the end arm
reaches the meatus. - At this point urine should start to flow into the collecting vessel
Describe the procedure to insert the catheter in a female?
- With the labia parted, ensuring that you identify the meatus
- Using your right hand only, pick up the catheter by its sleeve and start to insert it into the meatus while its tip was lubricated.
- Continuing to use the sleeve, insert the catheter until the end arm reaches the meatus
- At this point, urine should start to flow into the collecting vessel
- Inflate the balloon using 10ml of saline, ensuring that it does not cause any pain.
- Note: the volume used to fill the balloon may vary depending upon the size of the catheter used, check the packaging for the exact volume to use
Attach the catheter bag. - Gently pull on the catheter until
resistance is felt. This is when the
balloon will be resting on the urethral
opening of the bladder.
•Then reposition the foreskin(if in males). - Dispose of your gloves and equipment
in the clinical waste bin - Wash your hands.
- Afterwards record the volume of urine
collected in the catheter bag and ensure
that the patient is comfortable and
covered.
Common errors that occur during catheterisation?
- poor sterile technique
- blowing up balloon in urethra – i.e. not ensuring the catheter is in the bladder by seeing urine coming out from the Foleys catheter.
- failure to replace foreskin
Complications of urethral catheterisation?
Urinary tract infection (UTI)
• A chronic bladder infection can occur from urinary (10-100 ml) stasis at the
base of the bladder, which is obstructed by the balloon of the catheter.
• Pain due to traction on the drainage bag.
• A transitory stinging sensation is common in men that often occurs during
lubrication and can be minimized by cooling the gel to 4°C.
• Paraphimosis
• Urethral injury
• Catheter obstruction:
• due to the sediment buildup in patients with subclinical
bacteriuria. Flushing can often relieve the blockage. If
unsuccessful catheter replacement may be required.
•Urine leakage from the urethral meatus extrinsic to
the catheter
• Due to bladder spasms.
•A negative effect on the quality of life, especially for
patients with longterm indwelling catheters.
