Urinary Catheter Care

Question 1

what are some of the potential presentations of the urogenital patient?

Answer 1

FLUTD
incontinence
obstruction
trauma
neoplasia
kidney issues (renal failure, nephrectomy)

Question 2

define polyuria

Answer 2

increased volume of urine

Question 3

define pollakiuria

Answer 3

passing small amounts of urine often

Question 4

what is catheterisation?

Answer 4

inserting a urinary catheters into the urethra up to the level of the bladder

Question 5

what are the 2 potential options for duration of catheter placement?

Answer 5

temporary - removed immediately following procedure

indwelling - left in

Question 6

why do we catheterise a patient?

Answer 6

to obtain a urine sample
to empty the bladder prior to surgery and prevent contamination during perioperative period
to instill contrast media into the bladder for radiography
to maintain patency of the urethra or unblock
to monitor urine output
to divert urine (cystotomy tube)
to prevent urine scalding

Question 7

what are the alternative ways to sample urine (apart from catheterisation)?

Answer 7

manual expression
free catch
cystocyntesis

Question 8

what are the disadvantages of manual expression of the bladder?

Answer 8

care required as can rupture the bladder
not always possible in tense / fat animals
not sterile

Question 9

what are the disadvantages of free catch of urine?

Answer 9

can be time consuming

not sterile

Question 10

what are the disadvantages of cystocentesis?

Answer 10

vets only

ultrasound guided to avoid other structures

Question 11

what happens during cystocentesis?

Answer 11

sterile needle into the bladder - urine is drawn up in a syringe

Question 12

what is the equipment list for cystocentesis?

Answer 12

clippers / scrub / alcohol
needles (1 inch - longer)
syringe
collection pots
lab form

Question 13

in what position can cystocentesis be performed?

Answer 13

dorsal and lateral recumbancy

Question 14

what must the animal be allowed to do following cystocentesis?

Answer 14

void urine

Question 15

what are the 2 methods of cystocentesis?

Answer 15

blind

ultrasound guided

Question 16

in order to perform blind cystocentesis the bladder must be ___?

Answer 16

palpable

Question 17

what are the main types of urinary catheters?

Answer 17

portex
foley
jackson cat (Tom Cat)
slippery sam

Question 18

are portex catheters designed to be indwelling?

Answer 18

no - single use/temporary

Question 19

where are the holes located in portex catheters?

Answer 19

side holes

Question 20

what is the preferred type of indwelling catheter?

Answer 20

Foley

Question 21

what material is a Foley catheter made of?

Answer 21

silicone or latex

Question 22

how is the Foley catheter held in place once it is in the bladder?

Answer 22

inflatable balloon on the proximal end of the catheter is filled with sterile water

Question 23

what animals can a foley catheter be used for?

Answer 23

dogs only as not small enough for cats

Question 24

what is the jackson cat (Tom Cat) catheter useful for?

Answer 24

unblovking as easy to handle and rigid

Question 25

what features of the jackson cat (Tom Cat catheter) can cause problems with distal obstruction?

Answer 25

side holes in catheter

Question 26

is jackson cat (Tom Cat catheter) used for indwelling?

Answer 26

not really as too traumatic and short so may not reach bladder. can be sutured in for a short period of time

Question 27

what is a slippery sam catheter used for?

Answer 27

unblocking obstructions as open ended

Question 28

can slippery sam be used as an indwelling catheter?

Answer 28

yes is atraumatic but care must be taken as there is risk of the hub detatching

Question 29

what animals are usually considered relatively easy to catheterise?

Answer 29

male dogs and cats

Question 30

why are bitches and queens not as straightforwards to catheterise as male dogs or cats?

Answer 30

anatomy is different and urethral oriface is hidden

Question 31

how is the urethral orifice in bitches usually visualized?

Answer 31

using a speculum (can be done blind)

Question 32

how is the urethral orifice in queens usually visualized?

Answer 32

using an otoscope as speculum may be too large

Question 33

describe the technique for placement of a urinary catheter in the dog/tomcat?

Answer 33

patient restrained (possibly with sedation) wash hands and put on sterile gloves and apron expose penis from prepuce and prep with dilute iodine lubricate urinary catheter insert catheter into urethra and feed in until urine is seen in the catheter (do not force) empty bladder and remove or inflate bulb with desired amount and attatch to collection bag/bung

Question 34

what equipment is needed for catheterisation?

Answer 34

``` sterile gloves and apron diluted iodine solution (1:100) and swabs lubricant (potentially lidocaine gel) catheter of choice 50ml syringe 3 way tap container for sample closed system (if indwelling) sterile water for injection (if indwelling) speculum (for bitch) ```

Question 35

describe the technique for catheterisation of the bitch

Answer 35

chemical restraint likely (and analgesia) sternal recumbancy clip and clean vulva insert speculum until urethral oriface can be seen if no speculum then manually insert with catheter alongside and should feed into the urethral orifice (same process as for dog)

Question 36

what must happen before and after handling urinary catheters?

Answer 36

wash hands

Question 37

when should the bag be emptied and what should be done with the urine when it is emptied?

Answer 37

every 4 hours | amount of urine should be measured

Question 38

what does urine output measure?

Answer 38

kidney function | fluid therapy efficacy

Question 39

what should you do with the catheter bag once emptied?

Answer 39

wipe the outlet with a spirit swab

Question 40

what should you check for around the insertion site?

Answer 40

discomfort and swelling

Question 41

what should the catheter line be checked for?

Answer 41

kinks / blockages

Question 42

where should the catheter bag be kept?

Answer 42

off the floor (e.g. in lined litter tray) with bag lower than the patient

Question 43

when should urinary catheter be removed?

Answer 43

as soon as no longer needed

Question 44

what should be done to manage urine scalding?

Answer 44

clip hair away and clean

Question 45

what monitoring should patients with urinary catheters have?

Answer 45

UTI presence (temp, culture samples, urine appearance, pyrexia)

Question 46

what must be avoided in patients with a urinary catheter?

Answer 46

interference - buster collar

Question 47

when should antibiotics be used for patients with a urinary catheter?

Answer 47

no blanket use due to potential to create multi drug resistance culture and treat specific infection

Question 48

what are the key nursing considerations for the uro patients?

Answer 48

``` monitor BP bloods for renal function (urea, creatinine, electrolytes) USG prevent urine scalding post op care if surgery personal cleaning and care esp for cats with buster collars maintain fluid therapy monitor for UTI ```

Question 49

what are the risks of urinary catheterisation?

Answer 49

``` urethral rupture urethral trauma/inflammation urethral stricture formation infection blockage/obstruction of urinary catheter ```

Question 50

what is urethral stricture?

Answer 50

scar tissue which narrows the lumen of urethra which is very narrow

Question 51

when is urinary diversion used?

Answer 51

when we need to divert urine from either urethra (cystotomy) or ureters (nephrostomy)

Question 52

where is a cystotomy tube placed?

Answer 52

from bladder to outside via the abdominal wall

Question 53

where is a nephrostomy tube placed?

Answer 53

from kidney to outside

Question 54

when patients are in hospital how often is urinary output measured?

Answer 54

every 4 hours

Question 55

why should urine output be monitored?

Answer 55

tells us about renal function | tells us whether fluid therapy is appropriate

Question 56

how can we measure the volume of urine our patients have produced?

Answer 56

closed system collection

Question 57

what is normal urine production for animals?

Answer 57

1-2mls/kg/hour

Question 58

how should a value for urine output be given?

Answer 58

as a range to reflect 1-2mls

Question 59

how do you calculate urine output?

Answer 59

volume of urine/number of hours/weight

Question 60

how do you calculate an animals expected urine output?

Answer 60

BW(kg) x normal UOP per hour (1-2mls) x number of hours