Urinary Bladder Catheterization
Description:
Urinary catheterization, or "cathing" for short, a plastic tube known as a urinary catheter is inserted into a patient's bladder via their urethra. Catheterization allows the patient's urine to drain freely from the bladder for collection, or to inject liquids used for treatment or diagnosis of bladder conditions. The procedure of catheterization will usually be done by a clinician, often a nurse, although self-catheterization is possible as well.
Purposes:
· To obtain sterile urine for analysis and culture in patients unable to provide a clean voided specimen.
· For placement of indwelling catheter to monitor urine output and assess fluid status.
· To measure bladder residual urine volume.
· To instill radiologic contrast dye for radiologic studies.
· To empty neurogenic bladder.
· To relieve urinary retention or obstruction.
· To maintain urethral patency in patients with perineal injury (e.g., burns, contusions)
Materials/ Equipment Needed:
· Sterile catheter of appropriate size. An extra catheter should be at hand.
· Catheterization kit or individual sterile items:
§ 1-2 pairs of sterile gloves
§ Waterproof drape(s)
§ Antiseptic cottons
§ Cleansing balls
§ Forceps
§ Water-soluble lubricant
§ Urine receptacle
§ Specimen container
· 2% Xylocaine gel (if agency permits)
· Disposable clean gloves
· Supplies for performing perineal cleansing
· Bath blanket or sheet for draping the client
· Adequate lighting --- obtain a flashlight or lamp, if necessary
Procedure:
1. Introduce yourself, and verify the client’s identity. Explain the procedure to the client.
2. Perform hand washing and observe other infection control procedure.
3. Provide privacy.
4. Place the client in the appropriate position, and drape all areas except the perineum:
FEMALE: supine, with knees flexed, feet about 2 feet apart, and hips slightly externally rotated.
MALE: supine, legs slightly abducted
5. Establish adequate lighting. Stand on the client’s right if you are right handed, on the client’s left if you are left handed.
6. If using a collecting bag not contained within the catheterization kit, open the drainage package, and place the end of the tubing within reach.
7. If agency policy permits, apply clean gloves, and inject 10-15ml Xylocaine gel into the urethra o f the male client. Wipe the underside of the shaft to distribute the gel up the urethra. Wait at least 5 minutes for the gel to take effect before inserting the catheter. Remove gloves.
8. Open the catheterization kit. Place a waterproof drape under the buttocks (female) or penis (male) without contaminating the center of the drape with your hands.
9. Apply sterile gloves.
10. Organized the remaining supply.
11. Attach the prefilled syringe to the indwelling catheter inflation hub, and test the balloon.
12. Lubricate the catheter, and place it with the drainage end inside the collection container.
13. If desired, place the fenestrated drape over the perineum, exposing the urinary meatus.
14. Cleanse the meatus.
15. Insert the catheter.
16. Hold the catheter with the nondominant hand. In males, lay the penis down onto the drape, being careful that the catheter does not pull out.
17. For an indwelling catheter, inflate the retention balloon with the designated volume.
18. Collect urine specimen, if needed. Allow 20-30 ml to flow into the bottle without touching the catheter to the bottle.
19. Allow the straight catheter to continue draining. If necessary, attach the drainage end of and indwelling catheter to the collecting tubing and bag.
20. Examine and measure the urine. In some cases, only 750-1000 ml of urine is to be drained from the bladder at one time. Check agency policy.
21. Remove the straight catheter when urine flow stops.
22. Wipe the perineal area of any remaining antiseptic or lubricant. Replace foreskin, if retracted earlier, return the client into a comfortable position.
23. Discard all used supplies in appropriate receptacles, and perform hand hygiene.
24. Document the catheterization procedure including the size and results in the clients record.
Diagram/ Illustrations:
Nursing Responsibilities:
Before Procedure:
1. Assess:
· the client’s overall condition.
· If the client is able to cooperate and hold still during the procedure.
· If the clients can be positioned supine, with the head relatively flat.
· When the client last voided or was last catheterized.
· Percuss the bladder to check for fullness or distention.
2. Determine:
· The most appropriate method of catheterization
3. Assemble equipment and supplies
4. Perform routine perineal care to cleanse the meatus from gross contamination.
During Procedure:
Such precautions include: do health teachings
§ Cleansing the urethral area (area where catheter exits body) and the catheter itself.
§ Disconnecting drainage bag from catheter only with clean hands
§ Disconnecting drainage bag as seldom as possible.
§ Keeping drainage bag connector as clean as possible and cleansing the drainage bag periodically.
§ Use of a thin catheter where possible to reduce risk of harming the urethra during insertion.
§ Drinking sufficient liquid to produce at least two liters of urine daily
§ Sexual activity is very high risk for urinary infections, especially for catheterized women.
After Procedure:
· Sample handling
§ Divide sample, if necessary, and place in tightly closed containers.
§ Label specimen container(s), and send to the laboratory as soon as possible.
· Wash the perineum with a warm wet wash cloth or cotton balls to remove all remaining povidone-iodine.
Sources:
FUNDAMENTALS OF NURSING CHECKLIST 8TH EDITION OZIER AND ERB’S
Categories:
Procedures
This is quite the process. I had a doctor show me how to use a catheter for the first time. Once I saw how it worked it was a piece of cake after that. I have been using self catheters for years. I am always looking for good deals on self catheter supplies and I do come across some great sites and stores that have amazing deals.
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