URINARY ELIMINATION & CATHETERS

Objectives

Demonstrate correct technique for inserting indwelling and straight catheters

Recognizes signs and symptoms of infection related to urinary catheters

Demonstrate aseptic routine care of a patient with an indwelling catheter

Demonstrate correct technique for removing an indwelling catheter.

Demonstrate correct procedure for application of condom catheter

Document and report to RN care related to urinary drainage

Anatomy

Kidney - Urine production

Ureters - Tubes which connect the kidneys to the bladder.

Bladder - Reservoir for urine until the urge to void takes place.

Urethra - Tube from the bladder to the outside of the body in normal anatomy. Male = 20 cm long

Female = 4 cm long

Anatomy A continuous layer of mucous membrane lines

the kidney pelvis, ureters, urethra & bladder Because there is no break in this lining,

bacteria introduced into this normally sterile environment can quickly spread throughout the entire system

When the bladder is empty it falls into folds which provide pockets where bacteria can multiply

Because this membrane layer is highly vascular, bacteria can easily enter the blood stream & cause septicemia

Urinary Elimination System

Catheterization - Reasons

Collect a sterile specimen Check residual urine Inability to void related to post-op complications Before, during or after surgery to empty bladder Temporary/Permanent Incontinence: a. Total- continuous loss of urine from bladder b. Stress- leakage of small amounts of urine with physical stress i.e. coughing or sneezing

Catheterization - Reasons

Urge - Involuntary passage of urine after feeling strong need to void. Unable to stop urinating and can’t get to bathroom on time. Seen in the elderly, with UTIs and tumors.

Functional - Involuntary, unpredictable passage of urine related to no call light or immobility, etc.

Bladder Scan

Estimates residual urine Increased use over straight catheterization 90% accuracy Decreases risk of infection and discomfort

to patient

PRIOR to Catheterization

Know and ConfirmKnow and Confirm Doctor’s order Last void Patient’s level of consciousness and understanding Mobility, physical limitations, ability to cooperate Sex, age, catheter size

Kids 6-10 Female 14-16 Male 16-18)

Allergies to antiseptics, tape, rubber, latex Adverse conditions Impaired passage such as enlarge prostate

Catheter Types - Condom

Condom Catheter Condom Catheter (External, Texas, Urinary Sheath)

Incontinent men Soft rubber, latex, silicone Slides over Penis Tubing connects to tip of condom and flows

into collection bag.

Catheter Types - Condom

Remove for thirty minutes each day, clean and dry penis, re-apply new

catheter. Elastic tape may be used to secure

catheter in place. This tape will expand when the penis changes size.

Never use adhesive tape- cuts off blood flow which causes injury.

Straight CatheterStraight Catheter Removes urine from bladder aseptically due

to 1. Incontinence 2. Post void residuals 3. Sterile specimen Does not attach to a collection bag Considered a sterile procedure

Catheter Types - Straight

Catheter Types - IndwellingIndwelling Catheter (Foley)Indwelling Catheter (Foley) To remove urine aseptically Sterile procedure Has urinary collection bag May be used for extended periods of time

SuprapubicSuprapubic Catheter inserted into the bladder through

an opening in the lower abdomen (about 1 inch above the symphysis pubis)

Placed under anesthesia May be left in place for long periods of time Sutured into place.

Catheter Types - Suprapubic

Rules for Catheterization

1. Wash hands, use gloves2. Tubing without kinks/obstructions3. Drainage bag below bladder4. Attach to non-movable bed part5. Secure with leg strap

6. Check system for leaks

7. Perform perineal care BID, after all BMs &with cath care

8. Watch I&O closely

9. Report complaints of discomfort to nurse (pain, burning, irritation)

10. Record amount, color, clarity, odor, particles

Insertion/Application - CondomCondom Catheter Clean gloves to remove old catheter Wash and dry penis Apply skin prep to penis shaft Remove protective backing from condom

exposing adhesive strip

Insertion/Application - Condom Hold penis firmly. Roll condom onto

penis leaving 1inch space between penis and end of catheter.

Secure condom with elastic strip in spiral manner not completely on

penis Connect condom to drainage bag Check penis for redness and

excoriation

Have patient relax by taking slow deep breaths Lubricate catheter well To find female meatus

Look for the wink Betadine pools in the meatus Ask patient to bear down as if to void

If catheter enters the vagina, leave it To place catheter in an uncircumcised man – 1. Carefully pull back foreskin before

cleansing

Insertion Tips – Straight/Foley

Insertion Tips – Straight/FoleyWhen performing straight cath Know policy & procedure for maximum

amount of urine allowed to be withdrawn.

Insertion of Indwelling Catheter If indwelling catheter, GENTLY tug on

catheter until resistance is met to insure placement in bladder

Do peri care and apply leg band to secure catheter to patient’s leg

Remove gloves and discard supplies properly

Documentation

DocumentDocument Type of procedure Size of catheter and balloon Amount of fluid actually instilled into balloon Amount of urine returned Characteristics of urine (color, odor,

sediment) Specimen sent if applicable How patient tolerated procedure

Problems During Insertion

Catheter inserted into VaginaCatheter inserted into Vagina 1. Leave in place 2. Reposition fingers to re-visualize

meatus 3. Use new catheter 4. Repeat procedure

Problems During Insertion

Unable to insert into femaleUnable to insert into female 1. Ask patient or other team member to

hold legs apart 2. Observe urethral opening (before

cleansing) for movement when pressure is applied 3. Improve lighting 4. Repeat insertion procedure

Unable to insert catheter into maleUnable to insert catheter into male 1. Notify nurse 2. Repeat procedure but change the angle

of the penis 3. Try an a coude catheter

Problems During Insertion

Problems During Insertion

Catheter comes out with balloon inflatedCatheter comes out with balloon inflated 1. Check with nurse 2. Check for urethral trauma (pain,

bleeding) 3. Monitor urine output for bleeding 4. Obtain new catheter kit & reinsert with 10 ml balloon per nurse’s instruction

Care of Patient with a Catheter1. Keep catheter bag below level of bladder2. Attach drainage bag to bed frame (not side

rails)3. Secure tubing onto bed – urine should flow

freely from catheter to bag (coil tubing on bed)

4. Empty catheter bag every 8 hours or prn5. Provide catheter care & pericare as needed6. Do not allow the drain on the bag to touch

any surface7. Keep drainage bag off the floor

Catheter Removal

1. Physician’s order2. Gather supplies- 10cc syringe, gloves, chux3. Deflate balloon- note amount withdrawn4. Avoid pubic hair5. Pinch catheter; pull out on exhalation

steadily & gently6. Measure output7. Discard catheter bag properly8. Provide peri care9. Monitor patient for output10. If not voided in 4-6 hours, notify nurse

Following Catheter Removal1. Patient to void within 4-6 hours2. Urine amount 120-240 ml (or per policy)3. Observe bladder for distention4. Monitor patient for any complaints of

painful urination5. Monitor patient for hematuria

Catheter Removal DocumentationDocument :

Size of catheter removed Size and amount of fluid in balloon Patient tolerance Output in catheter bag Description of urine Peri care Time of removal

Voiding Following Catheter RemovalHints to assist patient to void after Hints to assist patient to void after

catheter removalcatheter removal Encourage oral fluids Proper position to urinate Sound of running water Sitz bath

Catheter Specimen - Syringe

Urinary Diversions

DefinitionDefinitionRemoval of bladder (cancer, bladder injuries) and making a new pathway for urine to exit the body.

Two Categories

1. Continent2. Noncontinent (incontinent)

Continent Urinary Diversions Surgery creates an internal pouch where urine is stored (Kock or Indiana Pouch) Do not need to wear an appliance Taught to insert catheter into the stoma several times a day to drain the urine

Noncontinent Urinary Diversions

Patient cannot control urine Must wear an external urinary ostomy pouch

Types of non-continent urinary Types of non-continent urinary diversionsdiversions

1. Ureterostomy

Ureterostomy

UreterostomyThe surgical creation of an artificial opening between the ureter and the abdomen.

Both ureters may be brought through the skin onto the abdomen Drains urine

Ileal Conduit

A small section of the ileum is resected from the intestine One end is sutured closed Ureters are implanted in the other endOpen end of the ileum becomes the stomaDrains urine

Ureterostomies