Urinary Catheterization – Nursing is a profession within the healthcare sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses may be differentiated from other healthcare providers by their approach to patient care, training, and scope of practice. Nurses practice in many specialisms with differing levels of prescriber authority.
Many nurses provide care within the ordering scope of physicians, and this traditional role has shaped the public image of nurses as care providers. However, nurses are permitted by most jurisdictions to practice independently in a variety of settings depending on training level. In the postwar period, nurse education has undergone a process of diversification towards advanced and specialized credentials, and many of the traditional regulations and provider roles are changing.
Nurses develop a plan of care, working collaboratively with physicians, therapists, the patient, the patient’s family, and other team members, that focus on treating illness to improve quality of life. Nurses may help coordinate the patient care performed by other members of an interdisciplinary healthcare team such as therapists, medical practitioners, and dietitians. Nurses provide care both interdependently, for example, with physicians, and independently as nursing professionals.
Urinary Catheterization
Definition of Catheter
In medicine, a catheter is a thin tube made from medical grade materials serving a broad range of functions. Catheters are medical devices that can be inserted in the body to treat diseases or perform a surgical procedure.
or
A urinary catheter is a flexible tube used to empty the bladder and collect urine in a drainage bag.
Definition of catheterization:
Catheterization is the introduction of a catheter (a hollow flexible tube) into a body cavity or organ to inject or remove a fluid.
or
Catheterization is the process of putting a tube into the body to allow fluids to pass or to make a passage wider.
Definition of Urinary catheterization:
Urinary catheterization is the insertion of a special catheter into the urinary bladder, using aseptic technique, for the purposes of evacuating or instilling fluids.
or
In urinary catheterization a latex, polyurethane, or silicone tube known as a urinary catheter is inserted into a patient’s bladder via the urethra.
or
Introducing a catheter into the urinary bladder through urethra using aseptic technique for the purpose of emptying the bladder is called urinary catheterization.
Purposes Of Catheterization:
1. To drain the bladder before, during, or after surgery.
2. For the relief of bladder distention.
3. For the control of incontinence.
4. When an accurate measurement of urine output is necessary.
5. For the orthopedic patient, those with casts, traction, pelvic fractures and the like.
7. When a sterile specimen is required for a diagnostic purpose (culture and sensitivity).
8. Often in the treatment of genito-urinary difficulties -irrigation, instillation
9. During the menstrual cycle of the female when an uncontaminated specimen is required.
Types of catheterization:
- Urethral catheterization
- Cardiac catheterization
- Arterial catheterization
- Ureteric catheterization
- Suprapubic catheterization
Types of catheters:
There are four types of catheters such as-
1. Rubber catheters.
2. Polythene catheters.
3. Hard rubber catheters
4. Metal catheters.
Types of Urinary Catheter:
There are three main types of catheters –
A. Indwelling Catheters (Urethral or Suprapubic Catheters): An indwelling catheter is a catheter that resides in the bladder. It may also be known as a Foley catheter. This type can be useful for both short and long periods of time. A doctor usually inserts an indwelling catheter into the bladder through the urethra.
B. External Catheters (Condom Catheters): A condom catheter is a catheter placed outside the body. This type of catheter is typically necessary for men who don’t have urinary retention problems but have serious functional or mental disabilities, such as dementia. A device that looks like a condom covers the penis head. A tube leads from the condom device to a drainage bag.
C. Short-Term (Intermittent) Catheters: Sometimes a patient only needs a catheter for a short period of time after surgery. After the bladder empties, it’s necessary to remove the short-term catheter.
Indwelling Catheter
Intermittent Catheter
External Catheter
Purpose of Urethral Catheterization:
- To empty bladder when patient cannot pass urine or to provide continuous drainage.
- To get a sterile sample of urine directly from the bladder for test when urethra is affected by infective disease.
- After certain operation over bladder or urethra or prostate.
- During paralysis of bladder in lower motor neuron type of paralysis.
- To differentiate diagnosis between suppression of nine and retention of urine.
Indications of Urinary Catheterization:
- • To relieve acute and chronic urinary retention.
- To collect a sample of sterile urine specimen.
- To relieve discomfort by bladder distension.
- To assess among of residual urine in case of incomplete emptying.
- To manage patients with spinal cord injuries.
- In case of prostatic enlargement, to prevent outflow.
- Preoperative use for selected surgical procedures.
- Patients undergoing urological surgery or other surgery on contiguous structures of the genitourinary tract.
- Emptying the bladder before, during or after surgery and before certain diagnosis examinations.
- Need for intra-operative monitoring of urinary output.
- Anticipated prolonged duration of surgery.
- To prevent urethral irrigations.
- To give bladder irrigations.
- Management of intractable incontinence.
- In case of terminal illness.
- Need for accurate measurements of urinary output in critically ill patients.
- To manage incontinency in unconscious patients.
- To improve comfort for end of life care if needed.
- To assist in healing of open sacral or perineal wounds in incontinent patients.
- Patient requires prolonged immobilization (e.g. potentially unstable thoracic or lumbar spine, multiple traumatic injuries such as pelvic fractures).
Contraindications for Urethral Catheterization
- Acute prostatitis.
- Suspicion of urethral trauma.
Complication of catheterization:
- Injury to urethra
- Haemorrhage
- Infection
- Stone formation
- Blockage of catheter
- Stricture urethra
Procedure of Female Catheterization:
A. Articles need for female catheterization:
- A sterile tray
- Rubber catheters
- Sterile cotton swabs in bowl
- Sterile kidney tray
- Sterile gloves
- Sterile gauze pieces
- Sterile towel for spreading below vulva.
- Light source or torch. (This is required even in day time to find out female urethral orifice which otherwise may pose difficulty without torch).
- Sterile bottle if sterile specimen is required.
- Macintosh
- Bed side screen
- Unsterite kidney tray.
B. Procedure:
1. Place the patient in the supine position with the knees flexed and separated and feet flat on the bed, about 60 cm apart.
2. If this position is uncomfortable, instruct the patient either to flex only one knee and keep the other leg flat on the bed, or to spread her legs as far apart as possible.
3. A lateral position may also be used for elderly or disabled patients.
4. With the thumb, middle and index fingers of the non-dominant hand, separate the labia majora and labia minora. Pull slightly upward to locate the urinary meatus. Maintain this position to avoid contamination during the procedure.
5. With dominant hand, cleanse the urinary meatus, using forceps and chlorhexidine soaked cotton balls.
Figure: Positioning the client in supine position & Inseting catheter.
6. Use each cotton ball for a single downward stroke only.
7. Place the drainage basin containing the catheter between the patient’s thighs.
8. Pick up the catheter with dominant hand.
9. Insert the lubricated tip of the catheter into the urinary meatus.
10. Advance the catheter about 5-5.75 cm, until urine begins to flow then advance the catheter a further 1-2 cm.
11. Note: If the catheter slips into the vagina, leave it there to assist as a landmark. With another lubricated sterile catheter, insert into the urinary meatus until get urine back.
12. Remove the catheter left in the vagina at this time,
13. Attach the syringe with the sterile water and inflate the balloon. It is recommended to inflate the 5cc balloon with 7-10cc of sterile water, and to inflate the 30cc balloon with 30-35cc of sterile water.
14. Improperly inflated balloons can cause drainage and leakage difficulties.
15. Gently pull back on the catheter until the balloon engages the bladder neck.
Procedure of Male Catheterization:
A. Articles need for female catheterization:
- A sterile tray
- Rubber catheters
- Sterile cotton swabs in bowl
- Sterile kidney tray
- Sterile gloves
- Sterile gauze pieces
- Sterile towel for spreading below vulva
- Light source or torch. (This is required even in day time to find out female urethral orifice which otherwise may pose difficulty without torch).
- Sterile bottle if sterile specimen is required.
- Makintosh
- Bed side screen
- Unsterite kidney tray.
B. Procedure:
1. Place the patient in the supine position with legs extended and flat on the bed.
2. Prepare the catheterization tray and catheter and drape the patient appropriately using the sterile drapes provided. Place a sterile drape under the patient’s buttocks and the fenestrated (drape with hole) drape over the penis.
3. Apply water-soluble lubricant to the catheter tip.
4. With your non-dominant hand, grasp the penis just below the glans and hold upright.
5. If the patient is uncircumcised, retract the foreskin. Replace the foreskin at the end of the procedure.
6. With your dominant hand, cleanse the glans using chlorhexidine soaked cotton balls. Use each cotton ball for a single circular motion.
7. Place the drainage basin containing the catheter on or next to the thighs,
8. With you non-dominant hand, gently straighten and stretch the penis. Lift it to an angle of 60-90 degrees. At this time you may use the urojet to anesthetize the urinary canal, which will minimize the discomfort.
9. With your dominant hand, insert the lubricated tip of the catheter into the urinary meatus.
10. Continue to advance the catheter completely to the bifurcation i.e. until only the inflation and drainage ports are exposed and urine flows (this is to ensure proper placement of the catheter in the bladder and prevent urethral injuries and hematuria that result when the foley catheter balloon is inflated in the urethra).
11. Note: If resistance is met during advancement of the catheter: Pause for 10-20 seconds. Instruct the patient to breathe deeply and evenly. Apply gentle pressure as the patient exhales.
12. If you still meet resistance, stop the procedure and repeat above steps.
13. Attach the syringe with the sterile water and inflate the balloon. It is recommended to inflate the 5cc balloon with 7-10cc of sterile water, and to inflate the 30cc balloon with 35cc of sterile water. Improperly inflated balloons can cause drainage and leakage difficulties.
14. Gently pull back on the catheter until the balloon engages the bladder neck.
15. Attach the urinary drainage bag and position it below the bladder level. Secure the catheter to the thigh. Avoid applying tension to the catheter.
16. Remove drapes and cover patient. Ensure drainage bag is attached to bed frame. Remove your gloves and wash hands.
17. Note: Never inflate a balloon before establishing that the catheter is in the bladder and not just in the urethra. If the patient reports discomfort, withdraw the fluid from the balloon and advance the catheter a little further, then re-inflate the balloon.
Procedure for Applying Condom Catheter:
A. Preparation
- Gather the following items:
- Waterproof pad or bath towel.
- Bowl of warm water, soap, washcloth, and hand towel.
- Correct size of condom catheter (small, medium, large, extra large).
- Velcro, tape, or other kind of sheath holding material.
- Urine bag with tube.
B. Procedure
1. Place the absorbent pad or bath towel under the individual if you are working in a chair or in bed.
2. Wash the penis using soap and water. Rinse and dry the penis carefully.
3. You may want to clip the hair or even shave the area near the base of the penis. Removing hair from this area will keep it from being caught in the condom or the attachment.
4. Inspect the penis to make sure it does not have any broken or reddened skin.
5. Wash, rinse, and dry your hands.
6. Hold the penis at a 90 degree angle from the body. Gently roll the condom over the penis. Leave 1 to 2 inches of the condom catheter at the end of the penis.
7. Wrap the sheath holder around the condom at the base of the penis. Do not wrap the sheath holder too tightly because this may stop blood from going to the penis.
8. Connect the condom catheter to the tube of the urine bag.
9. Make sure the condom is not twisted where it attaches to the catheter.
10. If you are using a small leg bag, use the catheter leg strap that came with the kit to secure the urine bag to the leg just below the knee. Leave some slack in the tube so the catheter will not be pulled when the individual moves his leg.
11. The urine collecting bag must be placed so that the urine flows downward. If he is in bed you may attach the collecting bag to the bed under the mattress. If he is sitting in a chair, the urine bag may be attached to the chair below the cushion he is sitting on.
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