B.P. Koirala Institute of Health Sciences College of Nursing
Procedure Manual On Urinary Catheterization
Subbmitted By Rita Pokharel Msc. Nursing 2011
Submitted To Medical surgical Department College of Nursing
Urinary Catheterization Definition / Introduction
The insertion of a rubber tube through the urethra into bladder using aseptic technique. The catheter provides a continuous flow of urine. The ability to insert a urinary catheter is an essential skill in medicine. Catheters are sized in units called French, where one French equals 1/3 of 1 mm. Catheters vary from 12 (small) FR to 48 (large) FR (3-16mm) in size. Types of urinary catheters
Intermittent catheterization and Indwelling catheterization
Purposes of urinary catheterization/indications.
Intermittent Long term management of clients with spinal cord injuries, neuromuscular degeneration or incompetent bladder. Relief of discomfort. Obtaining sample. Assessment of residual urine after voiding. Short term indwelling Prevention of urethral obstruction. Measurement of urinary output. Continuing of intermittent irrigation. To keep perineum and or surrounding area clean and dry after surgery. To keep bladder empty in case of surgery . Long term indwelling catheter. To keep patient clean and dry in case of loss of control over bladder functions.
Contraindications
Foley catheters are contraindicated in the presence of urethral trauma. Urethral injuries may occur in patients with multisystem injuries and pelvic factures, as well as straddle impacts. If this is suspected, one must perform a genital and rectal exam first. If one finds blood at the meatus of the urethra, a scrotal hematoma, a pelvic fracture, or a high riding prostate then a high suspicion of urethral tear is present. One must then perform retrograde urethrography (injecting 20 cc of contrast into the urethra)
Complications
The main complications are tissue trauma and infection. After 48 hours of catheterization, most catheters are colonized with bacteria, thus leading to possible bacteruria and its complications. Catheters can also cause renal inflammation, nephro-cysto-lithiasis, and pyelonephritis if left in for prolonged periods. The most common short term complications are inability to insert catheter, and causation of tissue trauma during the insertion. Articles required
Dressing trolley Catheterization set containing Sponge forceps Gauze pieces Perisheet Cotton balls Sterile bottle Lubricant(xylocain jelly) Cathter size according to age. Syringe 10ml with sterile water. Urobag Rubber mackintosh. Sterile gloves Antiseptic solution Adhesive tape Screen for privacy Standing lamp/torch light.
Procedure
1. Preparatory phase
Apply screen Prepare articles required. Explain the procedure to the patient. Open catheter tray using aseptic technique. Place waste receptacle in accessible place. Place th patient in supine position with knees bent, hips flexed and feet resting on bed about 2 feet apart. Drap the patient. Direct light visualization of genital area. Place mackintosh under patient's buttocks. Wash hands and put on sterile gloves.
2. Performance phase
Clean around the urethra with antiseptic solution. Move from inside to outside starting top and move downward. Dispose of cotton after each swab. Put xylocain jelly on the gauze piece by assistant and hold the catheter then put jelly on the tip of catheter. Introduce catheter 2-3 inches into urethra in female and 6-10 inches untill urine flows in male. Allow some flow of urine through catheter before collecting sample if we are going to take sample. Expand the ballon with sterile water. Fix the catheter by applyinf tape to thigh and catheter. Place the patient in comfortable position. Measure and observe urine output. Replace all articles after cleaning.
3. Follow up phase
Record date, time, procedure, size of catheter, amount and appearance of urine. Signature of nurse. Pinch off catheter gently when obstruction to flow. remove gently when urine ceases to flow if intermittent catheter.
4. Care of indwelling catheter
Clean arround the area where catheter enters (meatal-catheter junction) with soap and water daily. Avoid using powders and sprays on the perineal area. Avoid pulling on the catheter during cleaning.
(note:avoid contamination of catheter, make sure that catheter is not too tight at urethral meatus and label the specimen correctly then send it to laboratory if necessary.) References
1. Potter AP,perry CA. Fundamentals of nursing concepts, process and practice,London;mosby;1997:1348-1350. 2. Neltina M.S. Lippincott Manual of Nursing Practice,8th edition,Lippincott William and Wilkins;2006:752-756. 3. TUTH.Nursing Procedure Manual.2nd edition, JICA;2000:40-41 4. http://www.med.uottawa.ca/procedures/ucath/.retrived on 2011.12.2
