Catherization Flashcards
Describe bladder catherization
Introducing a narrow tube through the urethra and into the bladder to allow a continuous flow of urine into the drainage receptacle.
Is a physicians order required for catherization?
Yes for both insertion and removal but particularly from removal, often times physicians will need an additional urology consult before making the decision to remove an indwelling catheter.
What are the indications for short-term catherization?
- less than 14 days
- Select surgicial procedures/post-op care
- accurate monitoring of urine ouput every 1-2 hrs in critically ill patients
- prolonged immobilization due to trauma
- acute urinary retention or bladder outlet obstruction
- instillation of medications into bladder
- end of life care only if required for comfort
What are the indications for long-term catherization?
- more than 14 days
- bladder outlet obstruction pending surgery or if patient is not suitable for surgical intervention
- chronic retention related to neurological disease if intermittent catherization is not feasible
- stage 3 or 4 sacral pressure injury or perineal skin breakdown in incontinent patients
- intractable urinary incontinence if alternate approaches have been tried but not successful
What are the indications for intermittent catherization?
- One time use straight catheter
- Introduced urethrally for 5 – 10 minutes
- used to empty the bladder in people with poorly contractile bladder or bladder sphincter dyssenergia
- long term in person with spinal cord injury or spinal bifida
- can be used to collect sterile urine specimen, only in patients who are able to provide a midstream specimen.
Describe a straight (intermittent) catheter?
- A single use straight catheter is introduced for 5 to 10 minutes, just long enough to drain the bladder
- The straight catheter has a single lumen with a small opening about 1.3 cm from the tip. urine drains from the tip, through the lumen and into a receptacle
Why is the straight/intermittent catheter used?
Intermittent catheterization is performed by the patient or nurse and is common in patients with retention / incomplete bladder emptying due to neurogenic conditions like spinal cord injury.
Describe a coude catheter
Has a curved tip and is used for male patients who have enlarged prostates that partly obstruct the urethra.
Why is the coude catheter used?
- It is less traumatic during insertion because it is stiffer and easier to control than the straight tip catheter
- use of this type of catheter needs special education
Describe indwelling/foley catheter
- This kind of catheter is retained for longer periods in the bladder by means of a small balloon that anchors it against the bladder neck.
- They are either two lumen (most common type; one lumen drains urine and the other carries sterile water to inflate or deflate balloon) or three lumen (third lumen allows for irrigation).
Why is the indwelling/foley catheter used?
The catheter remains in place until the patient is able to void completely and voluntarily for as long as accurate measurements are needed. Can be used on a short-term or long-term basis.
Why would you use a triple lumen catheter (three way)?
- Clot drainage & irrigation or mucous and tissue fragments after urologic procedures or urogenital surgery
- used for continuous bladder irrigation
When would you use plastic catheter?
Suitable for intermittent use because of their inflexibility
Describe latex catheter
Come with or without coating (silicone, Teflon, or silver). Be aware of patient allergies to any of these materials. Latex catheters may become encrusted more quickly than other materials.
When would you use silicone or hydrophilic polymer-coated catheter?
Best suited for long-term use (2 – 3 months) because they cause less encrustation at the urethral meatus and cause less friction and irritation to tissues.
When would you use silver-hydrogel catheter?
For short-term use, silver-hydrogel catheters may delay the onset of bacteria.
Why do we want to secure in-dwelling catheters?
prevents movement and pulling on the catheter, reducing urethral trauma.
Where should the level of the urinary drainage bag be?
Keep the urinary drainage bag below the level of the bladder at all times
Do we have to drain the urine from the bag before transport?
yes
When should you empty the urine bag?
Empty the drainage bag when it is half-full. = to prevent infection as bacteria can grow up tubing
At least every 8 hours, recording the output amount. If large outputs are noted, empty more frequently.
Where do you obtain urine samples?
Obtain urine samples using the sampling port. Clean the port with disinfectant and use sterile syringe or cannula.
How much of the catheter do you lubricate for a female?
2.5 - 5 cm
How far will you likely insert the catheter before you see urine flow for a female?
5 - 7.5 cm
Describe how you clean around the urinary meatus of a male
In a circular motion from urethral meatus down to base of glans. Repeat 3 more times with new cotton ball
How much of the catheter do you need to lubricate for a male?
12.5 - 17.7 cm
how far would you insert the catheter before you see urine flow?
17 - 22.5 cm
Why do you hold the penis perpendicular to the body for insertion?
Straightens urethral canal to ease catheter insertion.
In what situation would you change the catheter before its due date?
if there is discharge or infection present
How often do you provide perineal care to patients with an indwelling catheter?
At least twice daily, after bowel movements or as needed.
Why is it important to avoid pooling of urine in drainage tubing?
Bacteria can travel up drainage tubing to grow in pools of urine. If urine flows back into the patients bladder an infection may develop.
Why is it important to routinely inspect drainage tubing for clots and sediments?
May indicate infection or other serious complications. May initiate pooling of urine which may reflux back into the bladder increasing risk for UTI.
what volume of fluid should be encouraged and why?
2000-2500 mL, if permitted.
- A high fluid intake produces a large volume of urine that flushed the bladder and keeps the catheter tubing free of segment. Minimum 30 mL should be evidenced.
Why should each patient have their own individual measuring container?
Preventing infection from spreading between patients, increased risk of nosocomial infections.
What is the purpose of bladder irrigation?
To prevent blood clots from occluding the catheter or to maintain patency after urogenital surgery
How do you do bladder irrigation?
Usually done by a continuous closed-bladder irrigation which is a procedure used to flush sterile fluid through the catheter and into your bladder by utilizing a three-way irrigation closed system that has a triple-lumen catheter. One lumen is for draining urine, another is for inflating the catheter balloon and the last one is for irrigation solution.
What is bladder irrigation?
a procedure to wash out the inside of the bladder
What can result from accumulated clots, sediment, or pus in a catheter?
Bleeding, potential urinary tract infection or sloughing tissue.
Describe a continuous closed bladder irrigation system
A catheter (thin tube) will be placed in the bladder. The catheter will have holes large enough to allow clots to pass.
It will have 3 tubes coming from the end. The first will be attached to a drainage bag, the second will be used to inflate the balloon that keeps it in place and the third will be attached to tubing that goes into 2 bags of sterile saline
When might you open the closed system to irrigate a catheter?
If catheter becomes occluded by sediment and encrustation, it should be changed to avoid flushing debris containing bacteria into the bladder
What is the rationale for performing a closed intermittent irrigation? (with double lumen catheter)
if catheter is occluded and deemed harmful to remove the catheter
What is a urometer?
A collection bag equipped with an hourly measuring device
Why would you use a urometer?
Patients who are acutely ill may require more accurate, hourly urine measurements
how much is small voids, and what does small, frequent voids after removing catherization indicate?
25-60 mL
Small, frequent voids may indicate bladder spasm or that the client is not emptying the bladder (urinary retention) with each void. May need to scan the bladder for residual urine volume.
Why do you need to monitor voids after removal of catherization?
Monitoring of voids is to assess for bladder distention, abdominal pain, dribbling, incontinence, incomplete voiding.
How long do you need to monitor the voids after removal of catherization?
The patient’s urinary function is assessed by noting the first voiding after catheter removal and by documenting time and amount of voiding during the next 24 – 48 hours.
Do you contact the physician if the patient is experiencing small, frequent voids and bladder is palpable?
yes
Why should you encourage patients to maintain or increase fluid volume?
To maintain normal urinary output and encourage initial voiding after catheter removal sooner so that they are less likely to need the catheter re-inserted
How long do you wait until you contact a physician if the patient has not voided?
8 hours after catheter removal
define incontinence
involuntary loss of urine
define urgency
sudden and compelling urge to void that cannot be postponed
define dysuria
painful or difficult urination
define urine frequency
voiding more than 8 times in 24 hours
define hesitancy in urination
difficulty initiating urination
define polyuria
voiding large amounts of urine
define oliguria
diminished urinary output relative to intake
define nocturia
getting up at night to void one or more times
define dribbling
leakage of urine despite voluntary control of urination
define hematuria
blood in urine
