Catheter Insertion

Question 1

What is urinary catheterization?

Answer 1

The introduction of a narrow tube through the urethra and into the bladder.

Question 2

What are the indications for a short-term indwelling catheter?

Answer 2

Urinary obstruction
Surgical repair of bladder, urethra, or surrounding structures
Prevention of urethral obstruction from blood clots
Measurement of urinary output in critically ill patients (accurate I & O)
Continuous or intermittent bladder irrigations

Question 3

What are the indications for a long-term indwelling catheter?

Answer 3

Chronic urinary retention not managed by intermittent catheterization
Skin problems
Palliation

Question 4

What are the indications for an intermittent catheter?

Answer 4

bladder distension
Obtain sterile urine specimen
Measure post void residual urine
Long term management of spinal cord injuries, neuromuscular degeneration, or incompetent bladder 
Managing urethral strictures

Question 5

What are the three main types of catheters?

Answer 5

Straight plastic catheter
Two-way foley catheter
Three-way foley catheter

Question 6

How do we select the correct catheter for a patient? (What are the guidelines for size, material, etc?)

Answer 6

Children 8-10 Fr.
Women 12-14 Fr.
Men 14-16 Fr.
20-24 Fr. Post prostatectomy
Latex and rubber can be left in up to 3 wks.
Silicone or Teflon for 2-3 mos.
Balloon size 5-10 cc, 30 cc post prostate surgery
Use sterile water to inflate balloon

Question 7

What are the risks that accompany a urinary catheter?

Answer 7

Infection
Inflammation
Trauma
Blockage

Question 8

What are common patient concerns with urinary catheterization?

Answer 8

Pain/discomfort
Fear or anxiety over intrusion into body
Embarrassment
Mobility
Body image 
Unable to regain bladder control upon discontinuation of catheter

Question 9

What patient teaching should be done prior to catheter insertion?

Answer 9

Explain procedure
May be asked to bear down or cough during insertion
provide rationale for the procedure
Expected sensations and symptoms to report to HCP
Provide opportunity to ask questions
Explain the risk of developing a UTI and preventative measures

Question 10

What patient teaching should be done when the urinary catheter is in situ?

Answer 10

Common to feel urge to void
Increase fluid intake (2-3L/d)
Move about freely
Avoid lying on tubing
Keep drainage bag below bladder
Pericare with soap and water BID
Monitor for strong odors, burning or discharge
Antispasmodic meds can be administered for comfort

Question 11

What are the common contamination risks when inserting a catheter?

Answer 11

Break in technique- unsterile equipment, lack of hand washing, contamination of gloves &/or catheter
Poor technique
Inadequate or improper cleansing of the perineum

Question 12

What should be recorded about a catheter insertion?

Answer 12

Size and type of catheter inserted
Reason for catheterization
Characteristics of urine, amount, color, consistency
Specimen collection 
Patient response to procedure 
Initiate I&O sheet
Patient teaching performed

Question 13

What is bladder irrigation?

Answer 13

Bladder irrigation is the process of instilling a fluid into the bladder and allowing it to passively drain out in order to flush out the bladder

Question 14

What is open bladder irrigation?

Answer 14

System is opened prn to irrigate
Requires double or triple lumen Foley
Always intermittent not continuous

Question 15

What is closed bladder irrigation?

Answer 15

System patency is maintained (closed)
Irrigation solution is instilled through the 3rd lumen of a three way Foley catheter
Can be intermittent or continuous
Requires triple lumen Foley

Question 16

What are the indications for bladder and catheter irrigation?

Answer 16

Flush out bladder eg. Post TUPR, post bladder resection for Ca
Instilling a medication
Maintain or restore catheter patency

Question 17

What are the principles/guidelines for catheter insertion?

Answer 17

Use sterile solution
Steady gentle force-do not exert force past resistance
Greater the height of the container= greater pressure of irrigation force
Physiologic solution is used
Irrigate until returns are clear
Law of gravity is used to facilitate drainage
Most of solution introduced into a body cavity is returned *(I &0)
Irrigation may cause discomfort
Forceful aspiration may cause mucosal damage
Irrigation returns are highly contaminated

Question 18

What are the essential things to monitor with patients who have bladder irrigation?

Answer 18

Monitor S&S of verbal or non verbal cues indicating discomfort/pain/pressure/spasms
Leakage of urine around the catheter
Distension at the suprapubic region
Monitor CBC and electrolytes  
No anticoagulants 
Maintain bedrest 
Monitor I&O
Monitor VS

Question 19

What are the essential things to monitor with the bladder irrigation system?

Answer 19

Assess system frequently
Check the irrigation for remaining volume, height of pole, and level of fluid in the drip chamber
Adjust the tubing clamps to ensure continuous flow rate
Assess catheter and tubing for patency, kinking and leakage
Check the drainage bag for amount, color, consistency, and position