Catheter Insertion Flashcards
What is urinary catheterization?
The introduction of a narrow tube through the urethra and into the bladder.
What are the indications for a short-term indwelling catheter?
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
What are the indications for a long-term indwelling catheter?
Chronic urinary retention not managed by intermittent catheterization
Skin problems
Palliation
What are the indications for an intermittent catheter?
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
What are the three main types of catheters?
Straight plastic catheter
Two-way foley catheter
Three-way foley catheter
How do we select the correct catheter for a patient? (What are the guidelines for size, material, etc?)
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
What are the risks that accompany a urinary catheter?
Infection
Inflammation
Trauma
Blockage
What are common patient concerns with urinary catheterization?
Pain/discomfort Fear or anxiety over intrusion into body Embarrassment Mobility Body image Unable to regain bladder control upon discontinuation of catheter
What patient teaching should be done prior to catheter insertion?
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
What patient teaching should be done when the urinary catheter is in situ?
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
What are the common contamination risks when inserting a catheter?
Break in technique- unsterile equipment, lack of hand washing, contamination of gloves &/or catheter
Poor technique
Inadequate or improper cleansing of the perineum
What should be recorded about a catheter insertion?
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
What is bladder irrigation?
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
What is open bladder irrigation?
System is opened prn to irrigate
Requires double or triple lumen Foley
Always intermittent not continuous
What is closed bladder irrigation?
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
What are the indications for bladder and catheter irrigation?
Flush out bladder eg. Post TUPR, post bladder resection for Ca
Instilling a medication
Maintain or restore catheter patency
What are the principles/guidelines for catheter insertion?
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
What are the essential things to monitor with patients who have bladder irrigation?
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
What are the essential things to monitor with the bladder irrigation system?
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
