Catheterisation/Aseptic Technique Flashcards
How maya sceptic technique vary from procedure to procedure?
As a procedure aseptic technique in itself may vary, however the principles remain. For example, to perform venepuncture you are required to clean the skin with an alcohol wipe and use a sterile needle. However to insert a chest drain, you would require full barrier precautions (sterile gloves and gown), sterile equipment, sterile drapes and antiseptic preparation for the insertion site. The rigour of the procedure is dependent on:
Whether the procedure is invasive
Whether the procedure involves placement of an invasive device which would
be classed as a foreign body
The time taken for any procedure to be completed (duration increases the
possibility of possible microbial contamination)
The likelihood, type and amount of potential microbial contamination from the
sources involved in the procedure e.g. environmental, equipment and human sources.
What equipment is required for catheterisation ?
Equipment Required
* Dressing Trolley
* Hard surface cleaning wipes e.g. Clinell wipes
* Disposable apron
* Sterile procedure pack
* Two pairs of sterile gloves
* Sterile 0.9% sodium chloride for cleansing
* 10mL sterile syringe filled with sterile water (sometimes included in
catheter packaging)
* Urinary catheter (correct length for sex, correct type/size for anticipated
use)
* Lubricating anaesthetic gel (prescribed on a Medicine Prescription sheet
relevant to the clinical setting)
* Drainage bag
* Waste disposal bag
* Alcohol Based Hand Rub (ABHR)
* CAUTI Insertion Checklist
* Absorbent pad
What is the method you should follow fora sceptic technique ?
- Perform hand hygiene by washing hands with non-antimicrobial soap and warm water. Introduce yourself to the patient. Confirm patient identity. Explain procedure and gain consent. Check for allergies (especially latex). Obtain chaperone.
- Prepare a clean dry working surface e.g. a dressing trolley. The trolley should be cleaned with cleaning wipes using a systematic approach starting with the top shelf e.g. top shelf, each leg in turn, bottom shelf.
- Put on a disposable apron to protect the patient and your clothing. Gather the appropriate equipment listed above and place the items on the bottom shelf of the trolley. Check expiry dates and that sterile packaging is intact.
- Assist the patient into a comfortable, supine position in a well-lit area and ensure they are not unduly exposed. Men should lie with legs straight out and slightly apart. Females should lie with knees flexed and hips abducted with heels together in order to relax the perineum. Place protective sheet/absorbent pad under the patient’s buttocks and adjust lighting as necessary.
- Undertake hand hygiene with ABHR. Open the outer packaging on the dressing pack allowing it to drop onto the top shelf of the trolley. Using your thumb and forefinger, open the outer sterile field using minimal touch to create a sterile field.
- Remove the outer packaging from all the remaining sterile equipment, carefully dropping the items onto the sterile field. Pour the sterile saline into the gallipot. Take care not to contaminate the equipment or the sterile field.
- Perform hand hygiene using ABHR.
- Apply sterile gloves.
- Tear the end off the protective plastic cover on the urinary catheter to expose the connection port. Connect the drainage bag to the urinary catheter taking care to ensure that the catheter remains inside the plastic sleeve.
How would you carry out Male Catheterisation?
- With your non-dominant hand and using a large sterile swab, grasp the shaft of the penis retracting the foreskin if present. Clean the glans and urethral meatus with the sterile 0.9% sodium chloride soaked gauze swabs, ensuring the tips of the fingers remain sterile. Clean away from the urethral meatus in one direction only, and pay particular attention to the junction of the foreskin and corona.
- Insert the syringe nozzle of the lubricating anaesthetic gel into the urethra. Slowly instill 11mL of the gel into the urethra, remove the nozzle and discard. Hold the glans firmly for about five minutes, or according to gel instructions, to prevent it leaking. Wipe the underside of the penile shaft with a dry swab in a downward movement to move gel towards the prostatic urethra. Wipe away any excess gel and dispose of gloves.
- Perform hand hygiene using ABHR and apply a new pair of sterile gloves. Tear a hole in the sterile drape and apply over the penis. Remove the catheter from the plastic sleeve. Using a gauze swab, hold the shaft of the penis in your non-dominant hand at a 90o angle from the pelvis, to extend the peno-scrotal flexure. This helps to facilitate catheterisation. Holding the catheter in your dominant hand, insert the catheter into the urethral meatus.
- If resistance is felt at the external sphincter, extend the penis towards the abdomen and ask the patient to strain gently as if trying to pass urine, or cough. At the same time, try to insert the catheter gently into the bladder. If resistance is still experienced or the patient has discomfort or bleeding stop the procedure and re-assess.
- Insert catheter for about 15–25cm or until you see urine flow. Once urine flows, insert the catheter for a further few centimetres before inflating the balloon to ensure that the catheter has cleared the prostatic bed and is in the bladder. Inflate the balloon with sterile water or solution according to the manufacturer’s directions. For pre-filled balloons, remove the clip and gently squeeze the reservoir of sterile water. Withdraw the catheter slightly until resistance is felt.
- Observe the patient for any signs of discomfort as balloon inflation should be pain free. If there is pain, deflate the balloon and insert the catheter slightly further into the urethra then re-inflate.
- Ensure the glans penis is clean, then reduce or reposition the foreskin. Make sure the patient is comfortable and the area is dry. Ensure that the drainage bag is secured below the level of the patient and that the catheter is not under tension. Remove sterile drape by tearing.
How would you carry out Female Catheterisation?
- With your non-dominant hand and using a large sterile swab, retract the labia minora to expose the urethral meatus. Clean the vulval area and urethral meatus with the sterile 0.9% sodium chloride soaked gauze swabs, ensuring the tips of the fingers remain sterile. Clean away from the urethral meatus downwards toward the perineum, using a fresh swab each time.
- Insert the syringe nozzle of the lubricating anaesthetic gel into the urethra. Slowly instill 6mL of the gel into the urethra, remove the nozzle and discard. Allow five minutes to elapse. Wipe away any excess gel and dispose of gloves.
- Perform hand hygiene using ABHR and apply a new pair of sterile gloves. Tear a hole in the sterile drape and apply over the vulval area. Remove the catheter from the plastic sleeve.
- Using a gauze swab, retract the labia minora to expose the urethral meatus. Holding the catheter in your dominant hand, insert the catheter into the urethral meatus.
- Insert catheter for about 6-8cm or until you see urine flow. Once urine flows, insert the catheter a further few centimetres before inflating the balloon to ensure that the catheter is in the bladder. Inflate the balloon with sterile water or solution according to the manufacturer’s directions. For pre-filled balloons, remove the clip and gently squeeze the reservoir of sterile water. Withdraw the catheter slightly until resistance is felt.
- Observe the patient for any signs of discomfort as inflation should be pain free. If there is pain, deflate the balloon and insert the catheter slightly further into the urethra then re-inflate.
- Make sure the patient is comfortable and the area is dry. Ensure that the drainage bag is secured below the level of the patient and that catheter is not under tension.
How should you finish the examination?
- Dispose of equipment in a healthcare waste bag or according to local policy. Wash your hands.
- Fully document the procedure, including date and time, catheter type, length, balloon size, batch/lot number, manufacturer, expiry date, anaesthetic lubricant, name and signature of professional and any problems encountered on insertion. If it is the initial catheterisation, the urine output on insertion should be measured and recorded.
- Provide the patient with information on the maintenance and care of their catheter and drainage system.
