Catheterization

Question 1

2 purposes for urinary catheterization

Answer 1

1. Draining the urinary bladder
2. Collecting urine for measurement

Question 2

catheterization allows a route of direct access to the bladder, what other 3 benefits does it provide?

Answer 2

1. Uncontaminated urinary samples
2. Reliable assessment of all urine output
3. Bypassing urinary obstructions

Question 3

indications for catheters

Answer 3

1. Impediment to urine flow
   ○ Acute urinary retention
   ○ Bladder outlet obstruction
   ○ Severe hematuria with clots
   ○ During and after surgery of the GU tract or adjacent structures
2. Diagnostic evaluation
   ○ Urine output measurement
   ○ Acquiring sterile urine sample in pts who cannot provide one
3. Treatment of GU conditions
   ○ Management of immobilized patients
   ○ Neurogenic bladder
   ○ Severe, refractory urinary incontinence
   ○ Improved patient comfort in hospice care
   ○ Intravesical pharmacologic therapy

Question 4

CI for catheters (absolute and relative)

Answer 4

1. Absolute - urethral injury
   ○ Pelvic trauma
   ○ Blood at urethral meatus or gross hematuria in
   context of trauma
2. Relative - urethral stricture, recent GU surgery, artificial urinary sphincter

Question 5

complications with catheters

Answer 5

Vary with type of catheter

1. Infectious - asx bacteriuria, UTI, epididymitis
2. Mechanical - Retained balloon fragments –> urethral obstruction
3. Bladder damage - fistula, perforation, stone formation
4. Urethral damage - trauma, stricture

Question 6

responsible catheter uses (4)

Answer 6

1. Use only when absolutely necessary
   ○ Do not use if pt can void spontaneously and reliably collect
   his/her own urine
2. Use sterile technique for placement
3. Use non-indwelling catheter if possible
4. Use for as short a time as possible

Question 7

4 types of urinary catheters

Answer 7

1. external
2. suprapubic
3. intermittent
4. indwelling

Question 8

3 types of external urinary catheters

Answer 8

1. condom catheter (M)
2. urinary pouch (M/F) - used for ostomies
3. PureWick (F)

Question 9

which urinary catheter is the least invasive? what is it not recommended for?

Answer 9

external
for accurate measurements, or obstruction

Question 10

pro vs cons of external catheters

Answer 10

pros - minimal/no urethral trauma, more comfort

cons

○ Skin irritation and scarring
○ Dislodgement and leakage
○ Penile ulceration and tissue loss
○ Inaccurate for most clinical diagnostic purposes

Question 11

CI for external urinary catheters

Answer 11

ulcerations, perineal dermatitis

Question 12

which catheter is the most invasive?

Answer 12

suprapubic urinary catheter
placed thru abd wall

Question 13

pros vs cons of suprapubic catheter

Answer 13

Advantages

○ Prevents urethral trauma/stricture
○ Less bacteriuria
○ Increased satisfaction vs. indwelling urethral catheters
○ Allows attempts at normal voiding
○ Less interference with sexual activity

Disadvantages

○ Requires surgical placement
○ May see long-term skin erosion, urinary leakage

Question 14

Urethral catheter that is placed and immediately removed after bladder is drained
what type of catheter is this?

Answer 14

intermittent urethral catheter
“straight cath”

Question 15

indications for intermittent urethral catheter

Answer 15

Short-term or long-term management of urinary retention, neurogenic bladder

○ May not be possible for some pts to self-catheterize
○ Must be done on regular basis in long-term pts

Question 16

common uses for indwelling urethral catheter

Answer 16

○ In-pt setting for short-term bladder drainage (< 3 wks)
○ Chronic urinary retention that can’t undergo other interventions
○ Chronic urinary incontinence refractory to all other tx methods

Question 17

which catheter is often associated with UTIs and discomfort/dissatisfaction

Answer 17

indwelling

Question 18

preliminary steps of placing an indwelling catheter?

Answer 18

○ Introduce self, identify pt
○ Explain procedure
○ Ensure pt consent for procedure
○ Wash hands and don non-sterile gloves
○ Assist pt into supine position, with legs spread
○ Ensure area (e.g., bed) is clear and treatment area is clean and exposed

Question 19

10 components in a indwelling catheter kit

Answer 19

● Sterile gloves
● Sterile drapes
● Cleansing solution
● Cotton swabs
● Forceps
● Sterile water
● Foley catheter - Usually 14-16 French
● Syringe
● Lubricant
● Collection bag and tubing

Question 20

steps for preparing for insertion when placing an indwelling catheter

Answer 20

1. Apply sterile gloves
2. Recommended not to inflate balloon prior to insertion
3. Coat distal portion of catheter in lubricant
4. Apply sterile drape on patient
5. Use non-dominant hand to separate labia or hold the penis
   - Keep non-dominant hand in position until after catheter is inserted
6. Cleanse the periurethral tissue with swabs using the dominant hand
   - Do not touch patient tissue directly with this hand

Question 21

steps for placing the catheter

Answer 21

1. Pick up catheter with (sterile) dominant hand
   - In male, lift penis to perpendicular position and apply gentle traction
2. Identify urethral meatus and gently insert lubricated tip of catheter
   - Should see urine flashback upon entering bladder
   - Insert at least one more inch
   — Some sources - insert to the hub (flared portion or “Y” portion)
3. Inflate balloon, using correct amount of sterile water
   - Usually 5-10 cc
   - Only inflate balloon if urine return is seen
4. After balloon is inflated, withdraw catheter until slight resistance is felt

Question 22

post-procedure care when placing an indwelling catheter

Answer 22

1. secure catheter to pt’s thigh/abd
2. be sure catheter is connected to drainage system
3. place drainage bag below level of bladder
4. ensure no kinking or potential obstruction

Question 23

general 5 steps when placing an indwelling catheter

Answer 23

1. preliminary steps
2. opening foley catheter kit
3. prepare for insetion
4. placing the catheter
5. post-procedure care