Catheterization Flashcards
Internal Sphincter
no control ( smooth muscle)
External Sphincter
can control ( skeletal muscles)
micturition process
urination process from brain sending signals
Kidneys-
Ureters-
Bladder - ( state the name)
Urethra-
Kidneys- filters wastes toxins, water from blood, nephron forms the urine
Ureters- transports urine through
peristaltic waves
Bladder - detrusor muscle that rises above
pubic bone when full, fills from
bottom upwards
Urethra- transports urine from the bladder to the
body’s exterior through the urinary meatus.
bladder capacity
urge to urinate
500-1000 ml
200- 450 ml
afferent pathway
efferent pathway
bladder to spinal cord
spinal cord to bladder
Impulses from sacral ( state 3 sacral)
allows voluntary control to void .
2 , 3 , 4
Factors causing interruption to void
( 4)
- Anesthesia
- Drugs
3.surgery
- childbirth
Anesthesia (general/ spinal)
explain spinal in the purpose of efferent pathways
General: acute urinary retention can follow all types of anesthetics or operations due to suppression of
urinary reflex.- inability to sense bladder fullness.General anesthesia induces unconsciousness, Airway Management: Airway control is required in general anesthesia,
Spinal medication: blocks the transmission of the afferent and efferent pathways, unable to sense the need to void, and inability of bladder muscles and urethral
sphincters to respond.
while spinal anesthesia induces regional anesthesia and blocks sensation in specific parts of the body.
whereas spinal anesthesia is administered regionally, targeting specific nerve pathways.but not in spinal anesthesia, where patients maintain spontaneous breathing.
Drugs ( define the classification, 2 drugs DEFINE AND STATE SIDE
EFFECTS)
( remember professor D *cant ……)
state the differences
Anticholinergics: HELP TP Decrease MUSCLSE
a.Atropine- used in surgery to decrease secretions (saliva),and increase heart rate.
SE: decreased urgency to void and retention.
b.Glycopyrolate (robinul)- reduces salivary secretions, GI anti-spasmodic, decreases GI motility,
SE: urinary hesitancy and retention
spinal vs epidural
Spinal anesthesia is injected directly into the cerebrospinal fluid, whereas epidural anesthesia is administered into the epidural space outside the spinal cord.
Onset and Duration: Spinal anesthesia acts quickly and has a shorter duration of action, while epidural anesthesia has a slower onset and can be prolonged through continuous infusions.
Surgery:
Kidney-
Ureters- EXPLAIN WHAT THIS TECHNIQUE PURPOSE
Bladder-
Urethra-
Kidney- potential for blood in urine called
Ureters- ureteroscopy* help grabs stone and bring it out* with stone extraction, blood in urine, spasm * because their irriatied
Bladder- TURBT * removes tumorr*: bladder spasm, observe for bleeding
Urethra- swelling from surgical manipulation,
cysto (BLADDERRR)
Pregnancy and Childbirth:
Hormonal changes -( relation to bladder muscle)
Muscles- (discuss results)
Trauma- ( give an examples)
Nerve injury - ( which branches)
Hormonal changes in pregnancy
cause the bladder muscle to lose tone
Muscles- pelvic floor tissue stretching during
delivery resulting in nerve damage
Trauma- Surgical instrumentation and difficult labor/delivery cause swelling, pain
ex)forceps /vacuum can cause hematoma on baby head
Nerve injury during delivery (afferent nerve
branches (S2-4)
Retention:
Urine fills the bladder but unable to empty properly
Does not respond to the micturition reflex
***Assess the abdomen for evidence
of bladder distention/tenderness
urinary retention types (3)
- Overflow
- Mechanical
3.Functional
Retention with overflow:( how much)
Bladder unable to respond to reflex, urine accumulates, bladder stretches, feelings of pressure, external urethral spasms & unable to hold back urine.
Urethra temporarily opens to let a
small overflow of urine out (25-60 ml)
Mechanical Retention of Urine:
( congenital * 3
vs acquired 4 )
Congenital * at birth*:
-urethral stricture (narrowing)
-urinary tract malformation
-spinal cord deformity
Acquired * happens *:
-calculus/tumor
-inflammatory/hyperplasia * access growth of tissue / enlargement ex) prostate ),
-trauma/pregnancy
-enlarged prostate
Functional Retention
( define/ examples 7 /kinds of drugs * 5*)
Neurogenic bladder- impaired nerve pathways may interfere with normal
micturition.
ie: MS, Parkinson’s disease, diabetes, spinal trauma , shy bladder, anxiety, aging
medications : given for pain/surgery
- narcotics
- sedatives
- antihistamines
- anti cholingeric
- gerenal and spinal anesthesia
Medications for retention and urgency? 2
- Cholinergic (urecholine)
stimulates the bladder to
contract, which improves
urine flow (retention) - Anti-cholinergic (ditropan)
for pts with over active
bladder. Anti-spasmodic
that relaxes the muscles in
the bladder to help decrease
problems of urgency and
frequent urination
Residual ( steps)
ASSESS BY?
amount urine in bladder 10-15 post void.
Assess by:
1. Bladder scanner: prior to use of a catheter to
determine amount of urine retained in bladder
- AFTER voiding (10-15 min)
ditropan
helps what kind of issues
for pts with over active
bladder. Anti-spasmodic
that relaxes the muscles in
the bladder to help decrease
problems of urgency and
frequent urination
Bladder scan-
used to
estimate volume of urine
in bladder
void
void
rebound tenderness
apendictitis
a rounded swelling above pubis
pt have absnce of urine.
The best way to assess for a distended bladder. This swelling represents the distended bladder rising above the pubis into the abdominal cavity. The client might experience tenderness or pressure above the symphysis
Nursing Intervention ( non-invasive) ( 8)
Promote normal
voiding:
Privacy
Comfort
Run water
Positioning
Warm water
Crede = pushing down on abdomen
Massage spine
(S2,3,4 level)
Bladder scan
bladder decompressions
(purpose/ when volume of urine is)
helps decompression of bladder/drain urinary to make it smaller
when volume of urine is known to be
excessive (>1L), notify provider for
guidance r/t gradual bladder decompressio
Catheterization (purpose /4types)
(invasive)
Purpose: Place catheter into the urinary bladder to
allow drainage of urine (strict asepsis!!!!)
Types of catheters:
Straight
Retention (double lumen foley)
Triple
supra above pubic / urthera is bypassed
Coude
Types of catheters:
Straight
-Straight catheters are used to drain the
Temporary Use: Straight catheters are designed for short-term use and are typically used on an as-needed basis.
No Balloon: Unlike indwelling catheters, straight catheters do not have a balloon to hold them in place; they rely on manual insertion and removal.
Purpose of catheters ( 6) contd.
To obtain a sterile urine specimen
Measure the amount of residual urine
Empty the bladder prior to surgery
Prevent post op bladder distention
Prevent urine from coming in contact with an
incision or open wound/skin breakdown
To obtain accurate intake and output (I&O)
Provide continuous or intermittent bladder irrigation
void
void
Triple lumen
(bladder/prostate sugery pts)
- need to retention
-clamp it
Facilitate continuous bladder irrigation or for instillation of medication. This catheter is primarily used following urological surgery or in case of bleeding from a bladder or prostate tumor and the bladder may need continuous or intermittent irrigation to clear blood clots or debris.
Supra
bypasseswhat
suprapubic catheter is a type of urinary catheter that is surgically inserted into the bladder through the abdominal wall, just above the pubic bone.
Suprapubic catheterization is often performed when long-term or permanent urinary drainage is required, or when other methods of catheterization (such as urethral catheterization) are not suitable or have failed.
by passes urethera
Coude
men with enlarge prostate
Retention Catheter
indwelling/foley
It is held in place by a balloon filled with sterile water, preventing it from slipping out. Foley catheters are commonly used in healthcare settings for patients who are unable to urinate naturally due to various medical conditions or surgeries. Here are the steps for inserting and managing a Foley catheter:
Catheter Size
Infants and young children-
Children-
Adults -
Elderly, thin adults-
Large meatal opening -
French system: the internal diameter of catheter-
the larger the number, the larger the lumen size
Infants and young children- 5-8 Fr
Children- 8-10 Fr
Adults 14-16 Fr ( normal 14)
Elderly, thin adults- 12-14 Fr
Large meatal opening -20-30 ( for weak bigger )
Retention Catheter Balloon Size
Child-
Normal size adult-
Long term use, post-op TURP, continuous
bladder irrigation-
Child- 3ml balloon with 5ml sterile water
Normal size adult- 5ml balloon with 10ml
sterile water
-30ml
*Not recommended to pre-test the balloon
prior to insertion
Inserting a Urinary Catheter
Prepare patient-
-Female Postioning
-Male- Postioing
-Pt with issues positions
tips:( 3)
- An indwelling catheter must be ordered by a
physician and is inserted only by a licensed nurse. (nursing students can with rn ) - Prepare patient- explain
- Wash hands, gather equipment
Female- supine, knees flexed.
Tips:
need good lighting for visualization
Variations in technique
bearing down may ease catheter insertion
Male- supine, legs straight
Pt sims postion with issues.
Application of Lubricant
Female-
Male-
Female- 1-2 (4inches) up the catheter. deep breath
Male- up to the Y connector
*hold penis at a 90 degree angle
5-7 inchess
Maintain Sterile Technique
Female Steps ( 3 steps)
If catheter is placed in vagina steps
- Cleansing Labia-
- Hold labia with non dominant hand-
3.Once hand is
positioned, keep in place-
DO NOT LET GO!
4.If catheter is placed in the vagina:
Leave it there
Begin with new catheter
NEVER use contaminated catheter
urinary stasis
urinary stayed in bladder
Male Tips
Catheterizations
cleanse urinary meatus in a circular
motion from meatus outwards
Hold penis at a 90 degree angle
Secure Urinary Catheter
explainpurpose whyyyyyy
Anchor tubing using tape or
catheter leg band check tubing.
causes infection if not tape to prevent movement.
Risks of Catheterization
(3)
Infection- Catheter associated urinary tract
infections (CAUTI) account for 80% of
hospital acquired infections
Trauma
Reflux
Removal of Catheter (6)
think about nurse duties
Wear clean gloves
Check balloon size
Completely deflate balloon (10ml syringe)
Measure urine output (U/O)
Observe for urinary retention post removal
Assess for signs of UTI (dysuria/frequency/fever/confusion * delrious/dementia )
Self or Intermittent
catheterization
Single use catheter to drain the bladder
Reasons:
Neurogenic bladder
Spinal cord injury
Self Catheterization (4)
Goal- empty bladder, prevent UTI
Good vision
Manual dexterity
Cognitive ability ( no dementia)
Motivation
Bladder Irrigation
Closed System
(triple lumen catheter)
five steps
DONTFORGET LAST STEP
Irrigation solution and tubing
Run in amount of fluid per
physician order*
Clamp during irrigation (retain bladder)
Unclamp to drain irrigant*
and urine
Subtract irrigant from urine* ( if i have 260 / 60 was irrgaint = my total is 200)
Benefits of self catheter (6)
Decrease in UTI’s
Independence
Decrease in reflux
Normal sexual relations
Release from dribbling
Return to work
Closed intermittent bladder
Irrigation via
specimen port using
state last important step when documenting findings
wash hands
cleanse specimen [port with alcohol
draw up sterile irrigation solution into 60 ml syringe, connect to specimen port( 10ml)
clamp drainage tubing
Unclamp drainage tubing and
allow irrigant and urine to drain
Subtract irrigant from urine total
Bladder irrigation–
Open System
Physician order/Not recommended
Obtaining a Sterile Urine Specimen
from a Catheter- ( 6 steps)
- Clamp drainage bag tubing below
the level of the specimen port for 15-30 min - Put on clean gloves
- Cleanse specimen port with alcohol and insert needless
access device with a 20-30 ml syringe into self sealing
specimen port @ 90 degrees and withdraw urine. - Place into sterile specimen container
- ***Must unclamp tubing
- Send to lab promptly for
analysis per facility policy ( ASAP or it’ll get infected)
Assessment for retention (4)
- abdominal assessment ( IPP- no A)
- assess I&O
- bladder scan - used to estimate
volume of urine in bladder
-palpating the bladder
Inserting a Urinary Catheter steps men
Catheterization in Men:
**1. Prepare the Patient:
Explain the procedure to the patient, ensuring informed consent.
Gather necessary supplies: sterile catheter, sterile lubricant, sterile gloves, antiseptic solution, drainage bag, and drapes.
**2. Position the Patient:
Have the patient lie on their back with knees bent and legs apart, or in a dorsal lithotomy position (similar to a gynecological exam position).
**3. Prepare and Cleanse:
Wash hands thoroughly and put on sterile gloves.
Cleanse the urethral meatus and surrounding area with an antiseptic solution.
**4. Insert the Catheter:
hold peepee @ 90 degree
Lubricate the catheter tip with sterile lubricant.
Hold the penis upright, perpendicular to the body.
Insert the catheter gently and slowly into the urethra until urine starts to flow.
Continue inserting the catheter about 2-3 inches more after urine starts flowing to ensure it is in the bladder.
**5. Secure the Catheter:
Secure the catheter to the patient’s thigh or abdomen using tape or a catheter stabilization device.
Connect the catheter to a drainage bag.
**6. Ensure Comfort and Safety:
Ensure the catheter is draining properly and that the patient is comfortable.
Wash hands and provide appropriate perineal care.
Inserting a Urinary Catheter steps woman
Insert the Catheter:
Lubricate the catheter tip with sterile lubricant.
With one hand, separate the labia.
Insert the catheter gently and slowly into the urethra until urine starts to flow.
Continue inserting the catheter about 2-3 inches more after urine starts flowing to ensure it is in the bladder.
**5. Secure the Catheter:
Secure the catheter to the patient’s thigh using tape or a catheter stabilization device.
Connect the catheter to a drainage bag.
**6. Ensure Comfort and Safety:
Ensure the catheter is draining properly and that the patient is comfortable.
Wash hands and provide appropriate perineal care.
In both cases, it’s essential to use sterile techniques, maintain patient dignity, and ensure proper catheter placement and securement to prevent complications. Proper training and following institutional protocols are essential for performing urinary catheterization safely and effectively.
balloon purpose in catheterizations
the balloon in a catheter is essential for ensuring proper placement, stability, and retention inside the
bladder.
It is a key component that allows the catheter to fulfill its purpose of draining urine effectively and safely. Healthcare professionals carefully inflate and deflate the balloon according to specific guidelines to ensure patient comfort and prevent complications.
obtaining specimen
NOT FROM BAG
- need to clamp bag ( 15 minutes)
-send to labs asap
if not refrigerate it
Benign prostatic hyperplasia meaning
With this condition, the urinary stream may be weak, or stop and start
REMEMBER THE PURPOSE OF IRRGATION
A client, who had a transurethral resection of the prostate (TURP), has a three-way indwelling urinary catheter with continuous bladder irrigation. In which of the following circumstances should the nurse increase the flow rate of the continuous bladder irrigation?
When drainage is continuous but slow.
When drainage appears cloudy and dark yellow.
When drainage becomes bright red.
When there is no drainage of urine and irrigating solution.
- The decision by the surgeon to insert a catheter after TURP or prostatectomy depends on the amount of bleeding that is expected after the procedure. During continuous bladder irrigation after a TURP or prostatectomy, the rate at which the solution enters the bladder should be increased when the drainage becomes brighter red. The color indicates the presence of blood. Increasing the fow of irrigating solution helps flush the catheter well so that clots do not plug it. There would be no reason to increase the flow rate when the return is continuous or when the return appears cloudy and dark yellow. Increasing the flow would be contraindi-cated when there is no return of urine and irrigating solution.
The infusion rate should be increased if the drainage is cherry colored or if clots are seen.
