Catheterization

Question 1

When might you use a short term indwelling catheter?

Answer 1

• urinary obstruction
• surgical repair of bladder, urethra, prostate
• prevention of urethral obstruction from blood clots
• input/output in critical patients
• continuous/intermittent irrigations

Question 2

How long can short-term indwelling catheters be left in?

Answer 2

Up to 14 days. Any longer than that, they are considered long-term.

Question 3

What are the indications for using a long-term Indwelling Catheter?

Answer 3

• Chronic urinary retention not managed intermittent catheterization
• skin problems
• palliation

Question 4

Is it better nursing practice to use intermittent catheter multiple times a day or use an indwelling catheter?

Answer 4

**In and Out catheters even 10x/day pose FAR less risk for causing infection than longterm indwelling catheter.

Question 5

Is the use of intermittent catheters a Dr’s order or a nurse’s initiated order?

Answer 5

Nurse Initiated

Question 6

Why might you use an intermittent catheter?

Answer 6

• bladder distension
• obtain sterile urine specimen
• long-term management of spinal cord injuries or incompetent bladder (patient can catheterize themselves to avoid incontinence)

Question 7

What type of catheter is used for bladder irrigation?

Answer 7

3-way foley

Question 8

What size of catheter would you use for children? Women? Men?

Answer 8

8-10 Fr.
12-14 Fr.
14-16 Fr.
**Best practice is to use the smallest appropriate catheter for your patient.

Question 9

Do you need to use a different size of catheter for a post prostatectomy patient?

Answer 9

20-24 Fr.

Question 10

How long can Latex and rubber catheters be left in?

Answer 10

Up to 3 weeks

Question 11

How long can Silicone of Teflon be left in?

Answer 11

2-3 months

Question 12

To inflate the balloon, do you use clean water, normal saline or sterile water?

Answer 12

STERILE WATER.

N/S can crystallize over time

Question 13

How frequently should we be doing pericare on our patients with catheters?

Answer 13

Twice a day AT LEAST. If independent, they require good teaching, if dependent it is our responsibility.

Question 14

What are signs of a UTI to watch for in your patient with a catheter?

Answer 14

• mentation changes
• change in urine quality/quantity
• blood in urine
• fever

Question 15

How can you avoid causing inflammation/trauma while inserting/using a catheter?

Answer 15

• proper lubrication

- properly adhere tubing to pts leg once it is inserted, so it isn’t moving around inside the urethra

Question 16

What would you say to a patient who is concerned about catheter insertion?

Answer 16

• not a painful procedure, simply uncomfortable
• teach about the allowance for mobilization with a catheter
• teach how bag has to be below level of bladder

Question 17

Will your patient be able to regain bladder control upon discontinuation of catheter?

Answer 17

• provide reassurance that pt will regain bladder control basically as soon as the catheter is removed
• May feel burning for the first few days post removal, just because of friction, but that should go away fairly quickly.

Question 18

Before inserting a catheter, what can I teach my patient?

Answer 18

• 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 19

If the patient constantly feels the need to void once the catheter has been inserted, what might be causing that?

Answer 19

The inflated balloon sitting on or irritating the bladder. Teach your patient NOT to attempt to push to void as this might result in urine bypassing the catheter, increasing risk for infection or potentially causing damage to the urethra.

Question 20

CASE FOR CHARTING

Answer 20

CASE FOR CHARTING

Question 21

What is bladder irrigation?

Answer 21

Process of instilling fluid (usually Normal Saline) into the bladder and allowing it to passively drain out in order to flush out the bladder

Question 22

When might you use open irrigation? Explain this procedure.

Answer 22

If a patient has a foley and it gets blocked. Foley system is opened to irrigate as needed. This is always used on an intermittent basis, NOT continuous.
**RARE, d/t high risk of infection.

Question 23

How is closed irrigation difference from open irrigation?

Answer 23

System is set up and it always remains closed. Irrigation is instilled through the 3rd lumen of a 3 way foley.
*Can be intermittent or continuous.

Question 24

What are the indications for bladder irrigations?

Answer 24

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

Question 25

If your patient is receiving CBI, should you encourage them to mobilize around the unit?

Answer 25

No. Too much equipment to carry around safely.

Question 26

What can I do if returns are sanguinous?

Answer 26

Assess activity level– lots of mobilization can cause irritation

Question 27

How can I intervene if I see no output from the catheter?

Answer 27

• Assess patient for fullness
• Palpate bladder
• Milk catheter
• Irrigate

Question 28

What can I do if my patient is complaining of abdominal cramping?

Answer 28

• Assess pain
• Assess outflow
• Assess tubing for kinks
• Provide analgesia

Question 29

What if my patient is complaining of a high urge to void with a catheter in?

Answer 29

• Assess for appropriate amount of outflow

- Teach about importance of not pushing in case of bypassing the catheter.