Catheters Flashcards
define frequency
needing to urinate more than 8 times during the day or more than 2 times at night
define urgency
- overactive bladder
- also called OAB
- causes frequent/ sudden urge to urinate that can be difficult to control
define dysuria
pain or discomfort during urination
define nocturia
abnormally increased production of urine during the night leading to an unusually frequent need to urinate
define incontinence
inability to control urine flow, resulting in involuntary discharge or leakage
define polyuria
increased rate of urine production
define oliguria
- low output of urine
- 300-500ml/day
define anuria
- absence of urine
- below 50mL/day
define hematuria
presence of blood in urine
define retention
accumulation of urine within the bladder because of the inability to urinate
What are the indications for urinary catheterization for indwelling?
- Acute urinary retention
- bladder outlet obstruction
- Accurate measurements of urinary output
- Decubitus ulcers
- Prolonged immobilization
- Improve comfort for end of life care
- Hematuria
- Obstruction
- Urological surgery
describe decubitus ulcers
open sacral or perineal pressure ulcer
When would you use an in/out urinary catheter?
- Used to drain bladder then removed
- Collection of sterile urine sample in select situations
- Instillation of medications into bladder
- Urodynamic testing
What are the different types of catheters?
- foley
- silicone
- silastic
- in/out (intermittent)
- Coude tip
- 3-way
describe a foley catheter
- indwelling with balloon
- latex
- used for about 1 month
describe a silicone foley catheter
- indwelling with balloon
- used when people have an allergy to latex
- used for 8-12 weeks
describe a silastic foley catheter
- indwelling with balloon
- used when people have an allergy to latex
- used for 8-12 weeks
describe an in/out catheter
- intermittent
- one time use
- does not stay in
- used to drain bladder then removed
describe a coude tip foley catheter
- used if having difficulty inserting a straight catheter
- used for people who have urethral blockages or BPH
- used for about 1 month
what does BPH stand for?
benign prostatic hyperplasia
describe a 3-way catheter
- used for bladder irrigation
- indwelling with balloon
- has 3 tips
- used for about 2-12 weeks
What are the 3 tips on a 3-way catheter used for?
- One with blue on it is used to inflate balloon
- Middle one is used to collect urine
- Top or right is used to flush
describe best practices to prevent urinary tract infections
- Peri care twice a day
- Catheter care twice a day
- Keep drainage bag below bladder
- Empty drainage bag several times/ shift
- Inspect for kinks in the line
- Wash hands before/ after catheter/ peri care
- Try and increase fluid intake for pt if not on fluid restriction
What is the difference between intermittent and indwelling catherization?
intermittent
- inserted through urethra into bladder to empty
- inserted/ removed several times/ day
indwelling
- inserted through urethra or stomach wall into bladder
- left in place for period of time
What is the difference between straight and foley catheters?
straight
- do not attach to collection bags
- do not have balloon
- used in bathroom/ other places where urine can be disposed of
- short term use
foley
- long term use
- drain into bag
- stay in situ with balloon
How do you determine the size of catheter needed?
- size varies on person’s anatomy and the catheter use
- women uretheral catheter size 12-14F
- men urethral size 14-16F
How do you determine how much fluid to use to inflate the balloon of a catheter?
- catheter will tell you on it how much water is needed to fill balloon
What causes urinary retention?
- surgical genito-urinary trauma can cause swelling/ bleeding
- anesthesia
- bladder outlet obstruction
- deficient detrusor contraction strength
in regards to urinary retention causes, describe anesthesia
allows bladder to fill more completely than normal before the urge to urinate is felt
in regards to urinary retention causes, describe deficient detrusor contraction strength
muscle no longer has the strength to contract with enough force or for long enough to completely empty the bladder
what is post-void residual?
the amount of urine left in bladder after urinating
What are the signs of catheter blockage?
- no urine draining
- no urine in bag
- urine leaking around catheter
- client has stomach cramps/ feels the urge to urinate
if you suspect a catheter blockage what should you do?
- check for kinks
- check position of catheter and drainage bag
- make sure bag is bellow bladder
- check leg straps fitted correctly
- assess for bladder spasms
- assess catheter in situ/ not being pulled on
- get pt to cough
- complete bladder scan
- notify MRP
what are the signs of urinary infection?
- cloudy urine
- hematuria
- strong urine odor
- urine leakage around catheter
- chills/ fever
- unexplained fatigue
- vomiting
- burning sensation around catheter
- pressure, pain/ discomfort in lower back or stomach
If you suspect a UTI what should you do?
- urinalysis
- urine culture
- C&S test
- review results/ report findings to MRP/ ask for antibiotics
if a UTI goes untreated what is the pt at risk of?
- kidney infection
- kidney damage
- decreased immune function > could lead to further infections
what does TURP stand for?
Transurethral Resection of the Prostate
What does CBI stand for?
continuous bladder irrigation
What are the complications following a TURP and having CBI?
- bleeding
- clot retention
- bladder spasms
- dilution hyponatremia associated with irrigation
what can RNs do with or without an order for the purpose of assessment or treating a condition through a nursing diagnosis?
insert, maintain and remove a urinary catheter including coude
what can RNs administer prior to catheterization at the beside upon nursing assessment of client’s needs?
administer lidocaine 2% gel (topical anesthetic)
Who should lidocaine be used for especially?
males if they exhibit anxiety
What are the different types of incontinence?
- stress
- urge
- mixed
- overflow
- functional
- reflex
in regards to the different types of incontinence, describe stress incontinence
Urine loss during activities
- coughing
- sneezing
- laughing
- jumping
- lifting
Common during pregnancy and after childbirth
in regards to the different types of incontinence, describe urge incontinence
- occasional sudden need to urinate with large volume urine loss
- can exist without incontinence
- common in neurologic diseases
in regards to the different types of incontinence, describe mixed incontinence
Combination of stress and urge incontinence
in regards to the different types of incontinence, describe overflow incontinence
- frequent dribble of urine due to inefficient bladder emptying
- symptoms similar to stress incontinence
- common in diabetic or enlarged prostate patients
in regards to the different types of incontinence, describe functional incontinence
- Urine loss not associated with any pathology or problem in the urinary system
- common in patients with head injury or Alzheimer’s
in regards to the different types of incontinence, describe reflex incontinence
- also known as spastic bladder
- bladder fills with urine and involuntary reflex causes it to contract in an effort to empty
- common in patients with spinal injuries above T12
define urinary retention
- inability to void
- can be chronic or acute
- can be caused by surgery, urethral trauma, obstruction
what are the signs and symptoms of urinary retention?
- bladder distention
- absence of urine output over several hours
- severe pain/ pressure in pelvic area
- restlessness
- diaphoresis
- urgency
define incontinence
inability to control the release of urine
How do you determine if someone’s bladder is full?
- palpate
- complete bladder scan
What do you need to input into the bladder scanner prior to using it?
- sex
- if person has had a hysterectomy
at what volume do you need to help someone empty their bladder?
300mL
if someone has a catheter how long after are they at risk for a CAUTI?
within 48hrs
what does CAUTI stand for?
Catheter Associated Urinary Tract Infection
how do you avoid causing urethral trauma when inserting a catheter?
- use lots of lube
- advise pt to inform RN if they feel any pain during procedure (they should not)
What does HOUDINI stand for?
H - hematuria
O - obstructed
U - urologic surgery
D - decubitus ulcers
I - input/output monitoring
N - not for resuscitation/ end of life
I - immobility due to physical restraints
how do you remove an indwelling catheter?
- explain procedure to client
- perineal hygiene
- check volume of water in balloon
- apply blue pad under genital area/ provide perineal privacy
- deflate balloon
- get pt to breath in and on their ex-hale gently put catheter out
- provide peri care again
- remove statlock
- get pt to notify when they urinate and encourage fluid intake
- document
What do you do if the balloon of the catheter will not deflate?
- try and advance catheter but must clean tube prior
- check for kinks
- let physician know
Once you report to the physician that the balloon of a catheter will not deflate what are you expecting they might say?
- leave catheter alone for a few hours and then try removing again
- might order catheter to be cut, drained and removed
After you remove a catheter what must you include in your charting?
- time or procedure
- integrity of balloon and catheter tip
- size of catheter
- volume of fluid removed from balloon
- pt’s tolerance
- type of urine sample collected prn
what are the steps in collecting a urine specimen sample from an indwelling catheter?
- clamp for 30 mins
- cleanse port
- attach lure lock syringe
- withdraw sample from above tubing
- disconnect
- place sample in sterile container
- unclamp
- label sample, place in biohazard bag, send to lab
When you go in to collect a urine sample from a catheter and the patient complains for discomfort, cramping and urge to void what is your first step?
check for kinks in tubing
How much urine should be produced per hour?
30mL/hr
How much fluid can your bladder hold?
300-500mL
How much urine per day does your body produce?
1-2L/day
How much fluid is in your bladder when your body triggers you to go pee?
150mL
prior to inserting a catheter what are the 2 things you should always ask your patient?
- are you allergic to latex
- are you allergic to iodine
What position do you put men and women in when inserting a catheter?
men
- supine
women
- dorsal recumbent (on back with legs in frog position towards the sides)
Why do you put women in a dorsal recumbent position when inserting a catheter?
opens pubic floor
how far do you insert an indwelling catheter?
2 inches past urine return
what should you tell your patient to do during a catheter insertion procedure?
- relax
- take deep breaths
- if you feel pain let me know but it shouldn’t hurt
what do you do if there is more than 700mL of urine retention via bladder scan?
pinch catheter periodically while draining to avoid spasms occurring > can cause collapsed bladder
What do you do if a catheter will not insert on a male pt?
- get them to take deep breaths
- hold penis at 90 degree angle > if not going in re-angle penis
What do you do if a catheter will not insert on a female pt?
get them to take deep breaths and relax
After inserting a Cather what do you need to include in your documentation?
- time of procedure
- type and size of catheter
- volume of water used to inflate balloon
- characteristics/ volume of urine output
- any difficulties
- pt’s tolerance
- presence of drainage
- specimens collected prn
What do you use to inflate a balloon for an indwelling catheter?
water and not normal saline b/c it crystallizes over time
What is a nephrostomy?
artificial opening created into renal pelvis to allow urinary diversion
what are the indications for a nephrostomy?
- removal of renal calculi
- decompression of obstructed system
- maintain/ improve renal function following ureteral obstruction
What are some complications related to nephrostomies?
- kidney infection
- skin breakdown
what do you need to monitor when someone has nephrostomy complications?
- urea
- electrolytes
- creatinine
if someone has a kidney infection what are some signs and symptoms?
- pain in kidney area
- fever
- chills
- changes in appearance in urine
What is a suprapubic catheter?
catheter surgically placed through abdominal wall into bladder
What are some indications for a suprapubic catheter?
- anatomical issues with urethra
- pelvic organ prolapse
- spinal injuries/ trauma
- lower body paralysis
- MS
- long term catheter use
- acute prostatitis
Why might a suprapubic catheter be seen in a younger population?
- person not a candidate for prostate surgery
- person is a quad or peripalegic > doesn’t get in the way during sexual activity
describe the care of a supra public catheter
- same as indwelling catheter as well as dressing around insertion site
- observe for S&S of infection
- monitor skin integrity at insertion site
When is a continuous bladder irrigation most often seen?
following a TURP treatment of BPH
When a CBI is running do you need to make sure of?
- irrigation bags do not run dry
- should have 2 hanging at different levels
What is inside the bags that are used for CBIs?
NaCl 3L
why do we regulate the flow for CBIs unless ordered by the doctor?
minimize formation of blood clots
what do you do to the flow rate over time for CBIs?
gradually reduce flow rate as bleeding diminishes
Can pts go home with a CBI?
no, will be taken out prior to discharge
What is the flow of a CBI based on?
colour or fluid coming out
will urine output be measured if someone is on CBI?
may or may not be depending on hospital policy
Where in a CBI system installed?
placed in situ in OR
Where does a CBI system drain into ?
- large night bag with open end into large bucket to avoid back flow into bladder
- some facilities have closed system to prevent infection
What if your CBI pt has bright red urinary drainage that is not slowing down?
incase flow and if it doesn’t change apply traction and notify physician
describe open intermittent irrigation
- allows irrigation of catheter through opening system
- increased infection risk despite sterile procedure being used
How much fluid do you insert while performing an open intermittent irrigation? What else do you need to assess?
- 30mL sterile saline into catheter with 60mL syringe
- watch to make sure there is 30mL fluid return
How many times can you perform an open intermittent irrigation at once
repeat up to 4 times
Do you need an order to perform an open intermittent irrigation?
yes
describe a closed intermittent irrigation
irrigation of catheter without opening the system
What is the preferred method for intermittent irrigation?
closed intermittent irrigation
How much fluid do you insert while performing an open intermittent irrigation? How do you complete this task?
instill 30mL sterile saline into injection port on catheter tubing while clamping drainage system
- watch to make sure 30mL of fluid returns
How many times can you perform a closed intermittent irrigation at once
can repeat up to 4 times
