Lab 5 - Catheters Flashcards
what is catheterization
- introducing a narrow tube thru the urethra and into the bladder to allow a continuous flow of urine into a drainage receptacle
in acute care, catheterization is particularly useful for…
- careful monitoring of output in hemodynamically unstable patients
what are 3 risks associated with catheterization
- catheter associated urinary tract infection
- blockage
- trauma to the urethra
due to the risks associated with catheterization, what is preferred
- preferred to rely on other measures for specimen collection or management of incontinence
what are 2 types of catheterization
- intermittent
- in-dwelling
describe how intermittent catheterization works
- a single-use straight catheter is introduced for 5-10 min, just long enough to drain the bladder
describe a straight catheter; how does it work
- single lumen with a small opening about 1.3 cm from the tip
- urine drains from the tip, thru the lumen, and into a receptacle
who performs intermittent catheterization
- the patient
- nurse
is intermittent catheterization sterile or clean in hospital ? why?
- sterile
- to reduce the risk of nosocomial infections
in the community, is intermittent catheterization sterile or clean?
- clean & is reused many times
for catheters that are reused in community settings, how are they cleaned between use?
- washed w soap & water& left to air dry until next use
what is a coude catheter? when is it used?
- type of catheter with a curved tip
- used for male patients with enlaged prostates that partly obstruct the urethra
what type of catheter is used for in-dwelling catheterization?
- foley
describe a foley catheter; when is it used
- retained for longer periods in the bladder
- uses a small balloon that anchora it against the bladder neck
how long do foley catheters stay in place
- until the pt is able to void completely and voluntarily
- or for as long as accurate mesaurements are needed
how many lumens can indwelling catheters have? which is more common?
- 2 (more common)or 3
describe the purpose of 2 lumens for indwelling catheters
- one lumen drains urine
- the other carries sterile water to inflate or deflate the balloon
describe the purpose of 3 lumens for indwelling catheters
- one carries urine
- one carries sterile water for the balloon
- the other allows for irrigation
how long can indwelling catheters be used for
- either short-term or long-term
what are 3 different materials that catheters can be made of
- latex
- silicone
- Teflon
list indications ofr short-term indwelling catheter (5)
- urine outflow is obstructed
- surgical repair of the bladder, urethra, and surrounding structures
- seeking to prevent urethral obstruction from blood clots
- measuring urine output in ciritcally ill patients
- continuous or intermittent bladder irrigation is required
list indications for long-term indwelling catheters (3)
- when chronic urinary retention is not manageable by intermittent catheterization
- when skin rashes, ulcers, or wounds become irritated by contact with urine
- in those w terminal illness when bed linen changes or toileting is painful
list indications for intermittent catheterization (6)
- seeking to relieve discomfort due to bladder distension, provision of distension
- when required to obtain a sterile urine specimen
- when required to assess residual urine after urination
- when managing urethral stricture
- when engaging in long-term management of pts with spinal cord injuries, neuromusc degeneration, or incompetent bladders
- pts who have incomplete bladder emptying due to neurogenic conditions (spinal cord injury for ex)
what is required for urethral catheterization
- physicians order
describe the similarities & differences between inserting an intermittent vs indwelling catheter?
- both require physicians order
- both use strict aseptic technique
- most steps are the same except for indwelling you need to inflate the balloon
what is a closed drainage system? what is the purpose?
- after inserting an indwelling catheter, you must maintain a closed urinary drainage system to minimize the risk of infection
- this is achieved by adding a sterile collection bag to the end of the catheter
how much urine can urinary drainage bags hold?
1000 - 1500 mL
what are some important considerations for urinary drainage bag
- they should never be raised above the level of the bladder
- should hang on the bed frame or wheelchair
- should not touch the floor
- do not hook onto the side rails
- when the patient ambulates ot must be below their waist
why shouldnt the drainage bag be attached to the side rails?
- it can be raised above the bladder accidentaly
- can cause tugging on the catheter
why shouldn’t the drainage bag be above the level of the bladder?
- urine in the bag & tubing becomes a medium for bacteria
- so if urine flows back into the bladder it can cause infection
what should you do if the catheter becomes disconnected from the drainage tubing
- both tips should be cleansed with an alcohol swab before being reconnected to minimize the transfer of microorganisms into the tubing
what do most drainage bags contain to prevent urine from flowing back into the bladder>
- antireflux valve
what is a spigot
- like a plug found at thr base of the bag which is used to empty the bag
when should the spigot be clamped? where should it be stored?
- should always be clamped except during emptying
- when it is off, it should be stored in the protective pouch on the side of the bag
how can we ensure that the drainage system remains unobstructed? (3)
- check for kinks or bends in the tubing
- avoid positioning the patient on the drainage tubing
- observe for clots or sediment that may occlude the collection tubing
list 3 nursing priorities for catheter care
- maintain patient comfort
- prevent infection
- maintain an unobstructed flow of urine
why do we need to provide perineal hygeine?
- buildup of secretions or encrustation at the catheter insertiong site is a source of irritation & potential infection
when should we provide perineal care (3)
- at least twice daily
- after a bowel movement
- as needed
describe how to provide perineal care
- soap & water
- or skin cleansers
what is one thing to be cautious about while providing perineal care? why?
- do not accidentally advance the catheter upward into the bladder during cleansing
- otherwise could introduce bacteria into the bladder
when should you provide catheter care?
- three times/day
- after defecation or bowel incontinence
all patients with catheters should have a daily fluid intake of ____ if permitted
- 2000 mL to 2500 mL
why should pts with a catheter have high fluid intake?
- will allow a large volume of urine that flushes the bladder & keeps the catheter clear of sediment
what is the most important strategy in preventing the onset of infection
- hand hygeine between patients
list 2 other ways to prevent infection
- maintaining a closed urinary drainage system (breaks in the system can lead to the intro of microorganisms)
- monitor the patency of the system to prevent pooling of urine
list 5 places at risk of introduction of infectious organisms into the urinary drainage system
- the site of catheter insertion
- the drainage bag
- the spigot
- the tube junction
- the juction of the tube & bag
what is the purpose of catheter irrigations
- to maintain patency of indwelling catheters
- blood, pus, or sediment can collect within tubing which can result in bladder distension and buildup of stagnant urine
- installation of sterile solution ordered by a physician clears the tubing of accumulated material
what might physicians order for pts with bladder infections
- antiseptic or antibiotic bladder irrigations to wash out the bladder & treat local infection
what kind of technique is folllowed for irrigation?
- sterile
what should you do before performing catheter irrigation
- assess the catheter for blockage
what is an indicator of blockage
- if the amt of urine in the drainage bag is less than the pts intake or less than the output of the previous shift
what is milking of tubing
- technique that may be done if urine is not draining freely
- gently squeezing and then releasing the drainage tube
- start from the pts body and work towards the drainage bag so the clot will not be forced back into the catheter
what is recommended during intermittent irrigations
- maintenance of a closed system
a single intermittent irrigation is safer and less likely to introduce infections into the urinary tract than…
- repeated irrigations
what are 2 methods for catheter irrigation
- closed bladder irrigation system
2. opening of the closed drainage system to instill irrigations
describe closed bladder irrigation; what is it used for
- provides frequent intermittent irrigation or continuous irrigation without disruption of the sterile catheter system using a 3-way catheter
- used for partial blocks or bladder instillations
what is closed bladder irrigation often used for
- pts who have had genitourinary surgery & are at risk of blood clots & mucous fragaments occluding the catheter
what is a con to opening the closed drainage system for irrigation?
- greater risk of infection
why might we need to open the closed drainage system for irrigation>
- if the catheter becomes blocked & it is undesriable to change the catheter
ex. after recent bladder or prostate surgery
when removing an indwelling catheter you.. (2)
- promote normal function of the bladder
- prevent trauma to the urethra
what is required to remove an indwelling catheter
- clean, disposable towel
- discard receptacle
- sterile syringe that is the same size of volume of the solution inside the balloon
- disposable gloves
what do some insitutions recommend doing while removing an indwelling catheter
- collect a sterile urine specimen
- send the catheter tip for culture & sensitivity
what position should the pt be in while removing an indwelling catheter
- the same position as during insertion
describe the steps to remove an indwelling catheter
- assist them in position
- remove tap that hold the catheter in place
- place towel in between the pt’s thighs
- insert the syringe & withdraw all the solution out of the balloon
- pull the catheter out smoothly & slowly
what would happen if the catheter was removed while the balloon is still partially inflated?
- trauma to the urethral canal as it is removed
what is normal for the pt to experience after removing of a catheter
- dysuria
- urinary frequency & retention until it gains full tone
how and for how long should you document & assess the pt’s urinary function after removal of a catheter?
- note the first void after removal
- document time & amt of voiding for next 24 hrs
what happens if the pt has not voided after 8 hrs past removal?
- may need to reinsert the catheter
what determines catheter size? what is preferred?
- the size of the patient’s urethral canal
- prefer the smallest effective size to prevent trauma
what does a larger gauge number mean ?
- larger gauge = larger the catheter siz
what size of catheter is used fro children? adults?
- children = 8-10
- adult female = 10-12
- adult male = 12-16
what determines the catheter material selection
- the expected length of catheterization
what material of catheter is used for intermittent? why?
- plastic
- bc of their flexibility
what material of catheters can be used for up to 3 weeks
- latex and rubber
what material of catheter is best suited for long term? why?
- pure silicone
- Teflon
bc they cause less encrustation at the urethral meatus
describe a pro to silicone catheters
- have larger interior lumens than those of catheters of the same size = more efficient urine drainage
describe 3 benefits to hydrophillic-coated catheters
- more comfortable
- less likely to inflame the urethral tisssue
- encrustation may develop more slowly
for patient who develop encrustations and blockages frequently, what type of catheter may be preferred
- an inexpensive catheter that is changed every 7-10 days
for short term use, what type of catheter is effective?
- silver-hydrogel catheters & catheters with anti-infective surfaces –> effective in delaying the onset of bacteriuria
what is an important thing to consider when selecting an indwelling catheter?
- balloon size
what sizes do balloons range from?
- 3 mL (pediatric) to 30 mL (postop volumes)
in adults, what size of baloon allows for optimal drainage?
5 mL
what is used to inflate the balloon? why?>
- only sterile water
- saline may crystalize = incomplete deflation of the baloon at time of removal
list 6 things that may cause urine leakage around the catheter
- bladder spasms secondary to constipation or fecal impaction
- large catheter baloon
- large catheter
- UTI
- kinking of the catheter
- trauma at the bladder neck due to traction on the baloon
what may be used to prevent urine leakage
- change in lumen size
- use of anticholinergic meds
- referall to urologist
list 9 ways to prevent infection in catheterized pts
- hand hygeine
- do not allow the spigot to touch a contaminated surface
- use only sterile technique to collect specimens
- if drainage tube becomes disconnected, wipe both ends with antimicrobial solution before reconnecting
- encourage fluid intake if allowed
- remove the catheter as soon as allowed
- keep the bag below bladder level
- prevent pooling of urine in the tubing
- prevent kinking of the tubing
- perform routine perineal hygeine
how often should the drainage bag be emptied
- at least every 8 hr
- more frequently if large outputs are notes
describe what things you should do prior to inserting a catheter (10)
- review physicians order, nurses notes
- close curtain or door
- assess status of pt
- assess pt knowledge of procedure
- explain procedure
- hand hygeine
- raise bed to approp height
- face pt & stand on approp side of bed
- clear bedside table & arrange equipment
- raise side rail on opp side & lower on working side
what type of things you should you assess about your pt before inserting a catheter (7)
- ask when they last voided or check I&O
- any mobility or physical limits (affects positioning)
- gender & age (affects position & size of catheter)
- distended bladder
- perform hand hygeine & put on gloves –> inspect perineum for odour. erythema, drainage
- note any pathological condition that may impair passage such as enlarged prostate
- allergies
what side of the bed should you stand on if left handed? right?
- left = right
- right = left
describe the steps to insert a catheter
- place waterproof pad under pt
- position pt
- drape pt to only expose genitals & cover legs
- wear disposble gloves & wash perineal area w soap & water, dry, remove gloves, hand hygeine
- position lamp or have assistant hold flashlight
- open package containing drainage system and set up
- open catheter kit
whaty position should a female be in for catheter insertion?
- dorsal recumbent: on back with knees flexed
- or side lying (sims) position with upper leg flexed if unable to do dorsal recumbent
what position should a male be in for catheter placement
- supine with thighs slightly abducted
describe what is to be done after opening catheter kit
- open up, starting with the fold away from you
- apply sterile gloves
- organize supplies: pour aspectic solution in container, open lube, open catheter
- apply lube to catheter
- apply sterile drape
- place sterile tray & contents on sterile drape
- clean urethral meatus
- pick up catheter with dom hand
- use nondom hand to hold penis or retract labia
- insert catheter
how much lube do you apply to the catheter
- 2.5-5 cm for women
- 12.5 - 17.7 cm for men
describe how to apply the sterile drape to a woman
- place drape on bed between thighs
- place fenestrated sterile drape over perineum, exposing labia
describe how to apply the sterile drape to a male
- apply drape over thighs just below penis
- drape fenestrated drape over penis with fenestrated slit resting over penis
describe how to clean the urethral meatus for a female
- use nondom hand to retract labia
- wipe from clitoris to anus
- first do far labial fold, near labial fold, and then directly over the center of the urethral meatus
- use a new gauze for each wipe
describe how to clean the urethral meatus for a male
- if not circumsized, retract foreskin with nondom hand
- grasp penis at shaft, retract urethral meatus between thumb & forefinger
- clean in a circular motion from urtheral meatus down to base of glands
- repeat 3 times, with a new cotton ball for each time
describe how to insert a catheter into a female
- ask pt to bear down as if voiding
- slowly insert thru urethral meatus
- advance catheter a total of 5-7.5 cm or until urine flows out
- when urine appears, advance another 2.5-5 cm
- release labia and hold catheter with nondom hand
- slowly inflate balloon & pull back gently
describe how to insert a catheter into a male
- lift penis to position perpendicular to pt’s body
- ask pt to bear down as if voiding
- advance catheter 17-22.5 cm or until urine flows
- when urine appears, advance another 2.5-5 cm
- lower penis & hold catheter with nondom hand
- inflate balloon & pull back gently
- reposition foreskin
describe the steps of catheter insertion post-insertion
- collect urine specimen as needed by holding end of catheter over cup
- allow bladder to empty fully unless contraindicated
- attach end of catheter to drainage bag
- anchor catheter
- assist pt to comfortable position
- remove gloves, clean up
- hand hygeine
- palpate bladder
- observe character & amt of urine
- ensure there is not leaking or kinks
why do we inflate a balloon for indwelling catheters?
- anchors the catheter in place above the bladder outlet to prevent removal
describe how to anchor a catheter for a female
- secure catheter tubing to innner thigh or abdomen with nonallergenic tape
- allow for slack so movement of the thigh does not create tension on catheter
describe how to anchor a catheter for a male
- same but tape to top of thigh vs inner
define micturition
- voiding
what influences the act of micturition
- complex interactions between the bladder, spinal cord, brain
- involves both autonomic (involuntary) and somatic (voluntary nerves)
list common symptoms associated with urinary disturbances (6)
- urgnecy
- frequency
- dysuria
- polyuria
- oliguria
- difficulty in starting the urinary stream
why do we want pts to have increased fluid intake
= increased urine formation = reduced risk of UTI
list 2 methods to promote the micturition relfex in pts
- assisting them in sensing the urge
2. urethral sphincter relaxation
when collected properly, a clean-voided urine specimen…
- does not contain bacteria from the urethral meatus
what is a pro and con to indwelling catheterization
- pro= stays in for extended period
- con = potential for biofilm formation = greater risk of infection than intermittent
describe the purpose of closed catheter irrigation
- maintain catheter patency
- prevent blood clots (espeically after urological surgery)
define polyuria
- increased amt of urine production
define oliguria
- low urine production
list 8 types of incontinence
- transient
- stress
- urge
- functional
- mixed
- overflow
- reflex
- total
define transient incontinence
- urine loss resulting from causes outside of or affecting the urinary system
- resolves when underlying cause is treated
ex. UTI, dementia, acute confusion
define urge incontinence
- urine loss associated with a sudden need to void that cannot be postponed
define stress incontinence
- urine loss resulting from increased intra-abdominal pressure
ex. coughing, sneezing, laughing - often small volume
define mixed incontinence
- features of both stress & urge
define functional incontinence
caused by:
- alterations in cognitive or physical function
- or enviro factors
- has bladder control but cannot reach the toilet
define overflow incontinence
- small or lrg amt of urine loss associated with overdistension of bladder
- may feel like the bladder is never empty
define reflex incontinence
- involuntary loss that occurs at somewhat predictable intervals
- bladder contracts spontaneously
- may be due to spinal cord dysfunction
define total incontinence
- continuous and unpredictable loss of urine due to damage of the nerves that control the bladder
define suprapubic catheter
- catheter inserted thru a small hold in your stomach & drains urine from the bladder
define urinary retention
- a condition in which you cannot fully empty all the urine from your bladder
define meatus
- natural body opening or canal
ex. urethral meatus
define culture & sensitivity (C&S)
- a culture is a test to find germs, bacteria, etc. that caise infection
- sensitivity checks to see what kind of med (such as an antibiotic) will treat the infection
define urinalysis
- test of ur urine
define urometer
- type of hydrometer
- measures the specific gravity of ur urine
define paraphimosis
- condition that only affects uncircumsized males
- develops when the foreskin can no linger be pulled over the tip of the penis
- causes the foreskin to become swollen & stuck, which can slow or stop the flor of blood to the tip of the penis
define paraphimosis
- condition that only affects uncircumsized males
- develops when the foreskin can no linger be pulled over the tip of the penis
- causes the foreskin to become swollen & stuck, which can slow or stop the flor of blood to the tip of the penis
how many principles of surgical asepsis is there
7
list the 7 principles of asepsois
- sterile object only remains sterile only when touched by another sterile object
- only sterile objects can be placed on sterile field
- a sterile object or field out of range of vision or an object held below the waist is contaminated
- sterile object becomes contaminated by prolonged exposure to air
- if a sterile surface comes in contact with a wet & contamined surface, the sterile object becomes contaimed thru capillary action
- fluid flows in the direction of gravity
- edges of a sterile field are considered contaminated
why is the principle “sterile objects only remain sterile when touched by another sterile object” important?
- guides the placement of sterile objects and how you handle them
why does a sterile object or field that it out of range of vision or held below the waist become contaminated?
- if left unattended, contamination can accidentally occur by falling hair, pt touching it, etc.
- object below the waist = cannot be viewed at all times
explain “ a sterile object or field can become contaminated by prolonged exposure to air”; what indications does this have
- microogranisms that travel by droplet thru the air can contaminate
- microorganisms travelling in air can land on sterile objects
= avoid activities that may create air currents, limit the number of people walking the area, keep movement or rearranging of sterile items to a minimum
what indications does “fluid flows in the direction of gravity” have
- hold hands above elbows
what size of border around a sterile field is considered nonsterile
2.5 cm
which hand should you glove first
- dominant
when inserting an urinary catheter into a female, you do not get urine back after correctly inserting the foley quite far. what do you think may have happened? how should you preceed?
- the Foley most likely entered the vagina inadvertently bc it is very close to the urethra
- leave the catheter inside the vagina, and insert a new one into the urethra bc now it will be clear which one is correct
due to the likelikhood of inadvertently inserting a catheter into a female’s vagina occurring, what might be a good idea to prepare prior to inserting a catheter on a female pt
come with 2 prepared catheters
in general, when inserting a catheter on a male or femalr, should you ever inflate the balloon without seeing urine return
no
- if you inflate a balloon that is not in the bladder can cause trauma to the urinary tract
a 12 Fr urinary catheter is ___ compared to a 16
smaller
a __ Fr is the most common size for the average sized pt
10-16 for adults (10-12 F, 12-16 M)
- recommendation is use the smallest diameter to prevent trauma
T or F: an indwelling catheter is changed every 30 days; why or why not
F
- routine catheter placement every 30 days without signs of infection, tube break down, dislodgement is no longer indicated
what might yiu suspect if ur pt has a catheter acquired infection/UTI? what would you want to do to confirm this suspicion
symptoms such as:
- burning sensation or pain upon voiding
- NV
- fever
- chills & malaise
- flank pain
- confusion/delirium
urine:
- odour
- cloudy
- hematuira
- get C&S and possibly replace the catheter
if you suspect your pt is retaining urine, how much (what vol) would generally acquire intervention
- post void residual volume greater than 100 mL or random readings of 400-600 mL
- plus signs of retention
why is the baloon of an indwelling catheter filled with sterile water over NS
- NS can crystalize over time which results in non-complete deflation of the balloon upon removal
when inserting a male catheter, resistance is met. what should you do next? what do you think may have caused this resistance?
- resistance is likely due to passing the prostate
- do not force it thru –> hold it still where resistance was met for few sec to see if relaxation has occurred before attempting to advance again
- if resistance does not subside then may need coude tip catheter
- stop current insertion & notify physician
nurses were historically told to pre-inflate the balloon of the catheter before insertintg it. this was known as “checking” the balloon for function. why is this practice no longer recommended
- many manufacturing companies now pre-test their balloons prior to steriorilzation so it is not needed
- also causes increased risk for trauma to the urethra due to change in shape & size of balloon
- checking the balloon prior to insertion does not guarantee that malfunction wont occur once inserted
see skill 33-5 on open gloving
…
see skill 33-2 on preparing a sterile field
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see skill 43-3 on indwelling catheter care
…
see box 43-8 on preventing infection in catheterized pts
- i found that this list was talked abt throughout the whole deck & very common sense so I didn’t find it necessary to repeat it all on this huge list
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