Lab - Week 1

Question 1

Urinary catheterisation.

Who can insert a catheter?

Answer 1

• Registered Nurses (RN)
• Registered Midwives (RM)
• Medical Officers (MO)

Question 2

Does male urinary catheterisation require education?

Answer 2

YES.

RN/RMs who have not received education on male urinary catheterisation must arrange bedside education from a RN/M, MO, or CNE experienced in male catheterisation

Question 3

What are some considerations with inserting urinary catheters?

Answer 3

• RN must not insert a urinary catheter without discussion with treating team, MO or continence service 
• “In/out” catheterisation are only to be performed after discussion with treating team, MO or continence service order 
• If the patient has a complicated urology history such as previous difficult catheterisation, known urethral stricture, urethroplasty, radical prostatectomy or a previous history of prostate brachytherapy or has known Autonomic dysreflexia please seek urology advice before insertion of the urinary catheter.

Question 4

What does Fr refer to?

Answer 4

Fr refers to the French scale system which is commonly used to measure the size of a catheter .

Question 5

Does the size of catheter vary between men and women?

Answer 5

YES.

Question 6

YES or NO.

Would you seek urology advice before inserting a catheter is a patient presented with haematuria with blood clots?

Answer 6

YES

Question 7

YES or NO.

Would you seek urology advice before inserting a catheter is a patient presented with moderate to heavy sediment or light haematuria with very small blood clots?

Answer 7

YES

Question 8

Alwatys ensure the catherter drainage bag is _________ the level of the bladder.

Answer 8

Below

Question 9

What is ‘residual volume’?

Answer 9

The urine obtained following the insertion of the catheter, until the initial flow of urine stops (approximately 15 mins).

Question 10

What do you do after one failed attempt in male catheterisation?

Answer 10

If failure to insert IUC/IDC after the first attempt then the RN may have a second attempt using a coudé tip catheter if one is available and the RN is competent to do so. If unsuccessful or not competent to use a coudé tip the procedure must be ceased and a MO skilled in catheterisation contacted

Question 11

Where and what should you document after the insertion of a catheter?

Answer 11

• Clinical notes – eMR auto test for IUC/IDC insertion
• Fluid balance chart: residual volume and progressive drainage.
• Bedside Clinical Handover tool: IUC/IDC insitu, date and time inserted and how often it is observed & recorded.

Question 12

What are some nuring considerations when inserting a urinary catheter?

Answer 12

• Catheter insertion may be difficult with a constipated patient as this can cause urethral blockage 
• Do not force a catheter into place. If resistance is felt and cannot be relieved, stop, and hand the procedure over to a more experienced RN or a MO skilled in catheterisation. 
• Administer analgesia or anti-anxiety medication where indicated 
• If catheter is fully inserted and no urine is sited escalate according to the PACE criteria (bladder scanner may have detected ascites or patient may be dehydrated) 
• Pain on inflation of the balloon is not expected and indicates the catheter is probably not in the bladder but in the urethra. Deflate the balloon immediately, advance the catheter further and re-inflate 
• Always ensure that the catheter drainage bag is below the level of the bladder

Question 13

List at least 4 indications for catheterisation.

Answer 13

• Urinary retention or obstruction
• Clot retention
• Monitoring for sepsis, trauma, electrolytes renal function
• Acute injury or surgical management
• Treatment and investigation
• Management of urinary incontinence
• Urogenital or bladder management
• Labour and delivery management

Question 14

What are the 4 steps of decision making for appropriate urinary catheter insertion?

Answer 14

1. Check for appropriate indication for catheterisation
2. Choose most appropriate catheter option
3. Confirm choice using additional guidance
4. Return to step 1 if contraindication for option is listd as described.

Question 15

Name 4 inappropriate reasons for catheter insertion.

Answer 15

• For a patient requiring bed rest or with decreased mobility that has no other clinical need for catheterisation
• For monitoring urinary output when the patient is able to void voluntarily or once the clinical need is no longer warranted
• For prolonged post-operative duration in the absence of an appropriate clinical indication for ongoing catheterisation.
• As a substitute for the nursing care of a patient with urinary incontinence, obesity, confusion, dementia or other reasons

Question 16

How can urinary retention be confirmed?

Answer 16

Retention can be confirmed by using a bladder scanner or if not available, through palpation and percussion of the bladder. Clinicians should refer to manufacturer’s instructions on how to use a bladder scanner.

Question 17

When should a interittent ‘in /out’ catheter be considered?

Answer 17

Intermittent ‘in / out’ catheterisation should be considered when a urinary catheter is required to be inserted and removed immediately after the completion of drainage.

Question 18

When should a short term indwelling catheter be considered?

Answer 18

Short term indwelling catheterisation should be used when bladder drainage is required for up to 14 days.

Question 19

Define suprapubic catheterisation.

Answer 19

The first insertion of a suprapubic catheter (SPC) is an invasive procedure where the catheter accesses the bladder directly through the abdomen. Consult with a senior medical officer when deciding whether a SPC is necessary.

Question 20

What influences chossing a catheter size.

Answer 20

The patient’s anatomy and clinical presentation will influence the size of the catheter and the catheter tip (round, curved, open-ended) required. The most appropriate size for the individual patient should be based on clinical assessment however clinicians should select the smallest sized catheter that will enable adequate access and drainage.

Question 21

When documenting insertion of a catheter what needs to be included?

Answer 21

• How consent was obtained and whom it was obtained from
• Indication for catheterisation
• Catheter option used (in/out, IDC, SPC)
• Size and type of catheter
• Time and date of insertion
• Balloon volume in
• Total urine volume drained on insertion (refer to the fluid balance chart);
• Any abnormalities observed during or after catheter insertion (e.g. pain, bleeding)
• Any clinical misadventures during insertion (e.g. false passage, haematuria, blockage)
• Presence of UTI signs and symptoms
• Colour of urine, sediment or abnormality
• Whether a urine specimen for culture was collected;
• Post procedure tests that are clinically relevant
• Follow up actions (e.g. review of catheter, catheter removal).

Question 22

Each shift what should a nurse be checking?

Answer 22

• Check if the drainage device requires emptying
• Check there are no loops or kinks in the drainage bag tubing and that urine is draining continuously
• Check that the catheter and drainage device are securely connected
• Check that the urine drainage bag is supported on a stand or hook that avoids loops in the tubing and keeps the outlet and tubing off the floor
• Check the drainage bag is always below the level of the bladder, including when the patient is being transported or ambulating
• Check the catheter remains secured to the patient with a securing device
• Check the drainage device is kept closed unless it is being emptied.