LEC 4: Urethral Catheterization Flashcards
Where is urine produced?
Urine is produced by the kidneys and flows down to the ureters and into the bladder
When you insert a catheter, where do you insert it?
Put it through the urethra
What are the types of Catheters?
- Intermittent or straight catheter
~ Can be in and out - Tieman’s (Coude) catheter
- Indwelling or Foley catheter
What do you need before inserting a catheter?
- A physician’s order
- Need to use sterile technique; don’t want to bring in microorganism
- Gather all supplies and bring extra sterile gloves and catheter
What are the part to a catheter?
- Lumen (can have more then one)
- Urine drainage
- Catheter tip
- Inflated ballon
Intermittent (straight) Catheters
- Are used for “in and out”
- Do not stay for a long period of time
- Used if catheter needs to be done quickly
- Have less of a chance to cause infection
- Can teach patient to do an “in and out” catheter
When would and intermittent catheter be used?
- When women are in labor
- Sterile urine sample
- Patient with long term spinal injuries
- Training patient with urine retention
Timen’s (Coude) Catheter
- Can be an indwelling or an in & out catheter
- Usually used after a prostrate surgery
- It is har at the tip and helps direct the catheter
- Good to use when prostrate is swollen and tend to not be straight
Indwelling (Foley/ Retention) Catheters
- Has a ballon, fill with 10 mL of saline once inserted into the patient
- Has two lumens
- Usually used with residents in long term car or with patients who have terminal illness (palliative)
- Want to measure output of urine
Where can microorganisms cause infection with catheters?
- The tip/ insertion part of the catheter
- The lumen (connection)
- Catheter bag
- Drainage port of the catheter bag
- Having the catheter bag above patient’s waist
How can you prevent infection?
- Keep a sterile filed
- Hand hygiene
- Avoid pooling of urine
- Keep the catheter bag below patients waist
- Drinking lots of fluids
- Good perennial care
How do you know if you got the catheter into the urethra/ is far enough?
Urine will start to come out
How long is a male urethra?
17 to 22.5 cm long
How long a a female urethra?
5 to 7.5 cm long
Insertion of Catheters
- Use sterile technique
- Gather all supplies
- Lubricate catheter; but not the full length of the urethra, need room to hold catheter for insertion
- Insert catheter 2.5 to 5 cm more once urine comes out
Documentation of Catheter Insertion
Need to document progress notes
- Reason for catheter
- Type of catheter
- How much sterile water put into the balloon
- COCA
- Patients response
Need to document fluid balance
What does COCA stand for?
Colour
Odour
Consistency
Amount
What is the minimum amount of urine that a patient needs to excrete per hour?
Need patients to have 30ml of urine an hour
Indwelling Catheter Care
Need to check catheter every 2 to 3 hours; looking for:
- Amount
- Is the catheter bag lower then the patients waist
- Check for any obstruction of the catheter bag
- Making sure the catheter bag is closed
- Empty catheter bag as needed
- COCA
Sterile Specimen Collection (Urine)
- When collecting a urine sample, need to make sure you clean the spigot (port) for 15 seconds with an alcohol wipe
- Usually want to collect 12 mL of urine
~ 6mL for a culture and sensitivity test
~ 4 mL for a urine analysis
Why do we need to collect a sterile specimen of urine?
- Find out what the kidneys are doing
- Analyze the chemical composition of the urine
- Culture and sensitivity can tell is if there is an infection and what microorganism is living in the bladder
Reasons for Catheter Irrigation
- Done to maintain or restore patency of the catheter
- Sterile procedure
- Need Dr.’s orders
What are the two types of catheter irrigation?
- Open
- Closed
- Closed intermittent irrigation
- Continious irrigation
Open Catheter Irrigation
- More prone to infections; generally do not want to do them
- Disconnect it from the bag
- Flush 30 to 50 mL of saline
- Document how much you get back (amount)
~ However much flush you put in
~ How much came out - Document COCA
Closed Catheter Irrigation
- Is a continuous irrigation into the bladder
- Usually used after a TURP surgery
- Need 3 lumens
- Do not want to see clots or infections
- Want to monitor vital signs to tell if patient has an infection or not
Catheter Removal
- Need Dr.’s orders
- Gather all suppliers; measuring container, clean gloves, sterile syringe, blue pad, perineal wipes/ towels
- Be sure to deflate the balloon before removing
- Patient should not feel any pain when removing the catheter
What do you document when removing a catheter?
- The liquid that came out from the balloon and amount
- COCA
- When you took out the catheter
- When the patient took their first pee
- Want to know if patient has any pain when they pee
How far do you want to lubricate the catheter for a male patient?
Lubricate 12.5 to 17.5cm
How far do you want to lubricate a catheter for a female patient?
Lubricate 2.5 to 5cm
Once urine appears, how fare do you want to move the catheter?
Advance an additional 2.5 to 5 cm
