LEC 4: Urethral Catheterization

Question 1

Where is urine produced?

Answer 1

Urine is produced by the kidneys and flows down to the ureters and into the bladder

Question 2

When you insert a catheter, where do you insert it?

Answer 2

Put it through the urethra

Question 3

What are the types of Catheters?

Answer 3

• Intermittent or straight catheter
  ~ Can be in and out
• Tieman’s (Coude) catheter
• Indwelling or Foley catheter

Question 4

What do you need before inserting a catheter?

Answer 4

• 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

Question 5

What are the part to a catheter?

Answer 5

• Lumen (can have more then one)
• Urine drainage
• Catheter tip
• Inflated ballon

Question 6

Intermittent (straight) Catheters

Answer 6

• 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

Question 7

When would and intermittent catheter be used?

Answer 7

• When women are in labor
• Sterile urine sample
• Patient with long term spinal injuries
• Training patient with urine retention

Question 8

Timen’s (Coude) Catheter

Answer 8

• 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

Question 9

Indwelling (Foley/ Retention) Catheters

Answer 9

• 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

Question 10

Where can microorganisms cause infection with catheters?

Answer 10

• 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

Question 11

How can you prevent infection?

Answer 11

• Keep a sterile filed
• Hand hygiene
• Avoid pooling of urine
• Keep the catheter bag below patients waist
• Drinking lots of fluids
• Good perennial care

Question 12

How do you know if you got the catheter into the urethra/ is far enough?

Answer 12

Urine will start to come out

Question 13

How long is a male urethra?

Answer 13

17 to 22.5 cm long

Question 14

How long a a female urethra?

Answer 14

5 to 7.5 cm long

Question 15

Insertion of Catheters

Answer 15

• 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

Question 16

Documentation of Catheter Insertion

Answer 16

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

Question 17

What does COCA stand for?

Answer 17

Colour
Odour
Consistency
Amount

Question 18

What is the minimum amount of urine that a patient needs to excrete per hour?

Answer 18

Need patients to have 30ml of urine an hour

Question 19

Indwelling Catheter Care

Answer 19

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

Question 20

Sterile Specimen Collection (Urine)

Answer 20

• 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

Question 21

Why do we need to collect a sterile specimen of urine?

Answer 21

• 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

Question 22

Reasons for Catheter Irrigation

Answer 22

• Done to maintain or restore patency of the catheter
• Sterile procedure
• Need Dr.’s orders

Question 23

What are the two types of catheter irrigation?

Answer 23

1. Open
2. Closed
   - Closed intermittent irrigation
   - Continious irrigation

Question 24

Open Catheter Irrigation

Answer 24

• 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

Question 25

Closed Catheter Irrigation

Answer 25

• 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

Question 26

Catheter Removal

Answer 26

• 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

Question 27

What do you document when removing a catheter?

Answer 27

• 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

Question 28

How far do you want to lubricate the catheter for a male patient?

Answer 28

Lubricate 12.5 to 17.5cm

Question 29

How far do you want to lubricate a catheter for a female patient?

Answer 29

Lubricate 2.5 to 5cm

Question 30

Once urine appears, how fare do you want to move the catheter?

Answer 30

Advance an additional 2.5 to 5 cm