Urethral Catheterization Flashcards
What is Urethral Catheterization?
What are the recommendations?
It’s a routine medical procedure that facilitates direct drainage of the urinary bladder
Urethral catheterization is insertion of hollow tube through the urethra into bladder for the removing urine
It is an aseptic procedure
It is recommended that those with prosthetic heart valve, artificial urethral sphincters or penile implant be given prophylactic antibiotics.
What is the diagnostic indication?
Collection of uncontaminated urine specimen
Monitoring of urine output
Measuring post void residual volume
Imaging of urinary tract
What is the therapeutic indication?
To relieve Urinary retention
Instillation of intravesical medical drug (gemcitabine)
Hygienic care of bedridden patient
Removing blood and clot in gross haematuria
Bladder irrigation after bladder surgery
What is are the contraindications, relative and general?
Traumatic injury to the lower urinary tract e.g Urethral tear ( blood /clot at the tip of urethra meatus )
Relative
Urethral stricture
Recent urethral surgery
Uncooperative patient
What are the types of catheter?
Material
1. Latex- hypersensitivity and anaphylaxis
2. Silicon
3. Silver alloy - reduced bacterial colonization
4. Antibiotics impregnated
Structure
1. Straight tip e.g foley
2. Coude tip – obstruction at prostrate (a urinary catheter with a curved or bent tip designed to navigate around obstructions in the urethra, particularly at the prostate)
3. 3-way catheter – gross haematuria (a urinary catheter with three channels that is used to irrigate the bladder. It has one channel for inflating a balloon, one for draining urine, and one for connecting irrigation fluid)
Duration
Intermittent catheter used to drain bladder for short period about 5 -10 min
Indwelling catheter
What should be in your Catheterization tray?
Povidone-iodine/ savlon
Flash light
sterile Cotton balls
Lidocaine gel2% in preloaded syringe
Sterile drape
Sterile gloves
Urethral catheter
Prefilled 10ml saline syringe
Water soluble lubricating gel
Urobag
forceps
3-4 sterile swab
Plaster /anchoring tape
Penile clamp*
What are the different sizes of catheters?
The French scale (Fr.) is used to denote the size.
Each unit denotes 0 .33mm in diameter
Children size (n/2 +8).
8Fr. and 10Fr. are used in children
14 and 16 in female
16 and 18 in male
20-24 in gross haematuria or 20-30 of 3-way catheter
What position should a patient be in to receive a catheter?
Supine position
Lithotomy or frog-like position
What position should be patient be in for catherterization?
Supine position
Lithotomy or frog-like position
What are the steps of the procedure?
Explain procedure to patient
Position the patient and uncover the genitalia
Maintain asepsis
Create sterile field or open sterile catheterization kit using sterile technique
Wash your hand
Put on sterile gloves
Place sterile fenestrated drape
Connect catheter to urobag
Pour the antiseptic solution over the sterile cotton balls by the help of assistant
Grasp the patient`s penis between your thumb and forefinger of your non-dominant hand. The hand is now contaminated
Use forceps/sterile gloved hand to hold the soaked cotton ball and swab the center of the meatus outward in a circular manner and continue outward using new cotton ball till entire glans is cleaned
Drop the forceps and cotton ball into disposal bag after use
Hold the penis at a 90-degree angle.
Using syringe with no needle, instill 15-20ml of lidocaine gel into urethral and place a finger on the meatus to prevent spillage of the anesthetic lubricant
Advance the catheter into the patient`s urinary meatus
Resistance may be encountered at the prostatic sphincter
Pause and allow the sphincter to relax
Lower the penis and continue to advance the catheter
DON’T FORCE CATHETER TO ADVANCE, CALL FOR HELP
When catheter has passed through prostatic sphincter into bladder, urine will start to flow. Advance about 5cm more or insert till you get to Y junction
Inflate balloon with 10mls of sterile water
Gently pull catheter until inflation balloon is snug against bladder neck
Anchor catheter tubing to medial part of the thigh without tension and urobag is below the bladder level
Evaluate catheter function and amount, colour, odour, and quality of urine
Remove gloves, dispose equipment appropriately and wash your hand
Document size of catheter, amount of water in balloon, patients response and assessment of the urine
What are the specifications for female catheterization?
Use the thumb and index finger of non-dominant hand to part labia majora and minora and keep it separated till you are done with the procedure
Use forceps/sterile gloved hand to pick up a cotton ball saturated with antiseptic solution to clean from above the meatus downward toward rectum.
Use one cotton bud for each stroke
What are the complications?
Infections
Urethral stricture
Urethral injury
Bleeding
Urine leakage
