Urinary Catheter Care Flashcards
what are some of the potential presentations of the urogenital patient?
FLUTD incontinence obstruction trauma neoplasia kidney issues (renal failure, nephrectomy)
define polyuria
increased volume of urine
define pollakiuria
passing small amounts of urine often
what is catheterisation?
inserting a urinary catheters into the urethra up to the level of the bladder
what are the 2 potential options for duration of catheter placement?
temporary - removed immediately following procedure
indwelling - left in
why do we catheterise a patient?
to obtain a urine sample
to empty the bladder prior to surgery and prevent contamination during perioperative period
to instill contrast media into the bladder for radiography
to maintain patency of the urethra or unblock
to monitor urine output
to divert urine (cystotomy tube)
to prevent urine scalding
what are the alternative ways to sample urine (apart from catheterisation)?
manual expression
free catch
cystocyntesis
what are the disadvantages of manual expression of the bladder?
care required as can rupture the bladder
not always possible in tense / fat animals
not sterile
what are the disadvantages of free catch of urine?
can be time consuming
not sterile
what are the disadvantages of cystocentesis?
vets only
ultrasound guided to avoid other structures
what happens during cystocentesis?
sterile needle into the bladder - urine is drawn up in a syringe
what is the equipment list for cystocentesis?
clippers / scrub / alcohol needles (1 inch - longer) syringe collection pots lab form
in what position can cystocentesis be performed?
dorsal and lateral recumbancy
what must the animal be allowed to do following cystocentesis?
void urine
what are the 2 methods of cystocentesis?
blind
ultrasound guided
in order to perform blind cystocentesis the bladder must be ___?
palpable
what are the main types of urinary catheters?
portex
foley
jackson cat (Tom Cat)
slippery sam
are portex catheters designed to be indwelling?
no - single use/temporary
where are the holes located in portex catheters?
side holes
what is the preferred type of indwelling catheter?
Foley
what material is a Foley catheter made of?
silicone or latex
how is the Foley catheter held in place once it is in the bladder?
inflatable balloon on the proximal end of the catheter is filled with sterile water
what animals can a foley catheter be used for?
dogs only as not small enough for cats
what is the jackson cat (Tom Cat) catheter useful for?
unblovking as easy to handle and rigid
what features of the jackson cat (Tom Cat catheter) can cause problems with distal obstruction?
side holes in catheter
is jackson cat (Tom Cat catheter) used for indwelling?
not really as too traumatic and short so may not reach bladder.
can be sutured in for a short period of time
what is a slippery sam catheter used for?
unblocking obstructions as open ended
can slippery sam be used as an indwelling catheter?
yes is atraumatic but care must be taken as there is risk of the hub detatching
what animals are usually considered relatively easy to catheterise?
male dogs and cats
why are bitches and queens not as straightforwards to catheterise as male dogs or cats?
anatomy is different and urethral oriface is hidden
how is the urethral orifice in bitches usually visualized?
using a speculum (can be done blind)
how is the urethral orifice in queens usually visualized?
using an otoscope as speculum may be too large
describe the technique for placement of a urinary catheter in the dog/tomcat?
patient restrained (possibly with sedation)
wash hands and put on sterile gloves and apron
expose penis from prepuce and prep with dilute iodine
lubricate urinary catheter
insert catheter into urethra and feed in until urine is seen in the catheter (do not force)
empty bladder and remove or inflate bulb with desired amount and attatch to collection bag/bung
what equipment is needed for catheterisation?
sterile gloves and apron diluted iodine solution (1:100) and swabs lubricant (potentially lidocaine gel) catheter of choice 50ml syringe 3 way tap container for sample closed system (if indwelling) sterile water for injection (if indwelling) speculum (for bitch)
describe the technique for catheterisation of the bitch
chemical restraint likely (and analgesia)
sternal recumbancy
clip and clean vulva
insert speculum until urethral oriface can be seen
if no speculum then manually insert with catheter alongside and should feed into the urethral orifice
(same process as for dog)
what must happen before and after handling urinary catheters?
wash hands
when should the bag be emptied and what should be done with the urine when it is emptied?
every 4 hours
amount of urine should be measured
what does urine output measure?
kidney function
fluid therapy efficacy
what should you do with the catheter bag once emptied?
wipe the outlet with a spirit swab
what should you check for around the insertion site?
discomfort and swelling
what should the catheter line be checked for?
kinks / blockages
where should the catheter bag be kept?
off the floor (e.g. in lined litter tray) with bag lower than the patient
when should urinary catheter be removed?
as soon as no longer needed
what should be done to manage urine scalding?
clip hair away and clean
what monitoring should patients with urinary catheters have?
UTI presence (temp, culture samples, urine appearance, pyrexia)
what must be avoided in patients with a urinary catheter?
interference - buster collar
when should antibiotics be used for patients with a urinary catheter?
no blanket use due to potential to create multi drug resistance
culture and treat specific infection
what are the key nursing considerations for the uro patients?
monitor BP bloods for renal function (urea, creatinine, electrolytes) USG prevent urine scalding post op care if surgery personal cleaning and care esp for cats with buster collars maintain fluid therapy monitor for UTI
what are the risks of urinary catheterisation?
urethral rupture urethral trauma/inflammation urethral stricture formation infection blockage/obstruction of urinary catheter
what is urethral stricture?
scar tissue which narrows the lumen of urethra which is very narrow
when is urinary diversion used?
when we need to divert urine from either urethra (cystotomy) or ureters (nephrostomy)
where is a cystotomy tube placed?
from bladder to outside via the abdominal wall
where is a nephrostomy tube placed?
from kidney to outside
when patients are in hospital how often is urinary output measured?
every 4 hours
why should urine output be monitored?
tells us about renal function
tells us whether fluid therapy is appropriate
how can we measure the volume of urine our patients have produced?
closed system collection
what is normal urine production for animals?
1-2mls/kg/hour
how should a value for urine output be given?
as a range to reflect 1-2mls
how do you calculate urine output?
volume of urine/number of hours/weight
how do you calculate an animals expected urine output?
BW(kg) x normal UOP per hour (1-2mls) x number of hours
