URINARY CATHETERIZATION Flashcards
What is urinary retention?
accumulation of urine in the bladder, inability to empty
how is urinary retention caused
inability to respond to micturition reflex, underactive/contractile detrusor and urethral obstruction
what happens when there is an accumulation of urinary retention
may lead to urinary incontinence
chronic vs acute retention
chronic:
Men - enlarged prostate
women - pelvic organ prolapse
Acute:
- Absence of urine output
- discomfort, diaphoresis, pain over symphis pubis and restlessness
causes of UTI
- STD
- catheterization
- e coli
- prostate disease
urinary diversion
urinaryy diversion to external source
Transient incontinence
urine loss resulting from causes outside of or affecting urinary system, resolves when underlying causes are treated
urge incontinence
sudden urge and need to void that cannot be potponed: overactive bladder
stress incontinence
urine loss resulting from intra-abdominal pressure - coughing, sneezing, laughing
overflow
involuntary loss of urine when bladder does not completely empty
mixed
urine loss that has both stress and urge incontinence
functional
urine loss due to not being able to go to toilet
frequency
voiding more 8 times in 24 hours - increased intake of fluid, polyuria, OBS, incomplete emptying
dysuria
experiencing pain/burning sensation during urination - bladder inflammation, urethral trauma
polyuria
voiding large amounts of urine- excess fluid intake, nocturnal polyuria , post obstructive diuresis
hematuria
blood in urine - renal disease, infection of kidnet, bleeding disorders, UTI
oliguria
diminishedd urinary output relative to intake - dehydration, increased ADH
elevated postvoid residual urine
neurogenic bladder, prostate enlargement
diuresis
increased/excessive formation of urine
pneumaturia
bubbles in urine - fistula bet colon and bladder, UTI
anuria
failure of kidneys to produce urine
nocturia
prevalent and bothersome lower urinary tract defined as waking up from sleep
hesitancy
difficulting initiating urination
dribbling
leakage of urine despite voluntary control of urination
How a uti develops and what can occur with it
- obstruction of urinary tract, incomplete bladder emptying and abnormal anatomy
- occurs due to E.coli bacteria especially in women
- UTI can spread to upper tract leading to the kindneys being damaged - pyleonephritis
- then can move to bloodstream - bacteremia - leading to urosepsis
- not all bacteria in urine causes infection
- patients with lower UTI may experience dysuria and fever,chills, nausea may start to develop as it worsens
- inflammation of bladder - cystitis - increases frequency and urgency and may cause incontinence, irritation of bladder results in heamturia
why do we use a condom catheter?
when a pt. experiences incontinece and is the second alternative to catheterization
Is there an infection in the bladder when a patient has cloudy, foul smelling urine, and change in color in the absence of symptoms?
does not indicate infection
duration for short term catheters (in days)
fewer than 14 days
duration for long term catheters (in days)
more than 14 days
when to use short term catheters?
- post op, when urine flow is obstructrd
- prolonged immobilization due to trauma
- instillations of medication into bladder
- to collect a sterile specimen when patient is unable to provide on their own
- end of life - if comfortable
when to use long term catheters?
- when pt. not suitable for surgical intervention
- neurological disease is short term not feasible
- stage 3/4 of sacral pressure injury
- if alternate approaches have been tried but not succesful
intermittent catheterization
single use, straight catheter introduced urethrally for 5-10 minutes, just long enough to drain the bladder. Straight catheter has a single lumen and small opening about 1.3cm ffrom the tip and the urine drains from the tip, through the lumen and into a receptacle
used - to assess residual urine after urination or as an alterative to long term indwelling catheterization
indwelling/foley catheter
retained for linger periods by means of a small balloon.
there are 2 types:
1. 2 lumen - 1 lumen to drain urine and the other to inflate sterile water into balloon - most common
2. 3 lumen - 3rd lumen allows fro irrigation
- used for patients that are immobile or have spinal injury resulting in paralysis
coude catheter
has a curved tip, typically used in men that have an enlarged prostate that partially obstructs the urethra
suprapubic catheterization
surgical placement of catheter through the abdominal wall above the symphsis pubis and into the urinary bladder
how to prevent infection in suprapubic catheters
adequate fluid intake will help risk of sedimentation or infection due to stagnation
catheter size for different genders and ages
children - 8-10 french gauge (larger the gauge - larger the catheter)
female - 10 to 12 fr gauge
male - 12-16 fr gauge
what kinda material are long term catheters made of and why
pure silicone or hydrophilic polymer coated catheters as they cause less encrustation at the urethral meatus and cause less friction and irritation to tissues
what size fr gauge is used after prostatectomy
20-24 fr three lumen catheter to allow clot drainage and irrigation
balloon sizes for different ages
3ml - children
10ml - adults
30ml - after prostatectomy to provide hemostasis of the prostatic bed
urinary catheter removal
- removed as soon as clinically appropriate - to prevent infection
- prior to removal - pt.understands the need to void
- should void with 4-6 hrs of catheter removal
complication during removal
inability to remove catheter due to balloon
lumen is cut
inability to deflate balloon
inability to void after removal (complication)
how to remove a catheter
- all the weird procedures, HH, intro, explain yada yada, order
- assess catheter site and note any abnormalities
- Place blue pad over clients thighs
- collect sample, if needed
- connect syringe and fully deflate balloon
- do not ever cut balloon lumen
- Slide cather out in one, gentle motion
- examine catheter to ensure it is intact and wrap in blue pad
- unhook collection bag, empty and measure output
- discard, clean, remove gloves, wash hands
- repostiion client
- teaching - unable to void after 4-6 hrs complication , burning
- document
Purpose of a continuous bladder irrigation?
to flush bladder continuously or intermittently
indication of a continuous bladder irrigation
post surgery for a prostate
types of continuous bladder irrigation
open/closed irrigation either with a double/triple lumen catheter
if a catheter becomes occluded by sediment and encrustation, what should be done?
should be changed to avoid flushingdebris containg bacteria into bladder
thing to note prior to a contiuous irrigation
1.assess urine color and presence of sediment
2. determine type of catheter - 2 lumen (closed intermittent irrigation/instillation)/3 lumen (closed contiunous irrigation)
3. determine volume of urine present in drainage system before starting
4. assess pt lower abdomen for bladder distention - detect whether catheter is blocking urinary drainage
5. postion client in dorsal recumabant/supine - promotes pt.comforty and provides easy access to catheter
closed intermittent irrigation - double lumen
- prepare a prescribed sterile solution in sterile graduated cup
- draw sterile solution into syringe using aseptic technique
** ensure irrigating fluid - remains sterile - clamp in dwelling cather just distal to injection port and clean injection port with antiseptic swab. insert needless syringe tip through port, slowly inject fluid into cather and bladder reduces trauma to bladder wall
- withdraw syringe, remove clamp and allow solution to drain into drainage bag. If instillation ordered by prescriber, keep clamped to allow solution to remain in bladder for ordered time
closed continuous irrigation with triple lumen
- using aseptic technique, insert tip of sterile irrigation tubing into bag of sterile irrigating solution
- Close clamp on tubing and hang bag of solution on IV pole
- open clamp and allow solution to flow through (prime) tubing, keeping end of tubing sterile. close clamp - removes air from tubing
- wipe off irrigation port of triple lumen catheter with antiseptic swab and then attatch to irrigation tubing (3rd lumen)
- be sure that drainage bag and tubinf are securely connected to drainage port of triple lumen catheter
- for intermittent flow - clamp tubing on drainage sysytem, open calmp for irrigation and allow prescribed fluid to enter bladder (100ml normal for adults). close irrigation clamp and then open drainage tubing clamp
- for continuous drainage - calaculate drip rate and adjust clamp on irrigation tubing accordingly. Be sure that clamp on drainage tubing is open and check volume of drainage bag (ensure drainage tubing is patent and avoid kinks)
- calculate fluid used to irrigate bladder and subtract from total output and this gives you the accurate urinary output
- assess characteristics of output: viscoscity, olour and presence of matter (sediment, clots, blood)
short vid link to understand all this better: https://www.youtube.com/watch?v=fOcK2nG95cY
What do you do when the irrigation solution does not retuen or is not flowing at prescribed rate, possible occlusion of catheter?
- examine tubing for kinks, clots or urine sediment
- evaluate bladder distention
- notify prescriber if irritant is retained, if pt. complains of pain, or if bladder is distented
what do you do when you see bright red bleeding with irrigation?
- assess for shock (check vitals, skin colour, and moisture)
- closed intermittent - stop irrigation
- closed continuous - leave flowing
- notify prescriber
what do you do when you see increased cloudiness of urine or fever
- monitor fever
- notify prescriber
- obtain steril urine specimen if ordered
what do you do when there is an increase in pain after irrigation?
- evaluate bladder distention
- examine if there are kinks, clots, sediments
- notify prescriber
how to calculate urine output after irrigation?
volume of fluid used for irrigation - total output
Types of urinary diversions
incontinent and continent
what is an incontinent diversion
ileal coduit (ileal loop) or colon conduit.
- pt. wears an ostomy appliance as there is no spinchter to control urine flow
what is continenet diversion?
reservoir created in abdomen using part of bowel and a spinchter is created (needs to be catheterized) eg - kock pouch
what is uretrostomy?
involves bringing the end of one or both ureters to abdominal surface and avoids the need for 2 collecting devices
what is trasureteroureterostomy?
connects the ureters and brings one out through abdominal wall. A tube may be placed directly onto the renal pelvis to provide urinary drainage and is called a nephrostomy
nursing consideration for diversion?
- risk of skin breakdown at stoma site
- assess pt urine output, amount and colour
- assess for infection at site/systemic
- assess pt acceptance of device - body image, sexuality
- complication : if outflow becomes blocker, there may be permanent damage due to kidneys due to backflow pressure or could be infection and can travel to kindeys causing hydronephrosis
why is a dialysis used?
when there is irreversible damge to glomeruli/ renal tubules and cause decline in kindey function and leads to end stage renal diseae
types of dialysis
peritoneal and hemodialysis
vid to understand better: https://www.youtube.com/watch?v=SgBMoCArNak
peritoneal dialysis
- indirect method of cleaning the blood of waste products and excess fluid using osmosis and diffusion.
- peritoneum fucntion as a semipermeable membane for the procedure
- sterile electrolye is instilled into the peritoneal cavity by gravity via a surgically placed catheter
what is hemodialysis
involves using a machine equipped with a semipermeable filtering membrane (artificial kidney) that removes accumulated wasted product and excess fluid from blood.
- Sterile electrolyte is pumped through one side of filter membrane (artficial kidney) while pt. blood passes through the other side
how to collect a midstream (clean voided) urine specimen
- using surgical asepsis, open sterile kit is using one or prepare sterile supplies. apply sterile gloves after opening sterile cup, placing cap with sterile inside surface up, dont touch th inside of container/cap
- allow or assist pt, to independantly clean perineum and collect specimen
A. for a female pt.
- spread labia with thumb and forefinger of non dom hanf providing access to urethral meatus
- clean area with cotton ball/gauze and approved solution, moving front to back. Using a fresh swab each time, repeat motion 3 times
B. for a male pt.
- hold pt. penis with one hand or have the pt. hold his penis. Using circular motion and antiseptic swab/cotton ball with approves solution, clean end of penis, moving from ventre to outside
- in uncircumcised male, foreskin should be retracted before cleaning.
- after pr has initiated urine stream, pass specimen collection container into stream and collect 30-60 ml
- transport specimen to lab within 15-30 minutes or refrigerate
why do we not collect urine in initial stream?
initial stream flushes out microorganisms that accumulate at the urethral meatus and prevents transfer specimen
why do we need to refrigirate urine samples if it goes beyond 30 minutes to give to lab?
prevents the growth of bacteria
if pt is menstruating, what do you do
you indicate this information to the lab
charecteristics of urine (CCO)
Colour - bleeding from kidneys or ureters causes dark red urine, bleeding from bladder/urethra causes urine to be bright red
Clarity - with renal disease, urine may appear clouds or foamy due to high protein concentration or it could be a result of bacteria
Odour - the more concentrated the urine, the stronger the odour. Sweet/fruity odour occurs from acetone seen with diabetes mellitus or starvation
NORMAL OR ABNORMAL:
a. hourl output of less than 30ml more than 2 hrs
b. 2000ml to 2500ml of urine daily
c. 800 -2000 ml of urine per day
d. change in urine volume
a. abnormal
b. abnormal
c. normal
d. abnormal - may indicate kiney disease or fluid alteration
