Urinary Elimination Flashcards
Urinary Catheterization definition
The placement of a tube through the urethra into the bladder to drain urine.
Indwelling Catheters are used for
may be short term (2 weeks or less) or long term (more than 1 month)
Intermittent Catheterization
used to measure PVR when a scanner is not available or to manage chronic urinary retention
What is the ultimate goal of Urinary Catherization
reduce CAUTI
PVR
post-void residual
In the female, the urethra is
smaller and hard to find
CDC Guidelines: Appropriate Indications for Indwelling urethral catheter
- acute retention of bladder outlet obstruction
- accurate I&O
- assist in healing with perineal wound
- prior to surgery (large diuretics)
- prolonged immobilization
- comfort in the end of life
What are the different types of catheters?
Straight
Coude tip (enlarged prostate
3 way catheter irrigation (continuous irrigation and med admin)
What allergies do you ask before performing a urinary catheter?
benedine
Condom/External Catheters/Urine Collection devices
purpose
Safe and non-invasive way to contain urine incontience
Condom/External Catheters/Urine Collection devices
Pre-Application
- Requires a provider order
- Check for allergies and sensitivities
- Assess skin integrity
- Wash and dry well- non-emollient soap
- Retract foreskin (if applicable) and Replace
Condom Catheter Secured by ____ tape
no
Condom Catheter Care
Change daily
clean site
check the tubing for patency
Check the skin for breakdown
Male External Catheter Securement
Wash and dry well- non-emollient soap
Follow directions to secure
Hang below bladder
Male External Catheter Care
Empty when ½ full
Change when the device turns white (24-48 hours)
Assess tubing for kinks and free flow
Assess skin breakdown
For both the condom catheter and the external catheter, allow for ______ away from penis to not allow tip to sit bathed in urine
1/2”
For females what catheter is the safest way to contain urinary incontinence
Purewick
- sucks urine away from pt to a designated cannister
Female External Catheter
Used for?
Invasive or Non-invasive ?
Procedure Type?
Via?
When do you replace?
Urinary incontinence
non-invasive, external device
Clean procedure
Wicks urine away from the patient via suction into a designated collection canister (suction below 40)
replace 8-12 hours
assess skin at least every two hours for proper placement
decrease CAUTI
Contraindication for female external catheter
Agitated, Combative or Uncooperative
Frequent, lose stools
Skin breakdown or irritation
Barrier Cream- impedes suction
Latex allergy
Indwelling and intermittent catheter placement
Pre-procedure
REQUIRES ORDER
BUDDY IN ROOM
ALLERGIES
SKIN INTEGRITY
WASH AND DRY WELL (NON EMOLLIENT SOAP BATH WIPES
Male – retract and replace
Clean procedure and patient positioning
What should you do if mistakenly put catheter in vagina?
leave as landmark and start over with new catheter
How many inches do you insert the catheter into the female?
2-3 inches after seeing urine
The male urethra is how many inches long?
7-8
With a male, when do you stop threading the catheter into the urethra?
all the way to the bifurcation site then inflate the balloon
Male Catheter Criticals to procedure
Hold Penis at a 90° angle
Proceed slowly
Stop if you meet resistance, may be a spasm
Wait and proceed unless increased pain
Advance to bifurcation
Clean your patient
Hang bag below level of bladder
Female Catheter Criticals to procedure
Always need help
Don’t depend on lithotomy position
Very easy to contaminate with patient skin, gown, pubic hair
Hold onto catheter before inflation
Clean patient
Leave enough loop not to pull before securing
Hang bag below level of bladder
If the urine bag shows no urine in 2 hours what do you do?
Check for kinks
Irrigate
Increase fluids
Bladder fullness
If the patient is experiencing pain with balloon inflation, what do you do?
Withdraw fluid back into syringe, advance catheter then inflate balloon
Once you see urine in a female catheter,
go 2-3 inches more
In a closed syringe irrigation reasons and what do you do?
- if large amount of mucous or hematoma
- Use room temperature, sterile solution to prevent cramping and discomfort
What cathter do you use for a enlarged prostate?
coude catheter
Who can place a coude catheter?
specially trained nurse
PCP
Urologist
The foreskin (if available) needs to be
retracted when cleaning and insertion
replace when done
DOCUMENT
Paraphimosis
foreskin becomes stuck behind the head of the penis and circulation begins to be cut off
- foreskin not replaced
Treatment of paraphimosis
caught early then pressure to glans and ice pack
Paraphimosis occurs by
When the foreskin becomes trapped behind the corona
- a tight band of tissue forms around the penis –
- impairs venous flow and lymphatic flow causing edema.
- As it worsens, blood flow decreases progressing to tissue ischemia and painful swelling of the glans –
- may lead to gangrene and auto amputation
Discontinuation of Indwelling Catheter
Perform peri care
Remove all water from the balloon with a syringe (double-check)
Gently remove catheter
After D/C, how long should you monitor voiding
Should void 4-8 hours
Monitor s/s of UTI, especially 2-3 days after removal
Is experiencing discomfort on the 1st void after removal okay?
yes
If patient spontaneously voids within 6 hours but it is less than 200mL,
perform bladder scan. Initiate straight catheterization if post void residual (PVR) is greater than 200mL
If patient spontaneously voids within 6 hours but is incontinent,
perform bladder scan, straight catheterization if PVR is >200mL.
If patient has not voided with six (6) hours after straight catheterization,
notify HCP
What can a nurse do to influence a patient to urinate if they have not after 4 hours of catheter removal?
stand and move
reposition
bedside commode
HOUDINI Criteria means
If patient meets one or more of the criteria below, the Foley Catheter should remain and be reassessed in 24 hours
HOUDINI
- Hematuria: gross or continuous bladder irrigation
- Obstruction: retention urinary
- Urologic: Surgery or urology placed catheter
- Decubitus: To assist in healing of open sacral or perineal wounds in incontinent patients (Stage III, IV or moisture related injury secondary to incontinence)
- I&O: critical for patient management or hemodynamic instability needing hourly I/O
- Neurogenic bladder dysfunction or chronic indwelling catheter
- Immobilization: due to physical constraints (i.e., potentially unstable fracture, spinal anesthesia, multiple traumatic injuries), or
- Improved patient comfort for end of life care)
How do you perform Peri and Catheter Care?
Perform every shift and PRN with soap and water
Use HH and gloves
Hold on to the catheter to keep from pulling
Retract labia
Process:
use disposable wash cloths
cleanse peri-area
clean catheter from meatus down the catheter- NEVER UP
Keep bag off floor and tubing downward from patient without kinks or loops
When should you perform peri and catheter care?
every shift or prn
How do you obtain a urine sample from catheter?
HH and Gloves
Clamp tubing about 3” below sampling port to accumulate port
Remove swab cap
Scrub sampling port with alcohol prep 20 seconds and allow to dry
Connect vacutainer to port
Collect at least 3mLs in First tube- gray- shake VIGOROUSLY
Collect at least 7mLs urine in Second tube – tiger striped. Invert 8-10 times
Remove Vacutainer and replace with a new swab cap
Label in patient’s room- place in lab bags for transport
Remove gloves and HH
When do you empty a male external catheter?
1/2 full
When do you assess the skin of a female patient with an external catheter? And why?
assess skin at least every two hours for proper placement
decrease CAUTI
What is the UA lab test tube order, amount needed and mixing technique?
3mLs in First tube- gray- shake VIGOROUSLY
7mLs urine in the Second tube – tiger striped. Invert 8-10 times
