Indwelling Catheterization

Subject: Fundamentals of Nursing

Overview

Indwelling Catheterization

A urinary catheter may be needed for a long time if it's not possible to treat the underlying condition that prevents the bladder from emptying naturally. The catheter is held in the bladder by a water-filled balloon, which prevents it falling out. These types of catheters are often known as Foley's catheters. A Foley's catheter is used with many disorders, procedures, or problems such as these:

Purposes

  • To relieve obstruction to urine outflow e.g. in prostate enlargement. 
  • To measure the urinary output accurately in severe ill and needed patients.
  • To continue drain of urine in urinary incontinence.
  • To facilitate continuous bladder drainage after major injury/surgery on urinary tract or other major surgeries.
  • To splint urethra promote healing after urological surgery.
  • To prevent from skin rashes, ulcers or wounds irritated by contact with urine.
  • To relieve acute or chronic urinary retention.
  • To provide continuous bladder irrigation.

Principles

  • Pathogenic organisms are transmitted from the source to a new host directly on by contaminated articles.
  • Urinary bladder is a sterile cavity and the urinary meatus acts as a portal of entry for pathogenic organisms.
  • Cleaning an area minimize the spread of organism. Do not allow tip of catheter to touch your hand or labia.
  • A break in the integrity of the skin and mucus membrane provides ready entrance for micro-organism.
  • Lubrication reduces friction, never use force while introducing the catheter.
  • Systematic ways of doing saves time, energy and material. Make the patient relaxed.
  • Through knowledge of anatomy and physiology of the genitourinary system facilities catheterization of the urinary bladder.
  • Use sterile technique during catheterization (because it leads UTI).
  • Avoid catheterization unless ordered. ld be elected according to the age of the patient.
  • Catheter should be selected according to the age of the patient.
    • Size of catheter:
    • Infant/young children: 5-8 Fr.
    • Older children: 8-12 Fr.
    • Women: 14-16 Fr.
    • Male Adult: 16-18 Fr.
  • Change the adhesive tape daily at different part of thigh.
  • Put uro-bag under the bed to prevent infection.

Articles

  • Screen,
  • A clean tray containing
    • Disposable gloves
    • Rubber mackintosh or draw sheet
    • Kidney tray
    • Towel
    • Antiseptic solution
    • Sterile saline
    • Adhesive tape and scissors (in case of retention catheter)
    • Specimen container if required.
  • Water soluble lubricant (xylocaine Jelly)
  • Flash light or spot light
  • Bath blanket
  • Uro-bag or collection bag.
  • A sterile tray with:
    • sterile gloves,
    • sterile drape,
    • small bowl,
    • cotton swabs,
    • catheter,
    • kidney tray,
    • Artery forceps.
    • dissecting forceps,
    • sterile syringe 10 or 20 ml and distilled water (in case of retention catheter).

Procedure

S.N. Nursing Action     Rationale
1 Identify the patient and assess the status of patient e.g. last voiding, level of awareness, physical limitation and pathological condition e.g. prostate enlargement, etc.     Proper assessment helps to identifying patient's ability to cooperate during procedure.
2 Review the physician's order and nursing care plan.     Ensures the reason for catherization.
3 Explain the procedure to the patient emphasizing how he/she has to co-operate.     It reduces anxiety and promotes cooperation which ensures smooth insertion of the catheter.
4 Close the door and screen the patient.     Maintains privacy.
5 Wash hands with soap and water.     Reduces the transmission of microorganisms.
6 Prepare all required equipment.     Keeping all articles ready for use helps in saving time.
7 Raise bed to appropriate working level, stand on right side of patient and shift patient closer to you.     Promotes the use of correct body mechanics.
8 Position patient, dorsal recumbent with knees flexed, and thighs externally rotated. Supine position with thighs slightly abducted for male patient.     Provides good view of perineal structure and prevents tension of abdominal and pelvic muscles.
9 Drape the patient with draw sheet or blanket up to the level of thigh.     Prevents from exposure body parts.
10 Adjust light/flash light to the area.     Helps to visualize the urinary meatus clearly.
11 Place mackintosh and draw sheet under the hip and put kidney tray in convenient area.     Prevents soiling of linen.
12

Open the sterile tray pour antiseptic solution into bowl, open outer cover of catheter and place in tray if prepackaged.

Open lubricant, squeeze and discard first drop and after that drop some on sterile guaze in the tray.

     Keeping all articles ready for use helps in saving time and prevents chance of contamination.
13 Wash hands/use sanitizer and wear sterile gloves.    

Helps to reduce spreading microorganisms.
14 Place the perineal sheet over genital area.     Maintains sterile working area.
15 Place the sterile tray, kidney tray between the client's thigh and sterile bottle within reach if necessary to receive sterile urine specimens.     Provides easy access to specimen.
16 For female clients, separate labia minora with two fingers (thumb and index) of the left hand to expose meatus.     Visualizes urethra clearly.
17

Take cotton balls in the right hand and swab the area right of the meatus, with downward stroke once and discard it in the kidney basin. Then take another cotton ball, clean the area left of the meatus, take the third and fourth balls and clean directly over the meatus from top to bottom, use more cotton balls if necessary.

Clean meatus with antiseptic solution if recommended.

In male, grasp penis firmly below glans with no dominant hand. Retract the foreskin and hold it retracted till end of procedure.

With non-dominant hand, use sterile swabs dipped in antiseptic solution to clean meatus and moving out in circular motion. Use one swab for each wipe. Repeate the cleaning using sterile saline in same manner.

    

Ensures perineal area aseptic.

Foreskin coming back into position before cathertion insertion will cause contamination.

Disinfectant can be irritating to skin and mucous membrane.
18 With gauze in the dominant hand, hold the catheter, with 9-10 cm from the tip pinching after the outlet. Moisten the tip with sterile glycerine or paraffin oil or water carefully, so as not to contaminate the tip. Use nondominant hand to spread the client's labia.    

Aids in easy insertion of catheter by reducing friction. 

Able to see the urethral opening.
19

Insert catheter gently into the meatus 4-5 cm in female and 15 to 25 cm in male of the, until urine flows freely.

If the passage seems to be obstructed, remove the catheter and report this to the doctor. Do not use force.

When urine begins to flow, advance the catheter another 1 inch.

When urine starts to flow, hold the catheter in place with the left hand to prevent the catheter  from slipping out.

Encourage patients to take deep breaths while inserting.

     Deep breathing relaxes the muscle.
20

If sterile specimen is ordered, lower the distal end of the catheter into a kidney tray. Discard first few cc of urine, and then collect urine into the specimen bottle.

Collect 120-180 cc or as required. Then direct the flow into the kidney tray.

     Collecting urine helps in assessing volume of urine drained. 
21

When urine ceases to flow pinch the catheter well and withdraw it gently if intermittent catherization is done.

If continual drainage is needed, attach a urinary bag to the distal end and fix the catheter in place.

  

 

 Ensures proper drainage.
22

Push 15 to 20 ml distilled water to inflate balloon in another tip of the catheter for fixing.

 

   Inflated balloon helps in retaining  catheter inside the bladder.
23 Pull gently on the catheter.     Ensures the balloon is seated against the neck of the bladder.
24 Connect catheter to uro-bag tied to bed below level of bladder.     Uro-bag above the level of the bladder will lead to back flow of urine and causes risk of infection.
25 Fix catheter to thigh using adhesive tapes.     Ensures adequate length to avoid traction.
26 Place the patient in comfortable position.      
27 Clean and replace articles. Wash hands.     Keeps the articles ready for next use.
28 Measure urine before discarding it, note colour, odor, sediment etc.      
29

Record and report the following things about the procedure such as: date and time, type of catheter used, amount of urine drained, any abnormality and signature.

Report to the senior staff about the procedure.

     Promotes communication among staff.

Figure: Inserting the Catheter:

Fig: Inserting the catheter
Things to remember

© 2021 Saralmind. All Rights Reserved.