Objective and Management of OT VI

CATHETERS

• Blockage of the urinary system that cannot be resolved medically or surgically or in which resident is deemed unsuitable for medicinal or surgical procedures
• Extensive skin aging brought on by or aggravated by incontinence
• Bladder neurogenic retention
• Palliative care for those who are dying
• Severely incontinent individuals who find it uncomfortable to receive hygiene and continence care

Short- term catheterization may be considered for

• Individuals who have recently undergone urologic surgery
• Patient whose urinary output must be accurately measured
• Acute urinary retention treatment

Risk of catheterization

• UTI
• Urinary tract structure and aging
• Bleeding
• Risk of chronic renal inflammation, chronic pyelonephritis
• Development of calculi

Various types of catheterization

• Suprapubic catheterization
  • Surgery is required to insert a suprapubic catheter into the bladder through the abdominal wall, diverting urine from the urethra.
  • A suprapubic catheter may be more comfortable for some patients than an indwelling catheterization due to the slightly lower risk of infection.
• Intermittent catheterization
  • Intermittent catheterization on either short or long term basis should be considered
  • In the short term, the rate of infection has been shown to be lower when using intermittent catheterization
  • Elderly residents have been shown to regain voiding more quickly following hip surgery

Complications of Urinary Catheters

• The symptoms of a UTI may include
  • Fever
  • Chills
  • Headache
  • Cloudy urine (due to pus)
  • Burning of the urethra or genital area
  • Leaking of urine out of the catheter
  • Blood in the urine
  • Foul-smelling urine
  • Low back pain and achiness
• Other complications from using a urinary catheter include:
  • Allergic reaction to the material used in the catheter, such as latex
  • Bladder stones
  • Blood in the urine
  • Injury to the urethra
  • Kidney damage (with long-term indwelling catheters)
  • Infection of the urinary tract, kidney, or blood (septicemia)

Nursing care for patient on catheterization

• Use of surgical sterile technique
  • Nurse should follow strict aseptic technique using for the insertion of indwelling or intermittent catheter
  • Hand washing should be performed immediately after and before procedure
  • Nurse should use sterile set and equipment
• Positioning of catheter and urinary bag
  • Kinking of the catheter tube can cause backflow and increase the risk of infection
  • The drainage bag should be kept lower than the patient without resting on the floor
  • The catheter should be properly secured after insertion to promote resident comfort and prevent movement, traction and potential kinking of the tube
• Emptying the urinary bag
  • The urinary drainage system should be kept closed at all times to reduce the risk of UTI
  • The urinary catheter bag should be emptied regularly
  • Contaminated should be prevented when emptying the catheter bag
  • Wear disposable gloves and wipe the drainage bag outlet with an alcohol swap after emptying the bag
  • Urine output should be recorded
• Catheter toilet
  • In female residents, the vulva, inner labia, and catheter should be cleansed thoroughly with soap and water then rinsed
  • In male residents, the meatus, penis, scrotal area and first part of the catheter should be cleansed with soap and water then rinsed
  • In uncircumcised male residents, the foreskin should be pulled back, washed and dried then replaced
  • The literature suggests that clean tap water and soap is as an effective as any antimicrobial solutions, eg. Povidone iodine, for cleaning of genitalia