1. Urinary Catheters N124IN Spring 2013 Week 12

2. Patient-Centered Care Urinary elimination may be compromised by a wide variety of illnesses and conditions. Provide assistance. ◦Physiological support such as invasive procedures ◦Physical support such as access to toilets or bedpans Provide privacy and respect. Consider culture and gender when providing care.

3. Safety Minimize the risk of introducing pathogens into the urinary tract. Use sterile technique when inserting a urinary catheter. Maintain a closed urinary drainage system. Keep drainage bags below the level of the bladder. Provide catheter care using aseptic technique. Remove urinary catheters as soon as medically indicated.

4. Assisting with Use of a Urinal A urinal is a container to hold urine when access to a toilet is restricted because of injury or illness. ◦Male and female urinals are available. Provide privacy. Encourage independence in use if possible. ◦Assist male to stand to void if able. ◦Position female supine. Use absorbent pads if needed. Assist patient with perineal care after use.

5. Applying a Condom-Type External Catheter External device for noninvasive urine collection for male patients. Less risk for urinary tract infection (UTI) than indwelling catheter Held in place by adhesive coating or strips ◦Refer to manufacturer’s guidelines for application. ◦Provide perineal care before application. ◦Avoid catching pubic hair in adhesive when applying. ◦Ensure that foreskin is replaced in uncircumcised patient.

6. Applying a Condom-Type External Catheter (cont’d) Attach to leg bag or larger urinary drainage bag. Observe skin under external catheter sheath. Provide regular perineal care.

7. Bladder Scan Bladder scanners provide noninvasive measurement of urine volume in the bladder. ◦Evaluate new-onset incontinence. ◦Assess bladder volume for incomplete emptying. ◦Evaluate suspected bladder distention. ◦Measure postvoid residual volumes. Follow manufacturer’s guidelines for accurate imaging.

8. Insertion of a Straight or Indwelling Catheter Urinary catheters remove urine from the bladder for monitoring output, relieving urinary obstruction, or incomplete bladder emptying. ◦May be temporary or long term Number of catheter lumens depends on purpose. Presence of balloon and balloon size depends on purpose. Catheter changes and length of time used must be individualized.

9. A, Straight catheter (cross-section). B, Indwelling retention catheter (cross-section). C, Triple-lumen catheter (cross-section)

10. Insertion of a Straight or Indwelling Catheter (cont’d) Position patient appropriately for gender. ◦Provide perineal care and locate urinary meatus. Maintain sterility of catheter kit when opening. ◦Identify sequence of supplies in kit to prevent contamination of underlying supplies. ◦Apply sterile gloves and arrange supplies on sterile field. Prepare antiseptic solution (cotton balls/swabs). Follow manufacturer’s instructions regarding balloon test (for indwelling catheter). Lubricate end of catheter (gender-specific).

11. A, Cleansing female perineum. B, Cleansing male urinary meatus

12. Insertion of a Straight or Indwelling Catheter (cont’d) Cleanse meatus. Insert catheter gently through meatus. Advance catheter until urine flows. ◦Remove straight catheter after urine stops flowing. ◦Advance indwelling catheter further to ensure correct placement (gender- specific). Inflate balloon with recommended fluid amount (indwelling catheter). ◦Gently pull catheter until resistance is felt. Secure tubing, allowing some slack.

13. Removal of Indwelling Catheter Removal of indwelling catheters reduces risk of catheter-associated infection. Position and drape patient for maximum privacy. ◦Place absorbent pad where drips may occur. Deflate balloon by gravity (passive). ◦Ensure that balloon is completely deflated and entire amount of fluid is removed. Gently remove catheter and inspect. Provide perineal care. Monitor voiding for 24 to 48 hours after removal.

14. Care of Indwelling Catheter Daily meatal care and care after fecal soiling decrease the risk of catheter-associated urinary tract infection (CAUTI). ◦Position patient and place absorbent pad. ◦Remove catheter tubing from securing device. ◦Retract labia or foreskin to expose meatus. ◦Stabilize catheter at meatus with gloved fingers. Gently cleanse with soap and water. ◦Start at meatus and move up catheter using circular motion approximately 10.2 cm (4 inches). Dry perineum and replace securing device.

15. Suprapubic Catheter Care Surgically placed catheters are secured with sutures, adhesives, or fluid-filled balloons. Determine how long catheter has been in use. ◦Established catheters: Cleanse with soap and water. ◦Newly inserted catheters: Treat as surgical incisions. Stabilize catheter. ◦Starting at insertion site, move up length of catheter approximately 5 cm (2 inches) using circular motion. Apply gauze dressing if indicated. Secure catheter using tape or securing device.

16. Performing Catheter Irrigation Irrigation is performed intermittently or continuously to maintain catheter patency. ◦Strict asepsis is required. Never use force to instill irrigation solution. Assess for bladder distention during procedure. Irrigate according to provider orders. ◦Closed continuous: Adjust drip rate at roller clamp, observe for catheter patency, and monitor outflow. ◦Closed intermittent: Inject with slow, even pressure.  Allow solution to dwell for prescribed time if ordered. ◦Open intermittent: Maintain sterility of open tubing during and after irrigation.

17. Urine Specimen Collection Urinalysis provides information about kidney or metabolic function, nutrition, and systemic diseases. Random urine specimens ◦Voided sample Culture and sensitivity ◦Clean voided midstream or from urinary catheter Timed specimens for quantitative analysis ◦2- to 72-hour specimen collection Chemical properties ◦Immersion of specially prepared strip into specimen

18. Urine Specimen Collection (cont’d) Midstream voided specimen ◦Perform or assist patient to cleanse perineum and meatus with soap and water and antiseptic provided. ◦Pass specimen container into stream without contaminating edge.  Collect 30 to 60 mL of urine. Collection from indwelling urinary catheter ◦Clamp drainage tube below withdrawal site. ◦Cleanse port for 15 seconds with disinfectant swab. ◦Use needleless syringe to withdraw 3 to 20 mL of urine, depending on sample required.

19. A, Rubber band used to clamp catheter drainage tube. B, Urine sample drawn from catheter port.

20. Collecting 24-Hour Timed Urine Specimens Collect all voided urine in a 24-hour period. Obtain appropriate container from laboratory. ◦It may or may not contain preservatives. ◦Label with appropriate patient identification. ◦Store per instructions and agency policy. Post a reminder sign of collection time frame. Discard first voided specimen; then start timed collection. ◦Restart timed period if urine is accidentally not collected. At end of collection period send appropriately labeled specimens to laboratory.