1. Urinary Catheterization

2. Catheters A hollow tube for instilling and removing fluid general term
many types and uses

3. Urinary Catheterization
Intro of cath through urethra into bladder
aseptic procedure
sterile technique

4. DANGERS
INJURY
INFECTION

5. Role of the nurse Use infrequently
Not for convenience of nursing staff
Advocate early removal

6. Reasons for Urinary Catheterization
Sterile specimen
Before surgery
Inability to void
Check residual

7. Reasons for Urinary Caths (continued)
Remove urine if greatly distended
Last resort for incontinence
Accurate I & O

8. Reasons for Urinary Caths (even more!)
Keep sutures clean
Dilate/splint urethra
Drainage / Irrigation
Instillation of meds

9. Types of Urinary Caths Most common are plastic or latex Rounded tip
Lubricated with water soluble gel

10. Catheter Sizes Measure of diameter
Listed as “FR” which stands for “French”
Size depends on age and sex

11. Male patients Urethra is longer Potential prostrate obstruction
Use larger FR if trouble
Reposition foreskin

12. How to select size: Adult : 14 or 16 or 18 Child: 8 or 10 Female: 16
Male: 18 (stiffer to pass thru prostate)

13. Retention or Indwelling Caths
Temporary or permanent drainage
attached to urinary collection bag
most common – Foley

14. Foley catheter Has double lumen
Balloon (at tip) inflated once in place
prevents slipping out of bladder
Use sterile water/saline

15. Foley (continued) Note the balloon size if c/o pain when you inflate:
- probably in urethra
- deflate & advance

16. Drainage system must be below the level of the bladder.
Figure 20-17
(From Potter, P.A., Perry, A.G. [2003]. Basic nursing: essentials for practice. [5th ed.]. St. Louis: Mosby.)
Drainage system must be below the level of the bladder.

17. Catheter Lumen Space within a tube Single (straight cath)
#1 urine
Double (Foley cath)
- #1 plus #2 balloon

18. Catheter Lumen Triple (3 way Foley)
- #1 and # 2 plus #3 to add irrigation/med
- often used with CBI.
(Continuous Bladder Irrigation)

19. Bladder irrigation May be continuous or intermittent If continuous
Will be triple lumen
Use solution ordered

20. Bladder irrigation If intermittent: Use urine lumen
Primarily use sterile NSS - new kit q time
allow gravity return
Check P & P manual

21. Why Irrigate a cath? To cleanse the lumen To increase the cath patency
To break up blood clotting

22. Straight caths To drain urine single lumen
intended to insert, drain, and withdrawal

23. Other cath types:
Suprapubic cath
- cystocath
Texas cath
- condom cath

24. A, Condom catheter. B, Condom catheter attached to leg bag.
Figure 20-15
(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)
A, Condom catheter. B, Condom catheter attached to leg bag.

25. Catheter insertion Position patient in dorsal recumbent
cc max. removed - prevents shock

26. Nursing care Closed, sterile system prevent pulling no kinks in tubing
tubing over leg on unaffected side

27. Nursing care (cont) Wash hands Wear gloves Never disconnect
Never irrigate without an order

28. Nursing care (cont) Cleanse daily No dependent loops Bag below bladder
Measure/record I & O
Check volume frequent

29. Nursing care (cont) Check: - color - consistency - odor
- any c/o of pain

30. Nursing measures to promote voiding
Provide privacy / relax
Female - sitting
Male - standing
Warm bedpan / urinal
Offer fluids

31. More nursing measures Power of imagery Place hands in water
Water over Perineal area
Only when these fail can we obtain cath order!

32. Potential problems after removal
Inability to void
- give 8-10 hours
Frequency, urgency, burning - s/s of UTI
Incontinence

33. Related procedures
Bladder retraining
Bladder scanning

34. A woman, calling Mount Sinai Hospital, said, "Hello, I want to know if a patient is getting better."
The voice on the other end of the line said, "Do you know the patient's name and room number?"
She said, "Yes, darling! She's Sarah Finkel, in Room 302."
He said, "Oh, yes. Mrs. Finkel is doing very well. In fact, she's had two full meals, her blood pressure is fine, she's going to be taken off the heart monitor in a couple of hours and if she continues this improvement, Dr. Cohen is going to send her home Tuesday."
The woman said, "Thank God! That's wonderful! Oh! That's fantastic! That's wonderful news!"
The man on the phone said, "From your enthusiasm, I take it you must be a close family member or a very close friend!"
She said, "I'm Sarah Finkel in 302! Cohen, my doctor, doesn't tell me a word!"
The
End