Exam 3- Lecture 1: Catheters and Sterile Field

What are the main sterile field rules?

• Must remain dry

• Keep above your waist

• NEVER turn your back on or walk away from sterile field

• Outer 1” border is NOT sterile

• When in doubt… throw it out!

What are procedures that NEED to be sterile?

• Urinary Catheter Insertion

• Trach suctioning

• Cleaning/Changing trach cannula

• Some wound care (not all)

• Central line dressing changes

Indications for Urethral Catheter:

1. Relief of ACUTE urinary obstruction/retention

2. Preventing contamination during surgical procedures

3. Accurate measurement of urine in ICU patients

4. Maintaining dry tissue during perineal/sacral wound healing in incontinence patients

5. Optimal management of patients who are immobilized (trauma, wounds, critical care)

6. Support patient comfort → END OF LIFE

_____ technique during catheter placement is critical

Sterile!

What are the 4 types of urethral catheters?

1. Straight (“in and out”)

2. Indwelling

3. Triple-lumen or “three-way”

4. Coudé

What type of catheter would you use for a man who has an enlarged prostate (BPH)?

Coudé Catheter

What is the main purpose of a triple-lumen or three way catheter?

It has 3 tubes:

• Balloon

• Urine drainage

• And med administration

Risks of catheterization:

• UTI’s → CAUTIs (catheter-associate UTIs)

• Urethral trauma (scarring)

• Urethral erosion

How do you choose the tubing size for a catheter?

Choose smallest suitable size → reduces risk of UTI and urethral trauma!

Straight Catheter (in and out)

Only left in place long enough to drain bladder

NO balloon

less risk for infection

Indications:

• obtaining urine for urinalysis/culture (sterile urine)

• drain residual urine in bladder

• chronic retention (patient with paraplegia)

Is a clean catch for urine sterile?

NO → a straight catheter is sterile though

Double-lumen indwelling catheter (folly cath)

• One lumen is to fill balloon

• Other lumen is for draining urine

• Left in place to continually drain

Coudé Catheter:

• Has stiffer, curved tip → allows catheter to pass more easily

• Indications: BPH

• Left in place to continually drain

Triple Lumen Catheter

Designed to allow sterile irrigation fluid to be added to bladder to wash out blood clots or provide antibiotic therapy (meds)

• One lumen for balloon

• One lumen for draining urine

• One lumen for bladder irrigation

What do you need to have before starting a catheter?

CLEAN PERINEAL AREA

Where do you attach the catheter tubing once placing it?

On the thigh → below waist level

NEVER attach the bag to the side rails

If you meet resistance when inserting a catheter, what do you do?

• Pull back on catheter and attempt to gently reinsert

• Ensure proper lubrication prior to inserting

• For male pt : make sure penis is STRAIGHT (upright)

• For female pt : are you in the urethra?

If you see no urine after insertion, what should you do?

Assess placement

• DO NOT inflate balloon until you see urine flow!

• Check if you are in the urethra or vagina for a female patient

• For male pt. may need coudé catheter to get around prostate

If you accidentally insert a catheter into the vagina instead of the urethra what should you do?

Keep catheter in place while inserting another new sterile catheter in the urethra to avoid inadvertently reinserting it into the vagina a second time

If you break sterile field during insertion, what should you do?

• MUST get a new kit or new gloves → CRUCIAL for UTI prevention

• If a sterile glove rips/tears… MUST get new gloves

What are the main ways to prevent UTIs with catheter care?

• Scheduled catheter care

- soap & warm water

- CHG

- avoid sweeping bacteria towards urethral meatus

• Bag BELOW bladder (avoid backflow of urine) → NOT ON FLOOR

• Empty urine bag when 2/3 full

What’s important to know with uncircumcised penises?

• You MUST pull back the foreskin before inserting catheter (clean before inserting)

• MUST pull the foreskin back over the penis when done… if not → paraphimosis!

What are the most common ways of contaminating the sterile field?

• Touching sterile field when opening catheter kit

→ Hands are clean so can only touch 1 inch border when opening flaps

• Improper opening of kit

→ Flaps falling back on the sterile field

→ MUST open the first flap AWAY from you

Can you touch the 1 inch border once sterile gloves are on?

NO → contaminates the sterile field

Can you open and don gloves on your sterile catheter field?

NO→ you must open and don sterile gloves separately from catheter sterile field

Can you drop your hands below the waist to throw away items while preparing sterile supplies?

NO → you must keep your hands above waist at all times during the process

Suprapubic Catheters

• Inserted through abdominal wall into bladder (surgery)

• Double lumen with a balloon

Suprapubic Catheter Indications

• Urethral catheterization contraindicated or not working (obstructions/injuries)

• After bladder surgery (short-term use)

• Chronic catheterization needed (neurogenic or atonic bladder)

Maintenance for Suprapubic Catheters:

• Drink PLENTY of fluids

• Daily cleansing around catheter site with soap and water

• AVOID use of creams or lotions around site

• Nurse assesses insertion site (leakage, s/s infection)

• Changed every 4-6 weeks

External Female Catheters

Used in those with incontinence → DECREASES CAUTI risk by avoiding indwelling caths

• Placed between labia and gluteal folds, tubing to LOW continuous suction

• Replaced every 8-12 hours (or immediately if soiled)

When is an external female catheter CONTRAINDICATED?

• If pt is agitated/uncooperative

• Frequent bowel incontinence

• Vaginal skin irritation or breakdown/ heavy menstruation

External Male Catheters

Over glans of penis or over the glans and down the shaft (condom cath)

• Risks: skin necrosis, penile strangulation, skin erosion

• Requires ROUTINE ASSESSMENT by RN!!!

• Replaced daily (and as needed)

• Most are connected to gravity drainage bag… NOT SUCTION (minus primofit cath)