Bladder Catheterization (Skills)

Indicaitons for Bladder Cath

Inability to void

Monitoring urinary output

Diagnostic purpose (VCUG or sterile specimen)

Bladder decompression / therapeutics

What can cause inability to void

Obstruction,

BPH,

tumor,

neurological disease

Acute urinary retention

What is the goal for urine output from cath

30 cc/hr

When do we want to monitor urine output

Insufficient hydration,

traumatic injury,

shock,

severe burns,

pre- or post-operative

What are therapeutic reasons for bladder cath

Irrigate and aspirate debris

CBI (continuous bladder irrigation)

Post-op prostate surgery

Prevent bladder distention after surgical procedure

Maintain urinary continence in certain urologic conditions

Preserve kidney function in certain disorders

Instill pharmaceutical or radiography contrast material into the bladder

Indication for continuous bladder irrigation

clot removal from hematuria

What are contraindications for bladder cath

Suspected urethral disruption

Significant resistance encountered with bladder catheterization

Known urinary tract obstruction

Recent reconstructive surgery of urethra or bladder neck

Combative or uncooperative patient

Acute infection of the urethra or bladder neck

Allergy to latex

Appearance of blood at the urethral meatus in a patient who has pelvic trauma can should

Get refer to urologist

Distance from Tip of Male Urethra to Bladder

6-7 in

Where are obstructions most likely to occur in male cath

1. Point of acute upward angulation between bulbous and membranous urethra

2. Bladder neck

What can cause bladder neck obstruction in males

Bladder neck stenosis

Enlarged median lobe of prostate

Distance from Tip of Female Urethera to Bladder

1.5 - 2 in

How does the female urinary tract change with age

Angle between urethra and bladder neck increases with age

In the older patient, the urethra is normally directed toward the sacrum

In the younger patient, the urethra is angled toward the umbilicus

How do we position patient for bladder catheterization

Males: supine position w/gentle traction on penis (sterile lubricant may be injected into urethra)

Females: supine position w/hips abducted (alternative, if necessary: lithotomy position)

How do we minimize the infection risk of bladder cath

Aseptic technique, proper sterile draping

Dominant hand is “sterile”

Non-dominant hand (holding penis or labia) is considered contaminated

What are the common size for catheter

F14, 16, or 18

How does catheter size work

Larger the number, large the cath (opposite of needle)

Types of Cath Tubes

Foley

Coude

Robinson / Straight

Double lumen indwelling

Texas

Types of Urinary Bag

Foley

Leg Bag

Robinson catheter

Designed for one-time use

For in-and-out catheterization, single-lumen

Foley catheter

For indwelling catheterization

Straight catheter

How do foley stay in place

Balloon is inflated after is properly placed

The balloon is inflated with sterile water use of saline may cause crystal formation in the balloon and cause a difficult removal

Use of triple-lumen indwelling catheter 

Continuous bladder irrigation and for instilling medications into the bladder

Coudé catheter

Catheter w/curved tip for maneuvering around enlarged prostate gland or other obstructions and false passages

Texas condom catheter

Used externally in men when indwelling catheter is not appropriate

Most Common Size for Adult Men Bladder Cath

14 Fr or 16 Fr most common

Larger catheters (20 Fr to 30 Fr) are used to evacuate blood

Most Common Size for Adult Woomen Bladder Cath

14 Fr or 16 Fr most common

How do you prep for bladder cath

Place all items in easy reach

Do not remove the tray covering or catheter until the sterile field is established w/patient positioned

Prepare three pieces of 6-inch-long tape

Position patient supine

Remove catheter tray wrappings and discard

How is cleansing done for bladder cath

Using forceps provided, pick up saturated cotton and clean genitalia at least three times

First 2-3 times, clean with saturated cotton, then “clean the field” with a final wipe of sterile cotton

Males: start at the urethral opening and work in a circular fashion to cleanse the glans, then repeat

Females: start at urethral opening and work from anterior to posterior with a swiping motion; first cleansing externally, then separate labia and cleanse internally; repeat the procedure

How do you insert a female bladder cath

Once the catheter inserted into the urethral opening, aim slightly ventral to avoid the catheter slipping into the vagina and advancing into bladder

Allows the catheter to follow the angle of the urethra

What should done if bladder cath enters the vaginal vault

Discard and repeat the procedure with a second sterile catheter

Or get another catheter and leave the first one in the vagina so you know where not to place the new one

How is a male bladder cath placed

Hold penis outstretched at 90-degree angle to body (elevate towards umbilicus)

Advance catheter gently

Resistance is very likely to be met at the external sphincter

By holding firm steady pressure against the sphincter, the muscle will eventually fatigue, and you will feel a release of pressure

How is sterile specimen collected from bladder cath

If sterile specimen is needed, remove container top and drain urine into container from end of catheter, then close container

Urine specimens should NEVER be obtained from the drainage bag

How do we secure cath

securely to inner thigh

Avoid creating traction at urethral opening by taping fully around catheter so tape adheres to itself, then place remainder of tape on leg

Allow enough slack to allow full movement of the leg On final tape, write time, date and size of catheter, and amount of sterile water in balloon (so same amount is later removed)

How is catheter removed

Remove the same amount of water via syringe from balloon

Once removed fluid, gently pull out the catheter

How do we cath urinary diversions

use sterile technique and cleanse the stoma just as you would the urinary meatus

Insert catheter slowly until the flow of urine begins

Purpose of Bladder Irrigation

Test the patency of the catheter lumen

Help combat infection when antibiotic solutions are used

Flush blood and other debris from the bladder

Instill pharmaceutical, radiopharmaceutical, or radiographic contrast for diagnostic testing