NRSG 301 Urinary Catheterization

What are factors that contribute to catheterization?

Male Obstructions (benign prostatic hyperplasia, prostate cancer)

- Female Obstructions (cancer, pelvic organ prolapse)

- Infectious and Inflammatory (prostatitis, vulvovaginitis, urethritis/UTI or STI)

- Neurological (stroke, Diabetes, MS, spinal trauma, Epi/Spinal anaesthesia)

- Postoperative complications (pain, medications, trauma or distension in surgery)

- Pregnancy induced

- Trauma to urethra, genitalia, or bladder

- Anxiety, psychological factors or medications

What are the indications for catheteization?

Urinary retention

- surgery

- urethtral obstruction

What are the signs and symptoms of a urinary retention?

Bladder distension, a sense of urine over several hours, sever pain pressure, rest,easiness, diaphoresis, urgency, decreased LOC

What is incontinence?

inability to control the release of urine (determination of type and cause)

How can you asses urinary retention?

Palpate (Punic sympsis)

- percussion - takes skilled practice

- bladder scan over 250 ml

How long do silicone catheters last?

8-12 weeks

How long do latex catheters last?

1 month

How long does silastic catheters last?

8-12 weeks

What are 3-way catheters used for?

Bladder irrigation

- CBIs

- 30 ml

What are the principles of Asespsis?

● Sterile to Sterile

● Dirty to dirty

● Wet surfaces are considered unsterile

● Anything below the waist is considered unsterile

● If you drop 'it', leave 'it'

● Any others

What position should males be in for cathetrization?

Supine

What position should females be in for cathetrization?

Dorsal recumbent

When should peri care be preformed?

Before and after cathetrization?

What should you do if u see 700 ml retention via bladder scan?

Periodically pinch catheter while draining to avoid spasms occurring can collapse bladder

What must be document when a catheter is inserted?

Time

- type and size

- volume of water used to inflate balloon

- characteristic and volume of urine output

- any difficulties and patients tolerance

- presence of drainage

- specimens collected if pertinent

When will an infection come up after cathetrization?

Within 48 hours

What is Houdini?

Indications for urinary cathetrization

- Haematuria

- Obstructed

- Urologic surgery

- Decubitus ulcers

- Input/output monitoring

- Not for resuscitation/end of care

- immobility due to physical restraints

What should do when removing an indwelling catheter?

Instructions to patient and provide perineal hygiene

Check volume of water in balloon

Clean procedure

Blue pad and perineal privacy

Deflate balloon with syringe

Gentle removal

Pericare, encourage fluid intake, monitor for post catheter voiding (hope to see within 4-6 hours)

What should you do when urine specimen collection?

Clamp for up to 30 mins

Cleanse port and attach syringe

Withdraw sample (min 30 mL)

Disconnect and place sample in sterile

container

*Unclamp

Label sample, Biohazard and send

What is a nephorstomy?

Artificial opening created into renal pelvis

to allow urinary diversion.

- Indications - removal of renal calculi,

decompression of obstructed system,

maintain or improve renal function,

following ureteral obstruction

Used in post renal complications

What are complications of nephostromys?

Kidney infection - pain in kidney area, fever and chills, changes in appearance in urine

-Skin breakdown

-Monitor urea, electrolytes and creatinine for

changes in kidney function

What is a suprapubic catheter?

Surgical placement through abdominal wall

into bladder

- Indications - anatomical issues with urethra,

pelvic organ prolapse, spinal injuries or

trauma, lower body paralysis, MS, long

term catheter use, acute prostatitis

What consists of suprapubic care?

Catheter care is the same as indwelling as well as dressing around insertion site

- Observe for S&S of infection as higher incident then urethral insertion

- Monitor for skin integrity at insertion site

What should be known about urostomy care?

Used when bladder can not store urine

Same technique as changing fecal ostomy

If stents present, keep sterile as directly into

kidney

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Stents should be into bag

Wipe ends of stent with sterile 4x4 to

remove mucous

Port to empty is different from fecal

collection bag

What should be known about CBIs?

Most often seen following a TURP for treatment of BPH

- Ensure that irrigation bags to not run dry

(NaCl 3L, 2 bags hanging at different

levels)

-Regulate flow to minimize the formation of blood clots, unless Dr order

-Gradually reduce flow rate as bleeding diminishes

Urine output m

What should be known about open intermittent irrigation?

Allows irrigation of catheter through opening system which increased infection risk despite sterile procedure being used

- Instill 30 mL sterile saline into catheter with catheter tip 60 mL syringe

- Watch to make sure that there is 30 mL of fluid returns

- May repeat up to 4 times

What should be known about closed intermittent irrigation?

Allows irrigation of catheter without opening the system - Preferred method

- Instill 30mL sterile saline into injection port on catheter tubing while clamping the drainage system

- Watch to make sure that there is 30 mL of fluid returns

-May repeat up to 4 times