Catheters and Sterile Field

Why do nurses use a sterile field?

to prevent infection

7 Rules about a sterile field

must remain dry, keep above your waist, never turn your back or walk away, outer 1 inch border is NOT sterile, open items away from you, never reach over the sterile field, when in doubt throw it out

Pouring sterile liquid onto sterile field

pour into sterile bowl, held 6 inches above field while pouring, pour away from the label

Name procedures that require sterile gloves.

Urinary catheter insertion, tracheostomy suctioning, cleaning/changing trach cannula, some wound care, and central line dressing changes.

What are the six research-supported indications for a urethral catheter?

Relief of acute urinary obstruction or retention; Prevent contamination during complex surgical procedures; Accurate urine measurement in critically ill patients; Maintain dry tissue for perineal/sacral wounds in incontinent patients; Management of patients immobilized for long periods; Patient comfort during end-of-life care

What technique must be used during urinary catheter placement?

Sterile technique

What are the four types of urethral catheters?

Straight (in-and-out) catheter; Indwelling catheter; Triple-lumen (three-way) catheter; Coudé catheter

What are the three risks of catheterization?

UTIs (CAUTIs catheter associated UTIs), urethral trauma (scarring, strictures), urethral erosion

What size catheter should be selected?

The smallest suitable size to reduce risk of UTI and urethral trauma

What is another name for a straight catheter?

In-and-out catheter

How long is a straight catheter left in place?

Only long enough to drain the bladder, then it is removed

What are common indications for a straight catheter?

Obtain urine for urinalysis or culture; Diagnose infection; Drain residual urine in bladder; Empty a continent urinary diversion (neobladder/Indiana pouch); Manage chronic retention (e.g., paraplegia)

Does a straight catheter have a balloon?

No

Why does a straight catheter have a lower infection risk than an indwelling catheter?

Because it is removed immediately after bladder drainage

Double lumen indwelling catheter functions

one lumen is to fill balloon to anchor it to the bladder and the other is for draining urine

What is the main purpose of an indwelling catheter?

To continuously drain urine from the bladder

What is unique about a Coudé catheter tip?

It has a stiffer, curved tip (allows catheter to pass more easily through partially obstructed urethra)

What condition commonly requires a Coudé catheter?

Benign Prostatic Hyperplasia (BPH)

What are the three lumens used for in a triple-lumen catheter?

Inflate balloon to anchor it to the bladder; Drain urine; Bladder irrigation

What is the purpose of bladder irrigation with a triple-lumen catheter?

To wash out blood clots or deliver localized antibiotic therapy

What are the two types of bladder irrigation?

Hand irrigation and continuous bladder irrigation (CBI)

What catheter size is typically required for continuous bladder irrigation?

20–22 French catheter

What is the first step before inserting a urethral catheter?

Start with a clean perineal area

What sterile supplies are typically included in an indwelling catheter kit?

• fenestrated drape

• square drape

• Sterile gloves

• Lubricant

• Antiseptic cleansing swabs

• Prefilled syringe with sterile water

• Catheter

• Tubing and collection drainage bag

• Leg securing device

What supplies are included in a straight catheter kit?

Same as indwelling kit except:

• No tubing or drainage bag

• No leg securing device

• No prefilled syringe (no balloon)

What should the nurse do if resistance is met during catheter insertion?

Pull back slightly and gently attempt to reposition and reinsert

What should be ensured before inserting a catheter to reduce resistance?

Adequate lubrication

What positioning helps during catheter insertion in male patients?

Straighten the penis

What should be assessed in a female patient if urine does not appear after catheter insertion?

Whether the catheter is in the urethra/bladder or accidentally in the vagina

When should the balloon of an indwelling catheter be inflated?

Only after urine flow is observed

What should you do if a catheter is accidentally inserted into the vagina?

Leave it in place and insert a new sterile catheter into the urethra.

Why is the incorrectly placed catheter left in the vagina temporarily?

To avoid accidentally reinserting the new catheter into the vagina again

What catheter may be needed for male patients if the prostate obstructs insertion?

Coudé catheter

What must be done if the sterile field is broken during catheter insertion?

Replace contaminated supplies (new kit, gloves, etc.)

How should routine catheter care be performed?

Soap and warm water with a washcloth per facility policy

What solution may help reduce catheter-associated UTIs (CAUTIs)?

Chlorhexidine gluconate

During catheter care, which direction should bacteria NOT be moved?

Toward the urethral meatus

What type of drainage system should be maintained to prevent infection?

Closed drainage system

Where should the catheter drainage bag be positioned?

Below the bladder (to prevent urine backflow) but not on the floor

When should the urine drainage bag be emptied?

When it is about 2/3 full

Why should catheter tubing be anchored to the patient’s thigh?

To prevent pulling and urethral trauma

What must be done before inserting a catheter in an uncircumcised male?

Gently pull back the foreskin to visualize the glans and urethral meatus (may be difficult if that pt has phimosis); allow for adequate cleaning of glands before inserting the catheter

What complication occurs if the foreskin is not returned over the glans of the penis?

Paraphimosis

What is a common mistake when opening a catheter kit?

Touching the sterile field with non-sterile hands

When opening sterile flaps, what part of the field can clean hands touch?

The 1-inch border only

Which direction should the first flap be opened?

Away from the body

Why must the first flap be opened away from you?

To avoid reaching over the sterile field

What is a common mistake when putting on sterile gloves?

Contaminating the gloves during donning

Where should sterile gloves be opened?

Separate from the sterile catheter field

How is a suprapubic catheter inserted?

Surgically through the abdominal wall into the bladder while under anesthesia

What type of catheter is usually used for suprapubic catheterization?

Double-lumen catheter with balloon

What are indications for a suprapubic catheter?

Urethral catheterization contraindicated or unsuccessful; Urethral obstruction or injury; Post bladder surgery; Chronic catheterization (neurogenic or atonic bladder)

Maintenance of Suprapubic Catheters

Drink plenty of fluids to maintain hydration and promote urinary
excretion; Daily cleansing around catheter site with soap and water; AVOID use of creams or lotions around site; Nurse should assess insertion site for leakage and s/s infection; Changed every 4-6 weeks

What is the purpose of external female catheters?

Manage incontinence and reduce CAUTI risk by avoiding indwelling catheters

What are common brand names for external female catheters?

PureWick and PrimaFit

Where is the wicking material placed in an external female catheter?

Between the labia and gluteal folds

How often should external female catheters be replaced?

Every 8–12 hours or immediately if soiled

External female catheters contraindicated if

agitated/uncooperative, frequent bowel incontinence, vaginal skin irritation
or breakdown, heavy menstruation, urinary retention

What is the most common type of external male catheter?

Condom catheter (over just the glans of the penis or over the glans
and down the shaft)

What are risks of external male catheters?

Skin necrosis; Penile strangulation; Dermatitis; Skin erosion; Infection

How often should external male catheters be replaced?

Daily and as needed

Do males have more or less pain with external catheters?

Male patients report more comfortable and less painful than indwelling

What drainage system do most external male catheters use?

Gravity drainage bag (not suction)

Which external male catheter can be connected to suction?

PrimoFit