Chapter 28- Urinary Catheters

Indwelling Catheter

A catheter left in the bladder, allowing continuous urine drainage into a bag.
Also known as a retention or Foley catheter.

Straight Catheter

Drains the bladder and is immediately removed after drainage.
Not left inside the bladder like an indwelling catheter.

Suprapubic Catheter

Surgically inserted through an incision over the pubic bone.
Requires a surgical procedure for insertion.
Inserted through a surgically created opening, not the meatus.
Used when the urethra is blocked or long-term catheterization is needed.

Catheterization

The process of inserting a catheter.
Requires formal training and agency approval.
Improper insertion can cause injury requiring surgery.

Safety

Urinary catheter procedures involve exposing and touching the perineum.
Maintain professional conduct to prevent any perception of sexual abuse.
Always keep the call light within the person's reach.
Use standard precautions due to potential microbes in urine.
Wear gloves and gowns to prevent exposure.

Types of Catheters

Straight Catheter:
- Drains the bladder and is removed immediately.
- Not left inside the bladder
Indwelling Catheter (Retention or Foley Catheter):
- Left inside the bladder for continuous drainage.
- Urine drains constantly into a drainage bag.
- A balloon at the tip is inflated with sterile water to prevent the catheter from coming out of the bladder.
- The balloon typically contains about 10 mL of water, depending on its size.

Indwelling Catheter Insertion

Inserted through the meatus and into the bladder.
A balloon is inflated inside the bladder to keep it in place.
Improper handling or cleaning can cause the catheter to tug on the bladder, potentially causing injury.
Requires proper sterile insertion and removal techniques.

Parts of an Indwelling Catheter

Detailed explanation and demonstration provided in clinicals.

Suprapubic Catheter

Surgically inserted through an incision over the pubic bone.
Less common and used when the urethra is blocked or long-term catheterization is needed.

Condom Catheters

A soft sheath that slides over the penis, not inserted into the bladder.
Proper application techniques will be demonstrated.

Responsibilities

Inserting and removing indwelling catheters is a nursing responsibility.
May be delegated if you have proper training from your state and agencies.
Inserting and removing suprapubic catheters are not nursing responsibilities and cannot be delegated to you.
Requires a surgeon due to the surgical incision and exposure of body organs.

Purposes of Catheters

To keep the bladder empty before, during, and after surgery to reduce the risk of bladder injury.
To promote comfort when a person is too weak or disabled to use a bedpan, commode, urinal, or toilet, especially for dying persons.
To protect wounds and pressure injuries from contact with urine.
For hourly urine output measures.
To collect sterile urine specimens.
To measure the amount of urine in the bladder after the person voids (residual urine).
Catheters are not used to treat incontinence but are a last resort.

Catheter-Associated Urinary Tract Infections (CAUTIs)

The urinary system is a sterile environment.
Infection can occur if microbes enter through the catheter.
CAUTIs can cause severe illness and death.
Proper catheter care reduces the risk.
Microbes travel up the catheter into the bladder and kidneys.

Drainage System Safety

Tubing should not have kinks or blockages to allow free urine flow.
The person should not be lying on the tubing.
Keep the catheter connected to the drainage tube.
Keep the drainage bag below the bladder.
Move the drainage bag to the other side of the bed when repositioning or turning the person.
Hang the bag from the bed frame or lower part of the chair frame. Do not hang it on the bed rail.
Hold the bag lower than the bladder when the person walks.
Do not let the bag touch or drag against the floor.
Position drainage tubing in a straight line or coil it on the bed.

Catheter Securing

For females, secure the catheter to the inner thigh.
For males, flip the penis upward and tape the catheter to the stomach or abdominal area, or tape it to their thigh.
Use a tube holder, tape, leg band, or other devices to secure the catheter to the abdomen or thigh.
Securing the catheter prevents movement and friction on the incision site (meatus).
Check for leaks and provide perineal care and catheter care according to the care plan (twice a day, daily, after bowel movements, or when discharge is present).

Measuring Urine Output

Emptying a drainage bag and measuring urine at the end of the shift.
When the bag is becoming full.
Before measuring the person's weight.
When changing from a leg bag to a standard drainage bag.
Report any increase or decrease in urine amount.
Provide a measuring container for each person and do not share containers.
Do not let the drain on the drainage bag touch any surface.

Observations to Report

Complaints of pain, burning, the need to void, or irritation.
The color, clarity, and odor of the urine and the presence of any particles or blood.
Signs of a UTI, such as fevers, chills, flank pain or tenderness, a change in urine color, smell, blood particles, cloudiness, any change in mental function, and urine leakage around the catheter area.

Catheter and Drainage Bag Positioning

The urine drainage bag secured to the bed frame or chair (non-movable part).
For females, taped to the inner thigh with a clamp or securing device.
For males, taped to the abdominal area or facing downward, coiled and clipped to the bed frame.

Catheter Securing Devices

Tube holders and leg bands are used to secure the catheter.

Catheter Care Responsibilities

Catheter care is a routine nursing test.
Get information from the nurse and care plan before beginning.
When to give catheter care (daily, twice a day, after bowel movements, or vaginal discharge).
What temperature to use for perineal care (typically 105 to 109 degrees, but follow the care plan).
What to secure the catheter with or where to secure it (thigh or abdomen), using a tube holder, leg band, tape, or other device.
How to position the drainage tubing (straight line or coil around the bed).
Where to secure the drainage tubing (bed, chair, or wheelchair) using a clip, bed sheet clamp, or other devices.

Observations to Report and Record

Complaints of burning, irritations, or the need to avoid.
Any blood, color clarity, and odor.
The main things you’re gonna record all the time are color, clarity, and odor.
Depending on the person, it can include blood in the urine, any complaints, cloudiness, any leakage, or drainage system leaks.

Catheter Care Safety

Clean, rinse, and dry the catheter from the meatus down four inches.
Hold the catheter tubing at the meatus to prevent tugging or pulling.
The catheter must not pull on the incision site to avoid discomfort and irritation.
Hold the catheter securely during catheter care.
Properly secure the catheter and ensure the tubing is not under the person to prevent blockage and discomfort.

Catheter Cleaning Process

Holding the catheter at the meatus for stability.
Wiping down the catheter four inches without tugging or pulling.
Washing with soap and water, rinsing with just water, and then drying with a dry towel, using three separate towels.
Always work down to avoid introducing microbes into the urinary tract.

Urinary Drainage Systems

A closed system is used for indwelling catheters.
Only urine should enter the system.

Types of Urinary Drainage Systems

Standard bags (hold about 2,000 mL of urine).
Leg bags (attached to the calf or thigh with elastic bands or Velcro, hold less than 1,000 milliliters of urine).
Leg bags are used when walking around.
Do not reinsert or reconnect it if it gets disconnected. Tell the nurse.
Wipe the end of the drainage tube with the antiseptic wipe and wipe the end of the catheter with another antiseptic wipe before reconnecting them.

Changing Drainage Bags

Leg bags are changed more often than standard bags.
They are changed back to your standard bag when the person gets in bed.
Use standard before leg bag.
The drainage bag stays lower than the bladder level.
Open the closed drainage system.
Prevent microbes from entering the urinary system.

Changing and Emptying Drainage Bags

Routine nursing tasks that require this infomration from the nurse:
Requires switching bags from standar to leg ones.
Urine drains from the bladder through the catheter into the drainage bag.
Gravity needs to assist, so always keep that bag below the bladder.
You will have drainage bag holders like this, which keep the bag clipped, but it's goona be held inside the bag, so it doesn't touch or hit against any surface.

Catheter Clamping

Can be used for bladder retraining.
The clamp is applied directly to the catheter itself.
Use a clamp when emptying it too.

Sterile Plug

Sterile cap and catheter plug.
Inside the cap is sterile, and you can only touch the end of the plug.

Connecting them

For people doing these catheter jobs you’re not gonna do it without proper training, guys, but we're gonna go over it
A sterile plug is inserted into the end of the catheter like such.
The sterile cap is on the end of the drainage tube right here.
Just change from you’re standard bag to you’re leg bag or vice versa.
Don't let the inside of the drainage tube hit the inside of the graft. It can contaminate it.
Need to tap off the excess urine and wipe the pee off. K.

Indwelling Catheter Lumens

An indwelling catheter has two lumens.
Sterile water is injected through one lumen to inflate the balloon.
Urine drains from the bladder through the other lumen.

Balloon Inflation

The balloon of an indwelling catheter is inflated with sterile water via a syringe.

Balloon Deflation for Catheter Removal

To remove a catheter, the balloon is deflated by removing all the water.
You need a syringe large enough to hold all the water.
Only the doctor orders catheter removal.
The person may need bladder training first.
Dysuria and urinary frequency are common after removing catheters.

Important steps before removing catheters

A catheter package prescribes the amount of water needed to inflate the balloons
For proper inflation, the amount of water used is greater than the balloon size
For example, in this photo, a 5-milliliter urinary catheter balloon is inflated with 10 milliliters of water.
Need to be big enough to keep it inside their bladder with no tension.

Condom Catheters

Often used for incontinent men, also called external catheters, Texas catheters, and urinary sheaths.
A soft sheath that slides over the penis and drains urine through tubing connected to a drainage bag.
Many men prefer leg bags.

Application Procedures

Condom catheters are changed daily after perineal care.
Follow the manufacturer's instructions.
Thoroughly wash and dry the penis before applying the catheter to prevent microbe buildup.
Some are self-adhering, and non-adhering types are secured with elastic tape.
Apply elastic tape in a spiral around the penis to allow for blood flow.
Never use adhesive tape or other tapes that do not expand.
Elastic tape is the only type used
Do not apply if the penis is red, irritated, or shows signs of skin breakdown.
About $1 inch of space is between the penis and the end of the catheter. Elastic tape is secured in a spiral around the shaft.