Uretheral Catheterization

Definition: Urethral catheterization involves introducing a rubber plastic tube through the urethra into the bladder.
Purpose:
- Facilitates continuous urine flow in patients who cannot urinate on their own.
- Allows hourly urine output assessment in hemodynamically unstable patients.
- Aids in strict intake and output records.
Risks:
- Urinary tract infection (UTI)
- Trauma to the urethra
Invasiveness: A highly invasive procedure that should be a last resort for treating incontinence.

Urinating Process:
- Urination (or micturition) is the discharge of urine from the bladder.
- Pathway: kidneys ➔ ureters ➔ bladder ➔ urethra ➔ outside.
Sterility: Most urinary structures are sterile, except for the distal urethra.
Infection Risk: Inserting a catheter risks introducing microorganisms into the bladder, potentially leading to serious infections that may affect kidneys.

At-Risk Patients: Those with lowered immune responses due to medications or diseases.
Insertion Considerations:
- Insertion technique must follow the normal contour of the urethra.
- Male catheterization is riskier due to longer and more complex urethra anatomy (20 cm).
- Female urethra is shorter (4-6.5 cm).

Materials: Commonly rubber or plastic (latex, silicone, PVC).
- Plastic Catheters: Suitable for intermittent use only. (in/out)
- Latex and Rubber Catheters: Can remain in place for up to three weeks.
- Silicone or Teflon Catheters: Best for long-term use (2-3 months).
Sizing: Measured by the diameter using the French scale.
- Typical sizes: 8-10 FR for children, 14-16 FR for adults.

Intermittent Catheterization (straight catheter):
- Single-use, drains bladder for about 5-10 minutes.
- Used for patients with incomplete bladder emptying, usually due to neurological conditions.
- Can be taught to patients for home use.
Indwelling Catheter (Foley catheter):
- Remains in place for long periods and needs regular changing (every 2-3 weeks).
- Can come in double or triple lumen types, used for continuous bladder irrigation as needed.
- Closed Drainage System: Critical for reducing infection risk; includes catheter, drainage bag, tubing.

Types:
- Intermittent for bladder distension, sterile urine specimen collection, assessment of urine, incomplete bladder emptying in spinal cord injuries.
- Short-term indwelling for patient with urinary obstruction, post-surgical bladder repair, mangement of output or critical care monitoring.
- Long-term has sever urinary intention, eposides of UTI, rashes, ulcers/wounds retenetion with urine and bed lined change hurts patient.
Last Resort in Incontinence: Used only after exhausting other options to manage incontinence.

Hand Hygiene: Essential for infection control when handling indwelling catheters. (wash area 3 times a day)
Closed Drainage System Maintenance: Avoid disconnections without proper cleansing. (with alachol)
Monitoring Techniques:
- Observe for kinks or obstruction in drainage system (should have a minimum output of 30 mL/hour).
- Ensure urine output is recorded accurately.

Indwelling Catheterization: Maintained for longer than 2-3 weeks, changed periodically.
- Types of Lumens: Double and triple lumen (for irrigation).
- Balloon Inflation: Typically inflated with 5, 10, or 30 mL of saline.
- Closed Drainage System: Essential component to reduce infection risk.
Proper Handling of Bags:
- Drainage bags must not touch the floor and should remain below bladder level.

Urinary retention, post-surgical repair, critical care settings requiring strict fluid monitoring, or for patients with skin irritations due to incontinence (but only as a last option).

Important Care Practices:
- Regular routine perineal care and hand hygiene. (3 times a day/ and after bowel movemnet)
- Monitor symptoms of urinary tract infections (pain, burning, fever, foul odor).
- Encourage adequate fluid intake unless contraindicated (e.g., renal failure).

Routine Documentation: Track intake/output, catheter care, and removal order.
Educate Patient: Teach signs of infection, maintaining drainage systems, and hygiene.
Fluid Intake: Aim for at least 2000-2500 mL/day if no restrictions.
Dietary Recommendations: Acidifying foods (cranberries, meat, cheese) to reduce infection risk.

Male Catheter Placement:
- Insert catheter 17 - 22.5 cm due to longer urethra.
Female Catheter Placement:
- Insert approximately 5 - 7.5 cm into the bladder.

Suprapubic Catheter: Surgically placed above the symphysis pubis, nonpainful for the patient and follows similar maintenance as indwelling catheters.
Continuous Bladder Irrigation: Can be open or closed systems; facilitates the flushing of bladder.

Preparation: Verify physician’s order, gather equipment, ensure sterile field, and obtain consent.
Catheter Insertion: Clean the area with appropriate technique, insert catheter until urine flows.
Drainage Connection and Securing: Attach drainage bag, secure catheter appropriately.
Documentation: Record urine characteristics, patient's response, and procedure details.

Post-Catheter Removal Monitoring: Monitor for proper urinary function, particularly in the first 24 hours post-removal.
- Consider bladder retraining to help regain muscle tone.
Documentation Requirements: Must include catheter type, inflating fluid amount, urine characteristics, and any patient teaching provided.