Urinary Catheterization

Introduction

Urinary catheterization is the introduction of a catheter through the urethra into the urinary bladder.  (Urine can also removed by means of a suprapubic catherter which is inserted by a physician, usually at the time of surgery).  The urinary tract is a sterile system so strict sterile technique is used for catheterization.

Indication for Catheterization
  1. Relief of urinary retention. (bladder normally hold 250-450 ml but may distend to 3000 ml).             
  2. Accurate assessment of urinary output (acutely ill).
  3. Bladder decompression, for abdominal and pelvic surgery.  Urologic surgery.
  4. Sterile specimen, on occasion.
  5. Assessment of residual volumes post voiding
  6. Long-term management of patients with neurological problems.
  7. Management of incontinence in selected clients.
  8. For patient comfort in selected procedures. 
  9. Not for convenience of nursing staff.

Types of Catheter

Two basic types

  • Straight – “French” – single lumen with eye opening ˝ from insertion tip. For intermittent catheterization.
  • Retention -  “Foley” – double lumen – indwelling.  One tube has a Balloon near the insertion tip.  Two openings at other end – one to drain urine, the other to inflate the balloon.
  •  Others:
    • Coude – curves tip – used for men with hypertrophic prostate.
    • Mushrooms
    • Wingtip or Malecot

*   Catheters are sized by the diameter of the lumen and the larger the number, the larger the lumen.

*   The balloons of the retention catheters are sized by the volume of fluid used to inflate them; commonly used sizes are 5 ml and 30 ml balloons

Intermittent Catheterization       
  1. Refers to the practice of inserting a straight catheter, draining the bladder and removing the catheter.  (aka “ in and out catheterization.”)
  2. It is performed for:
  • check for residual urine.
  • collect sterile specimen.
  • relief  of short-term retention, such as post surgical procedure.
  • Management of chronic retention using a clean technique, by the patient (self-cath).
  1. There has been a general policy limiting the amount of urine (700-1000 ml) that can be removed from the bladder on one catheterization.  There has been some controversy about this; refer to agency policy.

The Urinary Drainage System

  1. Fluids – Client should drink up to 3000 ml/day.  Keeps bladder flushed out.  Also decreases risk of infection: minimizes risk of sediment obstruction drainage tubing.
  2. Keep accurate I & O.
  3. Dietary measures – keep urine acidic – discourages growth of bacteria.
  4. Perineal care – No special cleaning other than routine hygienic care.
  5. Changing catheter/tubing – not cost effective.  The closed system should be maintained and the tubing not disconnected unless absolutely necessary.  Refer to agency policy.
  6. Client teaching – keep foley bag below bladder at all times; prevent loops or kinks – keep system patent. Prevent tension on catheter.  Keep bag off the floor. Force fluids.  Perineal care. 
  7. Collection of sterile specimen:
  • Disposable gloves
  • If no urine in tubing, clamp the drainage tubing for about 30 min. to allow fresh urine to accumulate in the bladder.
  • Wipe drainage port on retention catheter with alcohol wipe.  Obtain a 10-ml syringe with a sterile 20 gauge needle and insert into drainage port at 45 degree angle.
  • Withdraw at least 10 ml of urine or more and transfer to a sterile urine specimen container.
  • Cap, label and send immediately to lab with appropriate requisition slip.

Removal of Retention Catheters

  1. Must have physician’s order – to remove and/or to replace.
  2. If catheter has been in for some time, patient may have difficulty voiding and emptying the bladder.
  3. Catheter may be clamped for specified periods of time that allows the bladder to become distended.  Known as “bladder training.”
  4. To remove a retention catheter:
  • Obtain a receptacle for the catheter.
  • Obtain a clean towel, gloves, a sterile syringe and needle.  The syringe should be large enough to withdraw all the solution in the catheter balloon.  (the size of the balloon is noted on the catheter).
  • Gloves; remove tape on leg, place towel and receptacle between legs.
  • Insert syringe into injection port or the catheter and withdraw fluid from the balloon.
  • Gently withdraw the catheter and dispose of it.
  • Dry perineal area with towel.
  • Measure urine in bag and record amount.
  • Document time catheter was removed.
  • Following removal of catheter, determine the time of the first voiding, should be <8 hrs. If the amount is not sufficient quantity, the patient may be retaining urine.  Implement nursing interventions to facilitate voiding.

Urinary Irrigations

  1. An irrigation is a flushing with a specified solution.
  2. A bladder irrigation is carried out on a physician’s order to wash out the bladder or treat a bladder infection.
  3. Catheter irrigations are carried out to maintain or restore the patency of a catheter (remove blood clots or mucus).  A physician’s order is necessary.
  4. 3 methods: Always a sterile procedure -
  • maintaining closed system an injecting the solution through an aspiration port.
  • Irrigating through a 3-way catheter.
  • Irrigating through a catheter after separating the catheter and tubing.  (open system).
  1. Open System – although this may be used in some agencies, closed sterile drainage systems are recommended.
  2. Using  the 3-Way System, the frequency (continuous or intermittent),  type, amount and strength of solution are ordered by the physician.
  • Intermittent:  the tubing form the solution is open and the irrigant runs into the bladder, while the tubing to the drainage bag is clamped.  The fluid remains in the bladder for a period of time and then the clamp to the bag is released allowing the solution to flow into the bladder.
  • Continuous : the solution is regulated at a certain rate and allowed to flow continuously into the bladder and then freely into the drainage bag.

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