Describe bladder catherization
Introducing a narrow tube through the urethra and into the bladder to allow a continuous flow of urine into the drainage receptacle.
Is a physicians order required for catherization?
Yes for both insertion and removal but particularly from removal, often times physicians will need an additional urology consult before making the decision to remove an indwelling catheter.
What are the indications for short-term catherization?
- less than 14 days
- Select surgicial procedures/post-op care
- accurate monitoring of urine ouput every 1-2 hrs in critically ill patients
- prolonged immobilization due to trauma
- acute urinary retention or bladder outlet obstruction
- instillation of medications into bladder
- end of life care only if required for comfort
What are the indications for long-term catherization?
- more than 14 days
- bladder outlet obstruction pending surgery or if patient is not suitable for surgical intervention
- chronic retention related to neurological disease if intermittent catherization is not feasible
- stage 3 or 4 sacral pressure injury or perineal skin breakdown in incontinent patients
- intractable urinary incontinence if alternate approaches have been tried but not successful
What are the indications for intermittent catherization?
- One time use straight catheter
- Introduced urethrally for 5 – 10 minutes
- used to empty the bladder in people with poorly contractile bladder or bladder sphincter dyssenergia
- long term in person with spinal cord injury or spinal bifida
- can be used to collect sterile urine specimen, only in patients who are able to provide a midstream specimen.
Describe a straight (intermittent) catheter?
- A single use straight catheter is introduced for 5 to 10 minutes, just long enough to drain the bladder
- The straight catheter has a single lumen with a small opening about 1.3 cm from the tip. urine drains from the tip, through the lumen and into a receptacle
Why is the straight/intermittent catheter used?
Intermittent catheterization is performed by the patient or nurse and is common in patients with retention / incomplete bladder emptying due to neurogenic conditions like spinal cord injury.
Describe a coude catheter
Has a curved tip and is used for male patients who have enlarged prostates that partly obstruct the urethra.
Why is the coude catheter used?
- It is less traumatic during insertion because it is stiffer and easier to control than the straight tip catheter
- use of this type of catheter needs special education
Describe indwelling/foley catheter
- This kind of catheter is retained for longer periods in the bladder by means of a small balloon that anchors it against the bladder neck.
- They are either two lumen (most common type; one lumen drains urine and the other carries sterile water to inflate or deflate balloon) or three lumen (third lumen allows for irrigation).
Why is the indwelling/foley catheter used?
The catheter remains in place until the patient is able to void completely and voluntarily for as long as accurate measurements are needed. Can be used on a short-term or long-term basis.
Why would you use a triple lumen catheter (three way)?
- Clot drainage & irrigation or mucous and tissue fragments after urologic procedures or urogenital surgery
- used for continuous bladder irrigation
When would you use plastic catheter?
Suitable for intermittent use because of their inflexibility
Describe latex catheter
Come with or without coating (silicone, Teflon, or silver). Be aware of patient allergies to any of these materials. Latex catheters may become encrusted more quickly than other materials.
When would you use silicone or hydrophilic polymer-coated catheter?
Best suited for long-term use (2 – 3 months) because they cause less encrustation at the urethral meatus and cause less friction and irritation to tissues.
When would you use silver-hydrogel catheter?
For short-term use, silver-hydrogel catheters may delay the onset of bacteria.
Why do we want to secure in-dwelling catheters?
prevents movement and pulling on the catheter, reducing urethral trauma.
Where should the level of the urinary drainage bag be?
Keep the urinary drainage bag below the level of the bladder at all times
Do we have to drain the urine from the bag before transport?
yes
When should you empty the urine bag?
Empty the drainage bag when it is half-full. = to prevent infection as bacteria can grow up tubing
At least every 8 hours, recording the output amount. If large outputs are noted, empty more frequently.
Where do you obtain urine samples?
Obtain urine samples using the sampling port. Clean the port with disinfectant and use sterile syringe or cannula.
How much of the catheter do you lubricate for a female?
2.5 - 5 cm
How far will you likely insert the catheter before you see urine flow for a female?
5 - 7.5 cm
Describe how you clean around the urinary meatus of a male
In a circular motion from urethral meatus down to base of glans. Repeat 3 more times with new cotton ball
