When might you use a short term indwelling catheter?
- urinary obstruction
- surgical repair of bladder, urethra, prostate
- prevention of urethral obstruction from blood clots
- input/output in critical patients
- continuous/intermittent irrigations
How long can short-term indwelling catheters be left in?
Up to 14 days. Any longer than that, they are considered long-term.
What are the indications for using a long-term Indwelling Catheter?
- Chronic urinary retention not managed intermittent catheterization
- skin problems
- palliation
Is it better nursing practice to use intermittent catheter multiple times a day or use an indwelling catheter?
**In and Out catheters even 10x/day pose FAR less risk for causing infection than longterm indwelling catheter.
Is the use of intermittent catheters a Dr’s order or a nurse’s initiated order?
Nurse Initiated
Why might you use an intermittent catheter?
- bladder distension
- obtain sterile urine specimen
- long-term management of spinal cord injuries or incompetent bladder (patient can catheterize themselves to avoid incontinence)
What type of catheter is used for bladder irrigation?
3-way foley
What size of catheter would you use for children? Women? Men?
8-10 Fr.
12-14 Fr.
14-16 Fr.
**Best practice is to use the smallest appropriate catheter for your patient.
Do you need to use a different size of catheter for a post prostatectomy patient?
20-24 Fr.
How long can Latex and rubber catheters be left in?
Up to 3 weeks
How long can Silicone of Teflon be left in?
2-3 months
To inflate the balloon, do you use clean water, normal saline or sterile water?
STERILE WATER.
N/S can crystallize over time
How frequently should we be doing pericare on our patients with catheters?
Twice a day AT LEAST. If independent, they require good teaching, if dependent it is our responsibility.
What are signs of a UTI to watch for in your patient with a catheter?
- mentation changes
- change in urine quality/quantity
- blood in urine
- fever
How can you avoid causing inflammation/trauma while inserting/using a catheter?
- proper lubrication
- properly adhere tubing to pts leg once it is inserted, so it isn’t moving around inside the urethra
What would you say to a patient who is concerned about catheter insertion?
- not a painful procedure, simply uncomfortable
- teach about the allowance for mobilization with a catheter
- teach how bag has to be below level of bladder
Will your patient be able to regain bladder control upon discontinuation of catheter?
- provide reassurance that pt will regain bladder control basically as soon as the catheter is removed
- May feel burning for the first few days post removal, just because of friction, but that should go away fairly quickly.
Before inserting a catheter, what can I teach my patient?
- Explain procedure
- May be asked to bear down or cough during insertion
- provide rationale for the procedure
- Expected sensations and symptoms to report to HCP
- Provide opportunity to ask questions
- Explain the risk of developing a UTI and preventative measures
If the patient constantly feels the need to void once the catheter has been inserted, what might be causing that?
The inflated balloon sitting on or irritating the bladder. Teach your patient NOT to attempt to push to void as this might result in urine bypassing the catheter, increasing risk for infection or potentially causing damage to the urethra.
CASE FOR CHARTING
CASE FOR CHARTING
What is bladder irrigation?
Process of instilling fluid (usually Normal Saline) into the bladder and allowing it to passively drain out in order to flush out the bladder
When might you use open irrigation? Explain this procedure.
If a patient has a foley and it gets blocked. Foley system is opened to irrigate as needed. This is always used on an intermittent basis, NOT continuous.
**RARE, d/t high risk of infection.
How is closed irrigation difference from open irrigation?
System is set up and it always remains closed. Irrigation is instilled through the 3rd lumen of a 3 way foley.
*Can be intermittent or continuous.
What are the indications for bladder irrigations?
- Flush out bladder eg. Post TUPR, post bladder resection for Ca
- Instilling a medication
- Maintain or restore catheter patency
