Urinary Catheterization

Urinary Catheterization

Indication

-relief of acute urinary retention

-monitoring of urine output during critical illness

-drainage of urine and surgical debris following urological surgery 

-urodynamics studies

-intravesical drug instillation

long term catheterization for:

-incomplete emptying of the bladder due to neurological disorder or spinal cord damage

-bladder outlet obstruction in whom surgery is not possible

-intractable urinary incontinence

Contraindication

-abdominal or pelvic trauma 

-immediately following open prostatectomy

-epididymitis 

-haematuria ,urethral obstruction,discharge or pus

MALE URINARY CATHETERIZATION 

-sit the patient on the absordent pad ,ensuring they are not unduly exposed

-wash hands,put on apron and open the dressing pack

-open the remaining equipment onto the sterile dressing pack

-put on 2 pairs of sterile gloves

-clean  the outside of the foreskin and retract

-cleanse urethral meatus and penis,swabbing away from the urethral orifice

-arrange the sterile drape and place so that the penis passes through the hole in the drape 

-remove the outer pair of sterile gloves

-using a gauze swab hold the penis gently and laterally behind glans in vertical position

install approximately 10ml anaesthetics gel,warm the patient that slight stinging may be experienced(maybe reduce by chilling the gel)

-gently pinch the tip of the penis for atleast 1 min before attempting to pass the catheter 

-position the sterile bowl to catch urine and tear the top of the protective sleeve around the catheter ,leaving the remainder in place to act as a sterile covering

-using a sterile gauze swab hold the penis in an upright position 

-the catheter should pass easily and urine should flow within a few seconds,continue to advance to ensure that the balloon is within the bladder

-inflate the balloon with the  correct amount of sterile water

-withdraw the catheter gently until slight resistance is felt

-if appropriate ,a urine specimen can be collected for bacterial examination at this point

-attach the catheter to a closed drainage system

-it is essential that the foreskin is replaced back over the glands

-dispose all the equipment as per local infection control policy

-record the following in the patient 's records:the reason for catheterization.size of catheter ,amount of water in the balloon,gel used,any complication 

FEMALE URINARY CATHETERIZATION 

-identify and expose the urethral meatus by separating the labia minora

-cleanse the urethral orifice and surrounding area with cleansing solution (as above):cleansing should be carried out form the superior area in one downward motion

-it may be necessary to use the index finger of the hand not being used to hold the catheter to landmark the position of the urethra,in relatiom to the vagina

-once confident that the catheter is in the urethra ,advance it approximately 7-9cm or until urine flow commences ,then advance it further 2cm.

by lakdhes

ref:davidson