FACILITATING URINE ELIMINATION

PROCEDURES

1. PROVIDING URINAL

Definition :

Meeting urinary elimination need of bed ridden male patients using a urinal

Purposes:

To assist in urination for bed-ridden patients

Use of Urinal. Following are the proper procedures for handling a urinal for a
male patient

Articles required purposes

urinal To collect urine

Disposable gloves To hold the urinal and maintain asepsis and protect nurses
Hands.

Specimen container (neatly labeled) In case to collect urine

Basin with water To wash hands for mobile patients

towel To dry hands for mobile patients

Nursing procedure

Action rationale
1. Assess the patients normal urinary 1. Identifies normal pattern of urination
elimination habits

2.Palpate for distended bladder 2.Identifies if bladder is full and patients need to void
3.Assess patients knowledge regarding 3.Reveals need for patient instruction
urinal use

4.Explain the procedure to patient 4.Allows patient co-operation

5. Wash hands and don gloves 5. Reduce transmission of micro-organisms

6. Provide privacy by closing the door or bedside curtain 6. Promotes easy micturition

7. Assist to comfortable position like sitting, standing or 7. Men finds it easier to void and empty bladder
semi fowlers

8. Remove upper bed linen such that they are out of way but do
8. not
Maintain client privacy and comfort
unduly expose the patient

9. Patient should hold urinal and position penis in urinal, if9.Allows

can proper emptying of urine
stand leave patient until complete and ask to give a
sign or call bell when finished
(Or)
If unable : place the urinal in such a manner that penis is positioned
inside the urinal and hold the urinal
Avoids spillage of urine in linen

10. Once finished urinating remove the urinal

11. Remove the curtains 11. To promote patient comfort

12. Collect urine in container if required or observe the 12. To test urine sample as per doctors order
urine & empty the urinal into toilet and flush down

13. Cleanse urinal and return to patient bedside for 13. Allows easy access to urinal
further use

14. Allow patients to wash hands after use- to dip hands 14. Reduce spread of micro-organisms
in basin and dry with towel

15. Remove gloves and wash hands 15. Prevents spread to infection

16. Record and report patients ability to use urinal, 16. Communicates patient information to all
urine output, urine characteristics. health care
 2.OFFERING BED PAN

Offering a bedpan to meet the elimination need of bed ridden patient

Types

Regular

Fracture

 Purposes
 To facilitate bowel and bladder elimination
 To collect specimen
 To perform bowel and bladder training

Articles required purposes

Disposable gloves To hold the urinal and maintain asepsis and protect nurses hands

Clean bed pan with lid To collect urine or stool

Toilet tissue or gauze pieces in a bowl To clean the anal region

Artery forceps To hold the gauze

Specimen container (optional) To collect specimen

mackintosh To protect the beddings and garments

Soapand water in basin To clean hands of mobile patients

Nursing procedure

Action rationale
1. Assess patients normal bowel/bladder 1. Helps to plan nursing interventions
elimination

2. Assess patients normal level of mobility, amount of 2.Determine type of bedpan and assistance needed
assistance needed and positions that can be assumed for them

3. Explain the procedure to patients 3.Encourage patient co-operation

 4. Elevate side rails on opposite side 4.Reduce risk of accidental falls

5.Position bed to convenient height 5.Ensures good body mechanics

6. Provide privacy. Remove top sheet just enough , 6. Reduces embarrassment and promotes normal
so they are out of the way but do not unduly bowel elimination
expose.

7. Wash hands and don gloves 7. Reduce transmission of micro-organisms

8. In patients, who can move lower limbs, ask 8. Allows patient to support some weight by self
patient to flex knees resting weight on back
or legs, and then raising the buttocks

9. Place a mackintosh under the buttocks 9. To prevent accidental spills

11. MOBILE PATIENT: Place a regular bedpan under

the patient with the smooth rounded rim under
the patients buttocks
If unable to move, obtain assistance from another nurse
to lift patient to bedpan
Or

IMMOBILE PATIENT:
Position patient in side lying position, place bedpan
against buttocks and roll patient onto bedpan, back
to supine position

12. Elevate patients bed to semi Fowlers position or 12. Allows for a normal position
support back with pillows

13. Cover patient with bed linen and permit to be alone 13. Promotes dignity and prevents embarrassment
with call bell, elevate side rails

14. When removing bed pan, return bed to position used when 14. Allows for easy removal of bedpan
giving bed pan

Mobile patient : ask to flex knees , placing body weight on lower 15.Covering bed pan prevents accidental spillage
legs, lifting buttocks up from bedpan. Hold pan in dominant hand
and the other hand at the farthest end of bedpan. Remove , cover
and place in bedside.

Immobile patient :
Assist patient to roll off the pan, hold bedpan steady to avoid
spillage. remove , cover and place in bedside.
15.Collect specimen if indicated 15. To follow doctors order

16.If patient can help himself provide tissues to wipe , if 16. Prevents contamination and spread of infection.
helpless provide (perineal care with gauzes by help
of artery forceps)

17.Remove the mackintosh 17.Promote patient comfort

18.Provide soap and water to clean patients hand and dry 18.Ensures prevention of infection
thoroughly

19. Empty the bedpan as soon as possible in toilet and 19.Prevents offensive order
flush

20. Clean the bed pan 20. For prevention of infection

21. Remove gloves and wash hands 21. Prevention of infection

22. Position comfortably 22. Promotes patient safety

23. Record procedure 24. Communicates patient information to all

health care

3.PERINEAL CARE
Also referred to as perineal-genital care or pericare.

Definition:

Perineal care is cleansing the genitalia and surrounding area.

Purpose

1. promote patients comfort and cleanliness

2. Prevent infection in high risk

3. To remove normal perineal secretions and odours.

 Indications

 Before and after surgeries and procedures of perineum

 Patients unable to do self care
 Patients with catheters
 Fecal and urinary incontinence

Articles required purposes

Clean gloves Prevents contamination of hand

Mackintosh and towel To protect the beddings and garments

Kidney tray / paper bag To discard the waste

Soap in a soap dish To clean the perineum

Warm water in a bowl To clean the perineum

Bed pan If patient is in need of passing urine and stool

Drape sheet To provide privacy to the patient

A small tray with:-

Artery forceps To hold the gauze swabs

Gauze pieces or rag pieces To clean the perineum

Bowl with solution Solution to clean the perineum

Thump forceps To hold gauze from tray

Procedure

Action Rationale

Gather all required equipments in a trolley Organization facilitates accurate skill performance

Explain the procedure to the client. Providing information fosters cooperation

Perform hand hygiene and wear on gloves To prevent the spread of infection

Close the door of the room and place the screen To protect the client's privacy.

Raise the bed to a comfortable height if possible Proper positioning prevents back strain.

Preparation the position:

1) Place a mackintosh under the client's hips. Pad protects the bed from getting soiled

Help client to flex knees, and spread legs apart Provides exposure of genitalia

Diamond drape by placing top sheet with one corner Minimum exposure lessens embarrassment and helps to provide war
between patients leg and another over patients chest.
The 2 other corners hang over sides of bed. Tuck them
around patients leg and under hips

Place the bedpan under the buttocks

Take up one end of drape

Pour few water from above the perineum

Apply soap and clean

Pour water and thoroughly clean

Prepare the tray- pour solution in the bowl, and put

gauze pieces in tray and place the kidney tray near the
thighs

FEMALE PERINEAL CARE

Hold the artery forceps in right hand and thumb

forceps in left

With artery hold 1 gauze, dip in bowl and squeeze the

gauze with thump forceps in bowl

Wipe the mons pubis in zig zag method

Discard the gauze in kidney tray

Take another gauze with thump forceps , dip in bowl,

bring top of the kidney tray and with artery forceps
squeeze
Wipe the labia majora opposite site

Discard and use another gauze swab(same way) to

wipe labia majora same side

Discard and repeat on both labia minora opposite side and

same side

Spread the labia to wash the folds between the labia Secretions are tend to collect around the labia minora and
majora and minora facilitate bacterial growth

With left hand separate the labia (thump and index

finger) and expose the urethral meatus and orifice.

Use 1 gauze swab to clean the clitoris

Discard and use 1 gauze swab and clean the vaginal Using separate swabs prevent the transmission of
orifice (introits) in a rotating manner microorganism from one area to another

Discard and use another gauze to wipe from clitoris Wipe from least contaminated area (pubis) to area of greatest
till the anus contamination (the rectum)

repeat each step till clean

do not wipe in opposite direction From least contamination to most contamination

use only 1 gauzeswab for each stroke To Prevent Re-Contamination

Dry the perineum thoroughly, paying particular attention Moisture supports the growth of many microorganism.
To the folds between the labia.

For post delivery and menstruating woman apply a It prevents contamination of vagina and urethra from the anal
perineal pad as needed from front to back. region and also prevents soiling of linen.

MALE PERINEAL CARE

Gently grasp the client’s penis with non dominant hand . Prevent transferring organisms from the anus to the urethra

Carefully retract the foreskin of penis Secretions that collect under the foreskin can cause irritation and od

Clean the tip of penis with 1 gauze swab Cleanse the penis thoroughly

If the client is uncircumcised, retract the prepuce Retracting the foreskin is necessary to remove the smegma
(foreskin) to expose the glans penis (tip of penis). (thick, cheesy secretions) that collects under the foreskin and
Discard and use another to clean the retracted surface facilitates growth of microorganisms.
in circular motion

Cleanse in a circular motion or long strokes moving

from the tip of the penis backwards toward the pubic
area

Return the foreskin to its former position. Replacing the foreskin prevents constriction of the penis
Which may cause edema.

Cleanse the scrotum carefully with 1 gauze The scrotum tends to be more soiled than the penis because of its
proximity to the rectum; thus it is cleansed after the penis.

Remove the kidney tray and reposition the patient Provides comfort
comfortably

Remove the diamond drape.

Discard the soiled items according to hospital To prevent the spread of infection
Policy

Remove gloves and perform hand hygiene.

Document the procedure, describing the client’s skin To provide continuity of care. Giving signature maintains
condition. Sign the chart professional accountability.

2. CONDOM DRAINAGE

A condom catheter (also known as an external catheter), is a urine drainage system for men made of a condom
attached to a drainage tube and bag.

Applying a thin condom sheath to penis for drainage of urine without inserting a catheter into urethra.

INDICATIONS

1.Overactive bladder incontinence in men

 2.Urological problems in men

3. Complex orthopaedic

PURPOSES

1. To collect urine and control urinary incontinence.

2. To permit the client physical activity while controlling urine.

3. To prevent skin irritation as a result of urinary incontinence.

TYPES OF MALE EXTERNAL CATHETERS/ CONDOM DRAINAGE

1. One piece catheter

2. Two piece catheter
3. Male external catheter with an anti-reflux valve
4. Male external catheter with a balloon principle
5. Male external catheter with a help stripe.

Articles required purposes

Condom catheter of appropriate size To fit properly on the penis.

Urinary drainage bag with long tubing To collect urine

Basin of warm water and soap To clean the perineum

Washcloth and towel To dry the perineum

PROCEDURE

Action Rationale

1. Assess the patients normal urinary elimination 1. Identifies the patients normal pattern
habits

2. Explain procedure to patient and assess status of 2. Reduce anxiety and promote co-operation
patient
 3. Provide privacy by closing doors, or curtains 3. Maintain patient self esteem

4. Wash hands 4. Reduce infection transmission

5.Assist patient to supine position. 5.Promotes patient comfort

6.Place sheet over upper body and expose only 6.Promotes dignity of patient
genitalia
7. Assess the condition of penis for skin irritation, swelling, 7. Provide baseline information to compare changes after con
irritation application

8.Apply disposable glove 8.Prevents spread of infection

9.Provide skin preparation to the root of penis 9.Hair acts as reservoir of micro-organisms

10. Provide perineal care 10. Prevent spread of micro-organisms

11. Prepare urinary collection bag and tubing and 11. Provides easy access to equipments
clamp the exit ports

12. With non dominant hand grasp penis along shaft , 12. Prepares penis for easy condom placement
with dominant hand roll condom onto penis.

13.Allow 2.5-5 cm of space between tip of glans penis 13.Allow free passage of urine in collecting tube avoid
and end of condom catheter. irritation of tip of penis

14. Encircle penile shaft with strip of elastic adhesive. 14. Condom is secured so that it fits and stay on not too
Strip to touch only condom sheath tight not too tight to cause vasoconstriction

15. Connect drainage tubing to catheter and not 15. Allows urine to be collected and measured
twisted

16. Coil the excess tubing on bed and secure 16. Prevent tube occlusion

17. Place patient in safe and comfortable position 17. Promote patient comfort

18. Remove gloves. Dispose contaminated supplies 18. Prevents spread of infection
and wash hands

19. Check after 30-60min for observing urine 19. Determine if normal voiding occurs
drainage

20. Regularly inspect skin 20. To check for skin irritation

21. Record and report time of application and skin 21. Provides data to determine change in elimination
condition status

Removing a condom catheter

Most of the time, condoms can be rolled off easily.

Procedure

1. Grasp the edge of the condom near the base of the penis and carefully pull the condom off the penis.

2. If a lot of resistance is present, particularly if the condom is only recently applied, then wrap a damp cloth around
condom.

3. Hold the wash cloth in position for a minute or so. Gently attempt to remove the condom again.

4. To remove the drainage bag, clamp the tube closed. Release the leg straps, and disconnect the extension tubing at
the top of the bag.

5. Check skin on the penis’ shaft for signs of irritation, swelling or discoloration.

COMPLICATIONS

 Retracted penis
 Pressure sore
 Skin lesions/allergies
 Leakage
 Urinary Tract Infections (UTIs)

3.Catheterization
Catheterization is the introduction of catheter through the urethra into the bladder to remove urine.

Indwelling urinary catheter is a drainage tube that is inserted into the bladder through the urethra, is left in place,
and is connected to a closed drainage system.

Catheterization - Is it a new procedure?

N0

3000BC river reeds and onion stems were used to drain the bladder

Gold, tin, lead and silver tubes were then developed and used

1920’s first vulcanised rubber tubes were produced

1934 – Fredrick Foley developed first self retaining catheter

PURPOSE

1. Relive acute / chronic urinary retention and bladder overdistention.

2. Prevent bedwetting in incontinence

3. In continuous bladder irrigation

4. Obtain sterile specimen

5. Empty bladder for diagnostic or surgical procedures.

INDICATIONS

 Patients with a neurological condition or injury to bladder.

 Patients with outlet obstruction
 Palliative care patients
 Chronic urinary retention
 Surgical interventions

Exclusions For First Catheterization

• A history of complicated catheterization

• Advanced prostate cancer

• Advanced bladder cancer

• Post Urological Surgery

• Lymphoedema

• Known urethral Congenital Abnormalities

• Urethral Obstruction

• A history of urethral bleeding or undiagnosed Haematuria

• Acute Retention

TYPES

Intermittent Catheter. An intermittent catheter is used to drain the bladder for short periods (5-10 minutes). It may
be inserted by the patient.

Retention/Indwelling Catheter. This type of catheter is placed into the bladder and secured there for a period of time.
Catheter sizes

The relative size of a Foley catheter is described using French units (F). The most common sizes are 10 F to 22 F

Number 8 Fr. and 10 Fr. are used for children.

Number 14 Fr. and 16 Fr. are used for female adults.

Number 20 Fr. and 22 Fr. are usually used for male adults.

Available with 10 ml or 30 ml balloon in 12,14, 16, 18 20, 22 and 24 Fr sizes; and also available with 1.5 ml or 3 ml
balloon in 6, 8 and 10 Fr sizes.

Male catheters are 41- 45cm in length

Female catheters are 20- 25cm in length

Types of catheters

 A straight catheter, ( single lumen catheter) is used when the catheter is to be inserted for
immediate drainage of bladder. It is used to collect urine specimen. Catheter is removed immediately
after the purpose is served.

 An indwelling catheter,(double lumen catheter) also known as Foley catheter, is left inside the
bladder to provide continuous urine drainage.

 A suprapubic catheter is a type of indwelling catheter. The suprapubic catheter is inserted into the
bladder through a surgical incision made in the abdominal wall, right above the pubic bone.

 A 3-way catheter for continuous bladder irrigation (CBI) (triple lumen catheter) is a type of
indwelling catheter. It is inserted to irrigate the bladder to prevent obstruction .

Catheter types short term

Catheter material duration

PVC 14 days
Latex 14 days
Teflon coated latex 28days
Silicon elastomer – coated 12 weeks
latex
silicon 12 weeks
Hydrogel coated latex 12 weeks
 PRINCIPLES

Principle Action
1. Micro-organisms are everywhere -Emphasis on hand washing before and after procedure

2. Cleaning an area where there is less number - Perineum is shaved, cleaned and dried
of micro-organisms, before cleaning an - Area around meatus is clean area compared to
area where there are more micro-organisms area around anus
minimize spread of organisms - 1 swab is used for each wipe

3. Urinary bladder is sterile cavity - The part that enters the urethra and bladder is
not touched
- Catheterization is avoided as far as possible

4. A break in the skin and mucus membrane - Gentle insertion is done to prevent injury
provides ready assess to micro-organisms - Good source of light is used
- Catheters of correct size is used

5. Lubrication reduces friction - Sterile catheter is lubricated with sterile lubricant

6. Thorough knowledge of anatomy and - Difficulty may be experienced to locate urinary

physiology facilitates catheterization meatus situated just below clittoris just above
vaginal orifice
- Male urethra is ‘s’ shaped . In order to straighten
raise to 90 degree to legs

7. Systemic ways of doing things may save time - Assemble all equipments near patient
energy , material - Get assistance if needed

Articles required

Articles requred Purposes

Sterile catheterization tray

Sterile gloves To hold the sterile articles

Small bowls 2 1 for antiseptic, 1 for sterile water

Gauze swabs To provide perineal care

Sterile Kidney tray To keep the tip of sterile catheter

Artery forceps straight and curved To hold gauze

Thump forceps

Sterile slit towel To place over the perineum to create sterile

field
Clean tray containing

Flash light To visualize the perineum

Shaving set with blade To provide skin preparation of perineum

Articles for perineal care To provide perineal care

Disposable gloves To provide perineal care and skin preparation

Adhesive tapes and scissors To attach the urinary catheter

Kidney tray To collect soiled items

Antiseptic solution/ betadine To clean the perineum before catheterization

Specimen container To collect urine sample

Lubricant xylocain jelly To lubricate the catheter

Foley’s catheter

Syringe 20 cc To load sterile water to inflate the balloon

Sterile water 20 ml Inflate the balloon

 Procedure with (assistance )

Action Rationale
1. Review physicians order 1.Identify reason

2. Identify and asses clients voiding pattern 2.Identify patients ability to cooperate

3. Explain the procedure to patient 3. Reduce anxiety and promote cooperation

4. Provide privacy 4. Reduce embarrassment to patient

5.Perform medical hand washing 5. Reduce risk of transmission of micro

organism

6.Raise bed to appropriate position 6. Promote use of appropriate body

mechanism

7. Position patient 7. Provide good view of perineal structures

(A) female
dorsal recumbent with knees flexed and 2 feet apart thighs
externally rotated
(B) Male
supine position with thighs slightly
abducted or apart.

8. Place the mackintosh 8. Prevents spill of contents in bed

under buttocks

9. Diamond drape patient 9. Keep warmth and privacy

10. Prepare the skin 10. Prevents pathogens from entering urinary
tract

11. Clean perineum 11. Prevent spread of infection

12. Place sterile tray near bedside trolley 12. For easy performance of procedure

13. Perform surgical hand washing 13. Maintain asepsis

14. With sterile hand towel dry the hands 14. Moisture promotes infection
 15. Don sterile gloves with help of assistance 15. Maintain asepsis
(tear open to tray)

16. Open drape with ankle part of non 16. Hands are considered sterile
dominant hand

17. Open the bowl and with assistance pour 17. Helps maintain asepsis
anti-septic solution into bowl

18. Syringe is tear open to tray with assistance fill with 18. Instruments kept outside is considered unsterile
sterile water 20 mL

19. In females :Place a sterile gauze on the top of mons 19. Sterile gauze helps in separating the labias keeping the gl
pubis with artery forceps hand sterile

20. Clean perineum with antiseptic solution ( sterile artery and 20.Reduces risk of introducing micro-organisms into sterile b
sterile /gauze
21. Touch the inside of sterile container and take the slit 21. Any part outside the tray is unsterile
towel

22. Place in such a manner that slit towel exposes the 22. Promotes a sterile working environment surrounding gen
perineal area.

23. .From the tray pick the kidney tray and place inside 23. Provides sterile working environment
green towel

24. Ask assistance in using torch light to view urinary 24. Allows maximum exposure of orifices
meatus

25. .Holding catheter : 25. Maintains the sterile technique

With assistance open the sterile catheter cover half open.
Ask assistance to hold the distal end of half opened and inner
sterile cover.
Hold the tip of catheter with dominant hand so that sterile tip
cover is opened
Place that tip cover in kidney tray.

26. Take the catheter out. Hold one end of catheter loosely 26.Allow easier manipulation of catheter
coiled in palm of same hand.

27. Place the distal end of the catheter in the sterile kidney 27. To collect sterile urine specimen
tray

28. With assistance drop lubricant in a gauze piece 28. Allows easy lubrication of catheter
 29. Lubricate the tip with the lubricant. Lubricate catheter 29. For smooth insertion
(2.5 to 5 cm for women) and (12.5 to 17.5 cm for men)

30 . Female catheterization
With non dominant hand retract the labia to expose the 30. Gauze piece is sterile and prevent infection
Meatus by holding the gauze separately

31. Gently insert the catheter through the urethral orifice .

Gradually advance it into the urethra in an upward and 31.Allows easy insertion of catheter
backward direction

32. Ensure complete emptying of bladder

33. Male: lift penis from shaft just below glans , retract foreskin
and introduce 7-9 inches. Hold the penis at 60-90 degrees to
the body. Do not force to insert.

34. Collect the urine specimen in container by placing 34. Allows to obtain sterile specimen
open end of catheter into it or from sterile kidney tray

35. Clamp catheter using the artery forceps

36. Through the balloon inflation opening , administer with 36. Allows to inflate balloon
sterile water

37. Pull gently to feel the resistance 37. To ensure anchoring

38. Remove the kidney tray and slit towel

39. Ask assistance to open urobag to tray. 39. Urobag is attached under asepsis

40. Attach the urobag to the catheter

41. Release the clamp

42. Secure catheter 42. Ensures right placing of catheter and avoid dislodging
Females: secure into inner thigh, allow to stack so that
movement do not cause tension
Males: on top of thigh or lower abdomen with penis directed
towards chest

43. Attach the urobag to the bedside

 After care

 Remove the drape sheet

 Replace the articles
 Discard the soiled items
 Remove gloves
 Wash hands
 Send urine specimen for lab investigation
 Record the procedure
 Maintain intake – output

Procedure(without assistance)

Action

Repeat steps 1-12

Prepare the tray

Open the tray

With cheatles open the sterile part

Pour antiseptic solution in 1 bowl

Pour sterile water in 1 bowl

Without touching the interior apply lubricant in 1 sterile

gauze

Tear open the catheter and urobag and 10cc syringe in the sterile
tray 1 side

Cover 1 flap

Tear open the sterile gloves on top

Place the sterile hand towel on the top

CATHETER REMOVAL

Purposes

 Promote normal bladder function

 Prevent trauma to bladder
  Prevent infection

Articles required

 Disposable gloves
 Kidney tray
 Disposable syringe 20cc or 10 cc
 Mackintosh

PROCEDURE

Action Rationale

Check for doctors order Ensures correct patient and procedure

Assess the condition of patient Aids nursing intervention

explain the procedure to patient Allows patient participation

Perform bladder conditioning Allows to check bladder tone

Clamp the indwelling catheter for 3 hrs Allows to perform procedure well
Ask patient for sensation to urinate
If no, release and repeat clamping 3hrs
If yes, removal can be performed

Position patient in supine Promotes patient comfort

Provide privacy- Promotes patient safety

Perform hand washing

Prevention of infection
Don disposable gloves

Empty the uro bag. For easy removal

Remove the tape holding catheter to leg

Place the mackintosh under buttocks Avoids soiling of bed

Insert the hub of syringe into inflation valve and Removal of fluid prevents damage to urethra
allow fluid to drain into the syringe due to
gravity
 Make sure that the entire amount of fluid is To avoid any complications
aspirated
Ask patient to take deep breath. Pull catheter out Allows removal of catheter smoothly
slowly and smoothly during expiration.

Place the catheter and bag in bedpan. Catheter and bag is soiled

Discard the items rightly. For infection control

Remove the gloves Reduce trasmission of infection

Record the procedure Allows continuity of service

After care

Encourage patient to perform voiding in toilet

Instruct to drink lots of water

Notify physician if not voided for 8 hrs after procedure

Catheter Care
Cleansing the urethral meatus, the skin surrounding the catheter insertion site and perineum for patients with
retention catheter who are bedridden

PURPOSES

 Promote patient comfort

 Reduce chances of UTI

ARTICLES REQUIRED

Article Purpose
Flash light To view the genitalia

Adhesive tape and scissors To adhere the catheter

Kidney tray To collect soiled items

Antiseptic solution / betadine To provide catheter care

Specimen container To collect urine as per order.

 Sterile tray with:-

Sterile gloves To provide catheter care

Small bowl To pour antiseptic solution

Gauze swabs To provide catheter care

Artery forceps – straight and curved To hold the gauzes

Thump forceps

PROCEDURE

Action Rationale
1. Assess the episode of bowel/ bladder 1. Accumulation of secretions, may cause irritation to
elimination perineal tissues

2. Explain the procedure to patient 2. Reduce anxiety and promote co-operation

3. Provide privacy, door, curtain 3. Maintain client privacy

4. Perform hand hygiene 4. Reduce transmission of infection

5. Position patient 5. Ensure easy access and visualization of body parts

Dorsal recumbent to female
Supine/semi fowlers to male

6. Place mackintosh under the client 6. Protects bed from getting soiled

7. Provide diamond drape 7. Prevents unnecessary exposure of body parts

8. Remove the adhesive taping 8. To free the catheter

9. Apply sterile gloves 9. Maintain asepsis

10. Take a sterile gauze and keep below mons 10. Gauze is used to separate the labias
pubis

11. Clean surrounding of the meatus and the

catheter insertion site
13. Female catheter care

Clean the clittoris

Clean the labia minora opposite side

Clean labia minora same side

Clean labia majora opposite side

Clean labia majora same side

Clean the vaginal introitus

Clean from vaginal orifice till the anus

Clean the catheter 4 sides(top, right, left, bottom

using 4 gauze)

Male catheter care

Retract the foreskin

Clean the catheter insertion site

Clean the foreskin in rotating motion

Clean the penis in a circular motion downwards or

long strokes

Reposition the foreskin

Clean catheter in 4 directions(right, left, top, bottom)

Clean the scrotum

14. Re anchor the catheter tubing 14. To make the catheter in place

15. Place client in safe and comfortable position 15. Promote safety to client
16. Dispose the contaminated materials, 16. To prevent spread infection
remove gloves, perform hand hygiene

17. Record the procedure 17. To provide continuity of care. Giving signature maintains
professional accountability

BLADDER IRRIGATION

Definition:

It is the washing out of the urinary bladder, by directing stream of solution into the bladder using the urinary meatus
by means of catheter.

 Purpose
 Ensure patency of urinary drainage system
 Cleanse bladder from stagnant urine
 Relieve congestion and pain
 Promote healing of system
 Medicate lining of bladder
 Arrest bleeding
 Prepare bladder for surgery

Types of irrigation

 Closed intermittent: it is done with an aseptic syringe in which fluid is introduced in the urinary bladder and
drained out simultaneously

Closed continous: provides for frequent or continuous irrigation without disrupting of the sterile catheter system.
Done in genito-urinary surgery where there is a risk of blood clots.

 Open

Type of solutions

 STERILE WATER
 NS
 ACETIC ACID
Procedure

ACTION RATIONALE

Assess record to determine Helps plan interventions

• Purpose of irrigation
• Type

Assess clients urine- colour, clots, Indicates bleeding or any tissue problems
sediment

Palpate bladder Determines any distension

Review I/O record Determines baseline variables

Explain the procedure Promotes co-operation

Place mackintosh and towel under clients Prevents soiling of bed

buttock
Place female in dorsal recumbent Promotes flow of solution into bladder
position

Wash hands and put sterile gloves Reduce infection transmission

Closed intermittent irrigation Ensure solution remains sterile

Prepare the prescribed sterile solution in asepto
syringe

Clamp the catheter just below specimen Provides resistnace against which irrigant can be inserted
port forcefully

Cleanse injection port with antiseptic Reduce infection transmission

swab
Insert end of asepto syringe 30 degree Ensures hub enters lumen of catheter and flow is directed
angle into bladder

Slowly insert fluid into catheter and Slow and continous pressure dislodge pressure,
bladder clots and sediments

Withdraw syringe , remove clamp and allow solution

Allows to
drain by gravity
remain in bladder for ordered
time
Continue until ordered or until the
solution is clear

Closed continuous Prevents entry of micro-organisms

Apply gloves and using aseptic technique
insert sterile irrigation tubing into bag of
sterile irrigating solution

Close clamp on tubing and hang bag of

solution in IV pole

Open clamp and allow solution to flow Remove air from tubings
through tubing. Close clamp

Be sure that drainage tube and tubing are securely

Y- allows entry of solution
connected to double lumen or other arm of Y connector

Calculate the drip rate and adjust clamp, avoid kinks in even distribution
Ensures
continuous drainage.

In intermittent-clamp tubing on drainage system, open

Clamp regulates fluids
clamp on tubing, allow prescribed fluid to enter. Close
irrigation clamp, open drainage clamp.

When procedure completed dispose contaminated

Prevents spread of infection
supplies, remove gloves and perform hand hygiene.

Maintain I/O chart Maintains fluid balance

Record the procedure Promotes continuity of care