Male Catheterization

Objectives

• 1. Review the normal anatomy of the male genito-urinary system.

Skills Lab • 2. Identify a urinary bladder catheter (Foley catheter, Red Robinson) & its
parts.

• 3. Determine indications for bladder catheterization & drainage.

• 4. Determine contra-indications for bladder catheterization.
• 5. Identify equipment, materials & supplies needed for bladder
catheterization.

• 6. Demonstrate the procedures in catheter insertion, maintenance & removal

Materials and Equipment Anatomy

• Drapes
• Sterile lubricant
• French 16 foley catheter
• Red Robinson straight catheter
• Pair of sterile gloves
• Povidone iodine solution
• Topical lidocaine cream
• Cotton balls
• 10ml dis[posable needle
• 10ml sterila saline solution
• Plaster
• Urban

Parts of a urinary bladder catheter Indications

• a. for relief of acute urinary retention

• b. monitoring of urinary output in a critically ill or injured patient
• c. to obtain urine for diagnostic purposes
• d. for patients with a neurogenic bladder or mechanical inability to void
 Contraindications Procedure
Catheter Insertion
• a. lay all needed supplies, materials & equipment on a sterile eld
• a. suspicion of urethral trauma, of which a number of signs indicate injury • b. check Foley catheter balloon for leaks
• i. prostatic displacement on DRE • c. drape an eyesheet over the penis or spread a sterile towel below the
urethra
• ii. perineal hematoma
• iii. blood present in the urethral meatus • d. with the non-dominant hand, immobilize the penis and retract the foreskin
• b. pelvic fractures • e. with the dominant hand, cleanse the glans penis with cotton balls dipped in
povidone iodine solution

• f. lubricate the catheter tip with a sterile topical anesthetic or sterile lubricating
jelly

fi
Procedure Procedure
Catheter Insertion Catheter Removal
• g. insert the catheter gently into the urethra while applying gentle traction to the penis. • a. prepare materials & supplies on a sterile tray
An area of resistance is encountered as the catheter passes the prostate & into the
membranous urethra. Gentle continuous pressure of the catheter usually permits • b. drape an eyesheet over the penis or spread a sterile towel below the urethra
passage beyond this point with no di culty. Elevating the penis & retracting it superiorly
may further aid in passage of the catheter. • c. with the non-dominant hand, immobilize the penis
• h. pass the catheter well into the bladder up to level of Y-port to make sure catheter tip is • d. with the dominant hand, cleanse the glans penis & a few inches of the indwelling
in the bladder Foley catheter distal to the glans with cotton balls dipped in povidone iodine solution
• i. identify urine streaming out of the catheter • e. de ates the balloon with an empty syringe making sure that the rubber of the
in ation port has collapsed
• j. in ate the catheter balloon with 5 ml of saline
• k. pull the catheter gently forward & connect it to a sterile closed drainage system
• f. pull out the Foley catheter gently

• l. tape the catheter to the medial thigh of the patient to secure immobilization • g. wipe the glans penis with a sterile cloth
fl
ffi
fl
fl
Nasogastric Intubation Anatomy
Objectives
•1. Review the anatomy of the nose, pharynx & proximal alimentary tract
•2. Identify a nasogastric tube & its parts
•3. Determine indications for nasogastric intubation
•4. Determine equipment, materials & supplies needed for nasogastric intubation
•5. Demonstrate the following procedures
•- Nasogastric tube insertion
•-Nasogastric tube maintenance
•-How to irrigate a nasogastric tube
•-How to perform gastric lavage
•-Removing a nasogastric tube
The NGT and its parts
NGT Insertion
Procedure
• 1. Gather equipment
• 2. Don non-sterile gloves
• 3. Explain the procedure to the patient and show equipment
• 4. If possible, sit patient upright for optimal neck/stomach alignment
• 5. Examine nostrils for deformity/obstructions to determine best side for insertion
• 6. Measure tubing from bridge of nose to earlobe, then to the point halfway
between the end of the xiphoid process and umbilicus and mark it.
• 7. Mark measured length with a marker or note the distance
NGT Insertion
Procedure
• If resistance is met, rotate tube slowly with downward advancement toward
closes ear. Do not force entry of tube.
• 10. Withdraw tube immediately if changes occur in patient's respiratory
status, if tube coils in mouth, if the patient begins to cough or turns cyanotic.
• 11. Advance tube until mark is reached
Materials, Supplies and Equipment
• 1. nasogastric tube
• 2. lubricating jelly
• 3. clean, non-sterile gloves
• 4. bulb syringe
• 5. stethoscope
• 6. plaster
NGT Insertion
Procedure
• 8. Lubricate 2-4 inches of tube with lubricant (preferably 2%
Xylocaine). This procedure is very uncomfortable for many patients,
so a squirt of Xylocaine jelly in the nostril, and a spray of Xylocaine
to the back of the throat will help alleviate the discomfort.
• 9. Pass tube into anterior nasal opening pushing it gently to the
posterior nasal opening, then past the pharynx into the esophagus
and into the stomach.
• Instruct the patient to swallow (you may o er ice chips/water) and
advance the tube as the patient swallows. Swallowing of small sips
of water may enhance passage of tube into esophagus.
ff
NGT Insertion
Procedure
• 12. There are several ways of determining when the tube reaches the
stomach. First, the tube has marks, usually three, which indicate when the tip
has reached the esophagogastric junction, antrum, and pylorus, but this is not
the best guide because patients vary in size and tubes may coil within the
esophagus. Another method is to inject 10cc of air into the tube while a
stethoscope is placed over the left upper quadrant to detect the resultant
sounds. However, the most useful method by far is the aspiration of gastric
juice by attaching syringe to free end of the tube, aspirate sample of gastric
contents. Test the pH of the aspirated contents to ensure that the contents
are acidic. The pH should be below 6. Obtain an x-ray to verify placement
before instilling any feedings/medications or if you have concerns about the
placement of the tube.
NGT Insertion NGT Removal
Procedure
• 1. Explain to patient the procedure
• 13. Secure tube to nose with a plaster or commercially prepared tube holder • 2. Don clean, non-sterile gloves
• 14. If for suction, remove syringe from free end of tube; connect to suction; • 3. Remove anchoring tape from nose
set machine on type of suction and pressure as prescribed.
• 4. Fold or clamp tube so gastric contents in tube won't be aspirated upon
• 15. Document the reason for the tube insertion, type & size of tube, the nature withdrawal of tube
and amount of aspirate, the type of suction and pressure setting if for suction,
the nature and amount of drainage, and the e ectiveness of the intervention. • 5. Slowly withdraw tube from nose until all its length has been pulled out.
• 6. Discard NGI
• 7. Wipe patients nose with a clean tissue paper.
ff
Complications of NGT Insertion Digital Rectal Exam
• 1. mucosal ulceration
• 2. sinusitis
• 3. esophageal stricture • Should be performed on most
patients with abdominal pain and any
• 4. laryngeal obstruction concern for blood loss
• 5. otitis media
• 6. rupture of esophageal varices • Risks for prostate and rectal
carcinoma
• 7. inability to remove the tube
• 8. tracheo-esophageal stula • To check patients with spinal cord
• 9. esophageal perforation injury on the resolution of spinal
shock
• 10. insertion of NGT into submucosa of posterior pharynx
• 11. passage of NGT intracranially
• 12. nasal hemorrhage
fi
Technique Lateral Decubitus Position
Positions
Procedure