Urinary

Interventions

By: Nursing Skills Laboratory Group

1
2
Female Urinary System

3
Female Reproductive Organ

4
Male Urinary System

5
Male Reproductive Organ

6
Terminologies
• Urinary Continence – control of
elimination of urine
• Urinary Incontinence – is the inability
to control urinary elimination
• Urinary Retention - is the inability to
urinate or individual experiences
incomplete emptying of the bladder

7
• Urinary Hesitancy – decrease in the force of the
stream of urine, often with difficulty in the
beginning the flow; may be a result of obstruction
or stricture
• Urinary Frequency- frequent urination without
increase in total daily volume of urine
• Urinary Urgency – sudden strong desire to void
that can usually be controlled; caused by irritation
of the lower urinary tract, inflammation, calculi,
bladder cancer, neurogenic bladder

8
• Dysuria – burning sensation on
initiation of, during or at the end of
urination caused by infection and
inflammation
• Hematuria – “bloody urine”
• Pyuria – pus in the urine caused by
infection
• Nocturia – excess urination during night

9
 Characteristics of Urine
• Color – straw-colored, light yellow
or amber
• Odor – urea like odor
• Specific gravity – 1.003 to 1.035
• pH – 4.6 to 8 (slightly acidic)

10
Normal constituents of Urine:

• Water • uric acid (0.3g/L)

• Urea(92g/L) • organic salts
• Na (3.0g/L) • pigment urobilirubin
• K (1.5g/L) • creatinine (0.7g/L)
• Cl (6.0g/L) • sulfate (1.0g/L)
• phosphate (1.0g/L) (Note : No glucose and protein
contents in urine)

11
Urinary Catheterization

• It involves introduction of a rubber or

plastic tube through the urethra into
the bladder
• It is an insertion of a catheter or tube
into the bladder to remove urine
• The catheters have balloon at the distal
end that is inflated after insertion

12
• This procedure is performed for urinary
obstruction, following surgical procedures
to the urethra, in unconscious patients (due
to surgical anesthesia, coma, etc.), or for
any other problem in which the bladder
needs to be kept empty (decompressed) and
urinary flow assured.
• Catheterization in males is slightly more
difficult and uncomfortable than in females
because of the longer urethra.

13
Types of Urinary Catheterization
Intermittent or Straight
Catheterization
• Uses straight catheters placed at the
bladder for short periods of time (5 to 10
minutes)
Indwelling or Retention
Catheterization
• Uses foley catheters placed into the bladder
for extended periods of time
14
Purposes
• To relieve acute and chronic urinary retention
• To empty bladder before, during and after surgery
or before certain diagnostic procedures
• To determine amount of residual urine after
voiding
• To measure accurately the hourly urine output of
critically ill patients
• To instill medications into the bladder
• To obtain urine specimen for diagnostic purposes

15
Equipment
• Sterile catheter kit : sterile gloves, drapes,
catheter, antiseptic solution, lubricant, cotton
balls or gauze squares, forceps, pre-filled syringe,
basin and specimen container
• Flashlight or floor lamp
• Waterproof disposable pad
• Disposable urine collecting bag and drainage
tubings
• Disposable gloves

16
Sterile Catheter Kit

17
Catheters and Bag

18
19
20
21
 Female
Catheterization

22
Female Reproductive Organ

shamie0809 23
External Female Genitalia

24
 Remember CUVA before you enter !
(clitoris, Urethral orifice, Vaginal orifice and
Anus)

25
Female Urinary Catheterization

26
 Assessment

• Assess bladder fullness before performing.

• Ask client regarding allergies (latex and
iodine)
• Ask for history of previous catheterization.
The length of catheterization may have lead
to urinary strictures that poses difficulty of
insertion

27
 Nursing
Implementation

28
1. Assemble equipment. Perform hand hygiene .
Explain the skill and its purpose to patient.
Discuss any allergies to patient, especially to
iodine and latex.
2. Provide for good light. Artificial light is
recommended.
3. Provide for privacy.
4. Assists patient to dorsal recumbent position
with knees flexed and feet about 2 feet apart.
Drape patient. Or if preferable, place patient
in side-lying position. Slide water proof drape
under the patient.

29
5. Don gloves. Spread labia well with fingers
and clean area at vaginal orifice with
washcloth and warm water, using a
different corner of the washcloth with each
stroke. Wipe from above the orifice
downward toward the sacrum (front to
back). Rinse and dry. Remove gloves.
Perform hand hygiene again.
6. Prepare urine drainage set-up if indwelling
is to be inserted and is a separate urine
collection system is to be used.
30
7. Open sterile catheterization tray on clean
overbed table using sterile technique.
8. Put on sterile gloves. Grasp upper corners
of drape and unfold drape without
touching unsterile areas. Fold back corner
on each side to make a cuff over gloved
hands. Ask the patient to lift her buttocks
and slide sterile drape under her with
gloves protected by cuff.
9. A fenestrated sterile drape may be placed
over the perineal area exposing the labia.

31
10. Placed sterile tray on drape between the patient’s
thigh.
11. Open all supplies: (sterile Cath kit)
• If catheter is to be indwelling, test the catheter
balloon. Remove the protective cap on the tip of
the syringe and prefilled with sterile water to
the injection port. Inject appropriate amount of
fluid. If balloon inflates properly withdraw
fluid .
• Fluff cotton balls in tray before pouring
antiseptic solution over them. Open specimen
container if specimen has to be obtained.
• Lubricate 1 to 2 inches of the catheter tip.
32
12. With thumb and one finger at non-dominant
hand, spread labia and identify meatus. Be
prepared to maintain separation of labia with
one hand until catheter is inserted and urine is
flowing well and continuously.
13. With uncontaminated gloved hand, placed
drainage end of the catheter in receptacle. For an
insertion of an indwelling catheter that is pre-
attached to sterile tubing and drainage container,
position the catheter and set-up within easy reach
on sterile field. Ensure that clamp on drainage
bag is closed.

33
14. Insert catheter tip into meatus 5-7.5 cm (2”-3”) or
until urine flows. Do not force catheter through
urethra into bladder. Ask patient to breathe deeply,
& rotate catheter gently if slight resistance is met as
catheter reaches external sphincter. For an
indwelling catheter, once urine drains, advance
catheter another 2.5 to 5 cm (1”- 2”).
15. Hold catheter securely with non-dominant hand
while bladder empties. Collect a specimen if
required; specimen should be caught in middle of the
flow. After 50-100ml of urine has drained, placed the
specimen collection device under opening of catheter
and allow urine to drain into the container.

34
When enough urine has been caught , remove
specimen container. Continue drainage
accordingly to agency policy. Remove
catheter smoothly an slowly if a straight
catheterization was ordered. If catheter is to
be indwelling:
• Inflate the balloon according to
manufacturer’s recommendations.
• Tug gently on catheter after balloon is
inflated to feel resistance.

35
• Attach catheter to drainage system if
necessary.
• Secure to lower thigh with tape. Leave
some slack in catheter for leg movement
• Check that drainage tubing is not
kinked and that movement of side rails
does not interfere with catheter or
drainage bag.

36
16. Remove the equipment and make patient
comfortable in bed. Send urine specimen o
the laboratory promptly.
17. Perform perineal care.
18. Remove gloves from inside out. Perform
hand hygiene.
19. Record time of catheterization, size of
catheter, amount of urine, removed urine
appearance, whether a specimen was sent,
and the patient’s reaction in the medical
record. Document also in the I and O sheet.

37
3. No immediate flow of urine after insertion.
- Have client to take a deep breath, w/c helps
her relax the perineal and abdominal
muscles
- Rotate the catheter slightly, because the
drainage hole may be resting on the bladder
wall.
- Raise the head of the patient’s bed to
increase pressure in the bladder area

38
 Male
Catheterization

39
Male Reproductive Organ

40
41
42
 Nursing
Implementation

43
5. Place catheter set on or next to patient’s leg on
sterile drape.
6. Open all supplies: (Sterile Cath Kit)
• If catheter is to be indwelling, test the catheter
balloon. Remove the protective cap on the tip
of the syringe and pre-filled with sterile water
to the injection port. Inject appropriate
amount of fluid. If balloon inflates properly
withdraw fluid and leave syringe attached to
port.
• Fluff cotton balls in tray before pouring
antiseptic solution over them. Open specimen
container if specimen has to be obtained.
• Remove cap from syringe pre-filled with
lubricant
44
7. Lift penis with non dominant hand, which is then
considered contaminated. Retract foreskin in
uncircumcised patient. Clean area at the meatus.
With cotton ball held with a forceps. Use circular
motion , moving from meatus towards the base of
the penis for three cleansing.
8. Hold penis with slight outward tension and
perpendicular to patient’s body. Gently insert the
tip of the syringe with lubricant into the urethra
and instill the 10ml lubricant. If the kit does not
have a pre-filled syringe, lubricant catheter tip.

45
9. With dominant hand, placed drainage
end of catheter in receptacle. For
insertion of an indwelling catheter that
is pre-attached to sterile tubing and a
drainage container, position catheter
and set up with an easy reach on
sterile field. Ensure that the clamp on
drainage bag is closed.

46
11. Ask patient to bear down as if voiding.
Insert tip into the meatus. Advance
catheter 15-20cm (6-8inches) or until
urine flows. Do not use force to introduce
catheter. If catheter resists entry, ask
patient to breathe deeply and rotate
catheter slightly . For indwelling catheter
to bifurcation of catheter. Once balloon is
inflated, catheter may be gently pulled
back into place. Replace foreskin over the
catheter. Lower penis.
47
12. Follow actions 16 to 20 for female catheterization,
except that the catheter may be secured to the upper
thigh or lower abdomen with the penis directed toward
patient’s chest. Leave enough slack in catheter to
prevent tension.
13. Remove gloves from inside out. Perform hand hygiene.
14. Record time of catheterization, catheter and balloon
size , amount of urine removed, urine appearance,
whether a specimen was sent, and patient’s reaction to
the procedure in the medical record. Also document
urine amount on the I and O flow sheet.

48
Unexpected Situations
1. Nurse cannot insert catheter past 3-4” ,
and rotating the catheter and having
patient breath deeply are of no help.
- Refer to physician
- Attempts may traumatized the
urethra

49
2. Patient is obese or with retracted
penis.
- Have an assistant available to hold
the patient’s penis up and back.
Catheter is inserted up to the
bifurcation.

50
Constant Bladder
Irrigation
(Cystoclysis)

51
Continuous Bladder Irrigation

52
53
Indwelling catheter
(Urethral or Supra-pubic catheter)

• Used to facilitate urinary drainage after

all types of prostatectomies
(transurethral (TURPs), suprapubic,
retropubic and perineal)
• Closed irrigation permits either constant
or intermittent irrigation without the
hazard of breaking aseptic techniques.

54
• Isotonic irrigating fluid for
intermittent irrigation
incorporating small amounts, or for
continuous irrigation , enough to
maintain outflow of clear to slight
pink urine.
• The fluid must be isotonic because
water could lead to depletion of
electrolytes or water intoxication.
55
• Frequent assessment of the drainage
from the catheter. Keep accurate
records of I and O.
• May stay in place for at least 2-3 days
(simple TURP) or 12-14days until drain
is clear.
• Dribbling up to 3 mos. post TURP
among older men is not unusual.

56
57