 MUNI UNIVERSITY

 FACULTY OF HEALTH SCIENCE

 DEPARTMENT OF NURSING AND MIDWIFERY
 ADVAANCED CLINICAL NURSING
 CU:5
 NAME: OGERNRWOTH VICTOR
 SUPERVISOR:MRS.AKAO GRACE

 CONTACT.0772594948
 STUDENT NUMBER 2001200677
 EMAIL;2001200677@muni.ac.ug
URINE ELIMINATION/BLADDER
IRIGATION
 OBJECTIVES
 By the end of this lecture
 Learners should be able define urinal, bladder irrigation and catheterization.
 Demonstrate and illustrate giving and removal of urinal
 Understand the indications, and steps in bladder irrigation
 Explain the indications and illustrate catheterization
Meeting patients for urine elimination
GIVING URINAL

 Urinal is a vessel for receiving urine

INDICATIONS

 Used in patient who find it difficult to get out of bed

 TYPES
 Bowel
 trough
Troughs and urinal
EQUIPMENTS

 Urinal with end cover( usually attached)

 Toilet tissue
 Clean gloves
 Additional PPE like aproans,gloves,etc
Procedure for giving urinals

 Review the patient’s chart for any limitation in physical activities

 Bring urinal and other necessary equipment to the bed side stand or over bed table
 Perform hand hygiene and put on PPE if indicated
 Identify the patient
 Provide privacy
 Discuss the procedure with the patient and assess the patient’s ability to assist
with the procedure as well as possible hygiene preferences
 Put on gloves
Cont.

 Assist the patient tom an appropriate position as necessary eg standing on bed

side, lying on one side or back
 Cover the patient with the sheet
Removing the urinal

 Perform hand hygiene, put on gloves and additional PPE.

 Pull back the patient’s bed linen just enough to remove the urinal
 Remove the urinal and cover the open end
 Place urinal on the bed chair, if possible
 Return the patient to a comfortable position
 Make sure the linens under the patient is covered and dry
 Ensure the call bell is in bench
 Offer patient supplies to wash and dry his hands assisting as necessary
Cont.

 Put on clean gloves, empty and clean the urinal, measuring the urine in graduated
container as necessary
 Discard trash receptacle with used toilet paper per facility policy
 remove gloves and additional PPE if used and perform hand hygiene
 Document the patient’s tolerance of activities, record the amount of urine voided
on the intake output record, if possible record other unusual character or alteration
in patient’s skin
Bladder irrigation/flash out

 This is the procedure used for instilling of a solution into a bladder to provide
cleansing or medication
 It requires strict aseptic technique through out the procedure to minimize
contamination and subsequent development of a urinary UTI
cont.
INDICATION

 Acute urinary retention

 Chronic obstruction that cause Hydronephrosis
 Hygienic care of bed ridden patients
 Intermittent decompression of neurogenic bladder
Types of catheters

 Indwelling catheter

 External catheter (condom catheter)

 Short term catheters (intermittent catheters)
Hazards of bladder irrigation

 Urinary tract infection

 Tissue trauma
 Urethral irritation
 Bladder spasms
Preparation

 Use strict aseptic technique if intermittent irrigation is ordered

 Medication may be added to irrigation solution
 Isotonic irrigation solution are used
 Check prescribers order to determine if it’s a continuous or intermittent irrigation
Special consideration

 Assess bladder for distension because clots can occur

 Assess patient for LAP or cramping
 Perform manual irrigation as needed to remove clots reestablish irrigation flow
 If resistance is met during manual irrigation do not force irrigation fluids. Notify
the prescriber .
 Paedriatics,elderly,and mentally may need closer monitoring because the may not
be able to communicate effectively
Equipments

 Clean gloves
 Three way Foley catheter with drainage bag in place
 Warmed or room temperature sterile irrigation solution.
 Sterile infusion tubing
 Iv pole
Procedure for irrigation

 Review prescriber’s orders and obtain prescribed irrigation solution from

pharmacy,(unless solution is in place at bedside
 Place label on irrigation bag if not labeled include all patient’s details
Including date,time,room number, type of solution.
Gather all equipment's
Check patients identification band
Explain procedure and its purpose to patients and provide privacy
Organize equipments within easy reach and drape patients, expose only the access to
irrigation part
Cont.

 Don clean gloves and empty and empty, measure urine present in drainage bag
discard urine and gloves in appropriate receptacle
 Wash hands
 Hang irrigation bag on irrigation pole 24 to 36 inches above bladder
 Connect infusion bladder to irrigation solution. Prime drip chamber and flush
tubing with solution.
 Close infusion tube clamp and connect infusion tubing to irrigation port on the
three way catheter
Cont.

 Open flow clamp on urinary drainage bag

 Open flow clamp on infusion tubing and adjust the prescribed hourly rate
 Change or add irrigation as needed
 Maintaining aseptic technique
 Change infusion tubing every 24hours to 48hours
 Monitor urine output hourly as ordered, subtracting the amount of irrigant from
the total output from drainage bag
 Assess drainage bag frequently and empty as needed
 Assess color, clarity odor, and other characteristics of urinary output during
irrigation process and each time drainage bag is emptied
 Discard gloves and urine in appropriate receptacle
Catheterization `

 Indication for catheterization

 Relieving urinary retention
 Obtaining a sterile urinary specimen
 Emptying the bladder before,during,after procedures
 Monitoring renal function or critically ill patient
 Increasing comfort for terminally ill patient
 Incase of incontinence
 To measure the amount of residual urine
Equipments

 Top shelves
 2 towels
 1 drape
 2 Receiver
 Gauze swabs
 Cotton wool swabs
 2 galli pots
  Bottom
 Top shelves  2 Foley catheters of required sizes
 2 towels  Sterile ky Kelly
 1 drape  Antiseptic solution
 2 Receiver  3 receiver
 Gauze swabs  Spigot and drainage bag
 Cotton wool swabs  Sterile surgical gloves
 2 galli pots  20mls syringe and needles
 Specimen bottle
Catheterization equipments cont.

 Bottom  Bed side

 Plastic aprons  Screen
 Dressing mackintosh/towel  Hand washing equipment
 Sterile water  Basin
 Fluid balance chart  Soap
 Strapping  Hand towel
 Measuring jar
Steps in catheterization

 Identify the patient

 Discuss the procedure and his/her ability to assist
 Discuss any allergies with Patients especially iodine and latex
 Review the chart for any limitation in physical activity
 Bring the catheter kit and other necessary to the bed side
 Obtain an assistance
 Perform hand hygiene
 Provide privacy
 Provide for good light
Cont.

 Place a trash receptacles within easy reach

 Raise the bed within the comfortable working height
 Stand on the patients right if your right handed
 Assist the patient to the dorsal recumbent with knee flexed, feet about 2 feet apart
with legs abducted
 Open sterile catheterization tray on a clean over bed table using sterile technique
 Put on sterile gloves
 Grasp upper corners of the drape and unfold the drape with touching unsterile
areas
Cont.

 Place the sterile drape over the perennial areas.

 place the sterile receiver on the drape between the patient’s thigh
 Lubricate the end of the catheter without contamination
 Place the end of the catheter in the receiver using right glove and insert the
lubricated end gently into the urethra 4-5cm deep
 Collect urine without bottle touching the catheter allow 30-40mls
 Baloon the catheter with 15-20mls of sterile water
 Assist open the urinary bag and plaace on sterile surface
 Fix the catheter at inner aspect of the thigh with strapping
 Thank the patient and put her in a comfortable position
 Clear the trolley and screen
 Observe the urine for color,smell,and deposits, odor and specific gravity
 Document the procedure
Complication for catheterization

 UTI
 Urethral bleeding
 Urethral stricture
 Bladder stones
References

 Clinical nursing skills seventh edition by Sandra F.,Smith, Donna J.