Catheterization

Introduction
• Urinary catheterization is the placement of a tube through the
urethra into the bladder to drain urine.
• This is an invasive procedure that requires a medical order and aseptic
technique in institutional settings
• It may be short term (2 weeks or less) or long term (more than 1
month).
Cont..
• The steps for inserting an indwelling and a single-use
straight/intermittent catheter are the same.
• The difference lies in the inflation of a balloon to keep the indwelling
catheter in place and the presence of a closed drainage system.
Cont..
Indications for urinary catheters include:
• Perioperative use in selected surgeries
• Acute urinary retention or obstruction
• Hospice/comfort care/palliative care
• Accurate measurement of urinary output in critically ill patients
• Required strict immobilization for trauma or surgery
• Assistance in healing of severe perineal and sacral wounds in
incontinent patients
Types of catheter
Indwelling Catheters/ Foley catheter
• This type of catheter has to be inserted into the bladder through the
urethra or tiny hole in the abdomen. A tiny water-filled balloon at the
end of the catheter prevents the tube from sliding out of the body.
These are further categorized as: two way and three way catheter.
• Examples: urethral or suprapubic catheters
Cont..
External Catheter
• Patients who don’t have a urinary problem, but are facing from
dementia can use External Catheter. As the name suggests external,
they are placed outside the body. It is a condom-like device that
covers the penis head. It has lower risk as compared to Indwelling
catheters. But they need to be changed daily.
• Example: Condom Catheter
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Intermittent Catheter
• Post-surgery when the patient’s bladder is not performing well it can
be emptied using this short term catheter. After the bladder starts
performing catheter has to be removed.
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• Straight catheter: is used when catheter is to be used and removed
immediately.
• Condom catheter: consists of soft plastic or rubber sheath, tubing,
and a collection for a bag of urine. The sheath is placed over the penis
and the collection bag is attached to the leg.
• Suprapubic catheter: is a type of indwelling catheter. It is inserted
into the bladder through a surgical incision made in the abdominal
wall, right above the pubic bone.
 Straight catheter
2 way foley

Condom catheter
3 way foley
Urinary catheter sizes
• The French scale is used to decide the size of the catheters.
Procedure
Articles
• Screen
• Disposable gloves
• Rubber mackintosh or draw sheet
• Kidney tray
• Towel
• Antiseptic solution
• Distilled water
• Adhesive tape and scissors(in case of retention catheter)
• Specimen container if required
• Water soluble lubricant ( xylocaine jelly)
• Flash light or spot light
• Bath blanket
• Uro-bag or collection bag
Cont..
A sterile tray containing:
I. Sterile gloves
II. Sterile drape
III. Small bowl
IV. Cotton swabs
V. Catheter
VI. Kidney tray
VII. Artery forceps
VIII. Dissecting forceps
IX. Sterile syringe 10 or 20 ml and distilled water (in case if retention
catheter)
 Procedure for catheterization (for women)
• Review the physicians order.
• Identify the patient and assess the status of patient
• Explain the procedure to the patient emphasizing how he/she to co-operate.
• It reduces anxiety and promotes cooperation which ensures smooth insertion
of the catheter.
• Wash hands with soaps and water.
• Prepare all required equipment.
• Maintain privacy by screen.
• Raise bed to appropriate working level, stand on right side of patient and shift
patient closes to you.
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• Position patient, dorsal recumbent with knees flexes, and thighs
externally rotated.
• Drape the patient in the dorsal recumbent position with draw sheet
or blanket up to the level of thigh.
• Place mackintosh and draw sheet under the hip and put kidney tray in
convenient area.
• Open the sterile tray pour, antiseptic solution into bowl, open outer
cover of catheter and place in tray if prepackaged.
• Open lubricant, squeeze and discard first drop and after that drop
some on sterile guaze in the tray.
Cont..
• Wash and dry hands. Wear sterile gloves.
• Place the perineal sheet over genital area.
• Place the kidney tray to receive sterile urine specimens and sterile
bottle within reach if necessary.
• Separate labia minora with two fingers (thumb and index) of the left
hand using sponges to expose meatus.
• Take cotton balls in the right hand and swab the area right of the
meatus, with downward stroke once and discard it in the kidney
basin.
cont..
• Then take another cotton ball, clean the area left of the meatus, take the
third and fourth balls and clean directly over the meatus from top to
bottom, use more cotton balls if necessary.
• With gauze in the right hand, grasp the catheter, with 9-10 cm from the tip
pinching after the outlet.
• Moisten the tip with sterile glycerin or paraffin oil or water carefully. So as
not to contaminate the tip.
• Insert 4-5cm of the catheter gently into the meatus until urine flows freely.
• When urine starts to flow, hold the catheter in place with the left hand to
prevent the catheter from slipping out.
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• If sterile specimen is ordered, lower the distal end of the catheter into a
kidney tray. Discard first few cc of urine, and then collect urine into the
specimen bottle.
• Collect 120-180 cc or as required. Then direct the flow into the kidney tray.
• When urine ceases to flow pinch the catheter well and withdraw it gently.
If continual drainage is needed, attach a urinary bag to the distal end and
fix the catheter in place.
• Push 15 to 20 ml distilled water in another tip of the catheter for fixing.
• Pull catheter outward lightly to ascertain stability.
• Connect catheter to uro-bag tied to bed below level of bladder.
Cont..
• Fix catheter to thigh using adhesive tapes. Ensure adequate length to
avoid traction.
• Place the patient in comfortable position.
• Collect all equipment.
• Measure urine before discarding it, note color, odour, sediment etc.
• In utility room, clean equipment first with soap and water, dry and
return it to the central supply for re-sterilization.
• Record and report the following things about the procedure.
Catheterization in men
• Review the physicians order.
• Identify the patient and assess the status of patient
• Explain the procedure to the patient emphasizing how he/she to
coperate.
• It reduces anxiety and promotes cooperation which ensures smooth
insertion of the catheter.
• Wash hands with soaps and water
• Prepare all required equipment.
• Maintain privacy by screen.
Cont..
• Raise bed to appropriate working level, stand on right side of patient
and shift patient closes to you.
• Position patient (supine position with legs extended in flat bed).
• Place mackintosh and draw sheet under the hip and put kidney tray in
convenient area.
• Drape the patient in supine position with draw sheet or blanket up to
the level of thigh.
• Open the sterile tray pour antiseptic solution into bowl.
Cont..
• Open lubricant, squeeze and discard first drop and after that drop
some on sterile gauze in the tray.
• Wash and dry hands. Wear sterile gloves.
• Place the perineal sheet over genital area. Place the kidney tray to
receive sterile urine specimens and sterile bottle within reach if
necessary.
• Lift the penis to a position perpendicular to patient’s body and apply
light upward traction (with non- dominant hand) (lift the penis to
angle of about 60 degree in order to straighten the urethra.)
Cont..
• Retract the fore skin of the penis so that the meatus in exposed; clean
the area with antiseptic solution using forceps to hold cleansing
sponges, use one swab for each wipe.
• With gauze in the right hand, grasp the catheter, with 15-25 cm from
the tip pinching after the outlet. Moisten the tip with sterile glycerin
or paraffin oil or water carefully, so as not to contaminate the tip.
• Insert the catheter gently for about 15-25 cm or until begins to flow.
The size of the catheter and length of insertion and determined for
the individuals patients separately.
Cont..
• If the passage seems to be obstructed, remove the catheter and
report this to the doctor. Do not use force. Never use metal catheter.
• When urine begins to flow, advance the catheter another 1 inch.
• Allow the bladder empty completely as instructed.
• When urine ceases to flow pinch the catheter well and withdraw it
gently and reduce or reposition the foreskin.
• If continual drainage is needed, push 15 to 20 ml distilled water in
another tip of the catheter for fixing.
Cont..
• Pull catheter outward lightly to ascertain stability and attach a urinary
bag to the distal end and fix the catheter in place.
• Clean and dry the patient and leave him comfortable.
• Measure urine before discarding it, note color, odor, sediment, etc.
• Replace the equipment in proper place after decontaminating and
cleansing.
• Record and report in the patient’s chart.
Care of Patient with an Indwelling Catheter
• In caring for a patient with an indwelling catheter, the main goal is to
prevent infection of the urinary tract.
Purposes
• To prevent urinary obstruction.
• To prevent ascending infection.
• To make free flow of urine.
• To make comfort to the patient.
Prevention of Ascending Infection
• Wash hands before and after caring for a patient with an indwelling catheter.
• Must use sterile technique to change and care bag and tube.
• Give or help the patient with perineal hygiene twice a day and after each defecation.
• Clean the perineal area thoroughly, especially around the meatus, daily and after each
bowel movement.
• The best way to prevent infection, encourage patient to drink a lot of fluid everyday
up to three litters. Drinking a lot to produces a lot of urine which keeps the bladder
flushed out and stops sediment from sticking in the catheter.
• Teach the patient the importance of personal hygiene.
• Ensure that each client has a separate receptacle for measuring urine to prevent cross
contamination.
Maintaining Drainage
• Note the volume and character of urine and record observations carefully.
• Avoid prolonged clamping or kinking of tubing.
• Remind the patient never to lie on the tubing and to check it to make sure there
are no bends in the tube.
• Prevent pooling and reflex of urine into the bladder by following measures.
Keep the drainage bag below the level of the bladder. If needed, need to clamp
the catheter.
Not allow to fill up drainage bag.
Drain all urine from the tube into the bag before the client exercise or ambulates.
While changing position or bed making, drainage bag should be clamped
Cont..
• Empty the drainage bag at least every 8 hours.
• Disconnect drainage bag from catheter only with clean hands.
• If sediment gathers in the tubing or drainage bag or if there is a leak,
you need change the tube and bag.
• Frequent irrigation may be ordered when a blood clot or other debris
threatens to bleed the catheter.
• Change catheters only as necessary. The interval between catheter
changes varies and should be individualized for the patient based on
the clinical symptoms:
catheter encrustations, leakage, bleeding and catheter associated UTIs.