Urinary Catheterization Procedure Female Ppt

How Should I Prepare For Self

Your healthcare provider will show you how to perform self-catheterization. The process gets easier with practice. Before performing self-catheterization, you should:

• Try to urinate the regular way.
• Wash your hands with soap and water.
• Wash your genitals with soap and water or an antiseptic towelette. This step lowers infection risk.
• Remove the catheter from its package being careful to keep it very clean.
• Apply a water-based lubricant on the tip and top two inches of the insertion end of the catheter if needed. Some catheters come pre-lubricated.

Presentation On Theme: Urinary Bladder Catheterization Presentation Transcript:

1 Urinary Bladder Catheterization

2 DefinitionInvasive aseptic or sterile procedure where a flexible draining tube is placed through the urethra into the bladder to empty the patients bladder of urineConsiderationsPatient may be asked to urinate prior to procedurePatient may arrive to the OR with a catheter in placeCatheter may be left in or changedWill be placed pre-operatively and remain in place post-operatively

3 Types of Catheters Robinson or Rob-nel used for one time emptying prior to procedureis a straight less flexible catheterIndwelling Foley used if surgeon wants bladder to be drained continuously during surgeryCarson-Coude tip of catheter slightly bent to aid in passing through an obstructed urethra Supra-pubic/Mushroom catheter

9 Catheter Materials Consider types of materials catheters are made of:Latex rubberPolyvinyl chloride Silicone

10 Types of Drainage SystemsGravity bagUrimeterSterile container

11 Purpose To empty or decompress the bladder during a surgical procedureDrain urine from the bladderObtain a sterile urine specimen for lab analysis

12 Reasons for CatheterizationPelvic surgeryGenitourinary system surgerySpinal or epidural anesthesiaSurgery expected to last more than 2 hoursPatient having difficulty urinatingPatient unconscious

14 Procedure Identify self if patient alert/awake Identify patientExplain procedure if patient awake/alertKNOW allergy status Know where alternatives are

25 SummaryCatheterizationPurposeConsiderationsMaleFemale

Slide 1: Securing Drainage Bag

• Advance tubing another 3-5 cm once you see urine in the tubing
• Inflate balloon with 10 cc sterile water

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Filiform And Follower Catheters

In patients with severe urethral strictures or urethral folds, it may be impossible to pass a Foley catheter or a coudé catheter. The next step in the progression to catheterize the bladder is to use filiform and follower catheters. Filiforms are very narrow, flexible, and solid catheters. Their sole function is to successfully negotiate a strictured urethral segment and enter the bladder. The distal end of the filiform catheter may be straight or pig-tailed and are available in a variety of sizes . The proximal end of the filiform catheter is a standard size and contains a metal female connector . The followers are flexible, hollow catheters that attach to the filiform catheters. The distal end of the follower catheter contains a metal male connector, to attach to the proximal end of the filiform catheter, and a hole to allow urine to enter the catheter . The follower catheters come in a variety of sizes and allow the physician to dilate the urethra and catheterize the bladder. The proximal end of the follower catheter is open and accepts a Christmas tree adaptor .

Photographs of the ends of the filiform and follower catheters. A. Distal ends of the filiform catheter. B. Proximal ends of the filiform catheter. C. Distal ends of the follower catheter. D. Proximal ends of the follower catheter.

Slide : Indwelling Urinary Catheters1

Images: Figure l. Routes of entry of uropathogens to catheterized urinary tract.An image depicts the male and female lower urinary tract system, and the difference in placement of a catheter in the bladder.

Source: Maki DG, Tambyah PA. Engineering out the risk of infection with urinary catheters. Emerg Infect Dis. 2001 Mar-Apr 7:342-7.*CMS, State Operations Manual, 2014.

1. Maki DG, Tambyah PA. Engineering out the risk for infection with urinary catheters. Emerg Infect Dis. 2001 7:342-7. PMID: 11294737.

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When To Seek Medical Advice

You should contact a district nurse or nurse practitioner or your GP if:

• you develop severe or persistent bladder spasms
• your catheter is blocked, or urine is leaking around the edges
• you have persistent blood in your urine, or are passing large clots
• you have symptoms of a UTI, such as pain, a high temperature and chills
• your catheter falls out

If your catheter falls out and you cant contact a doctor or nurse immediately, go to your nearest accident and emergency department.

When Should You Contact Your Healthcare Provider About Your Urine Drainage Bag

Contact your healthcare provider if you have:

• Cloudy, foul-smelling urine.
• Red or pink urine, mean that there is blood in the urine.
• A fever greater than 101 degrees Fahrenheit.
• Pain or burning in your urethra, bladder or lower back.
• Swelling, draining, or redness in your urethra .

You should also contact your healthcare provider if no urine has drained from your catheter in six to eight hours or if your catheter is leaking.

Symptoms of a urinary tract infection may include:

• A need to urinate often.
• A painful, burning feeling in the area of the bladder or urethra while you are urinating.
• Nausea or vomiting.

You may also feel bad all over â tired, shaky, washed out âand feel pain even when you are not urinating. The urine itself may look milky or cloudy or even reddish if blood is present.

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Catheter Types And Sizes

Catheter sizes and types are as follows :

• Adults – Foley catheter

• Adult males with obstruction at the prostate – Coudé tip

• Adults with gross hematuria – Foley catheter or 3-way irrigation catheter

• Children – Foley to determine size, divide child’s age by 2 and then add 8

• Infants younger than 6 months – Feeding tube with tape

  Urethral catheter types: 1) Straight tip 2) Coude tip 3) 3-way catheter irrigation.

Catheter materials include the following:

Place the patient supine, in the frogleg position, with knees flexed.

Explain the procedure, benefits, risks, complications, and alternatives to the patient or the patient’s representative.

Position the patient supine, in bed, and uncover the genitalia.

Open the catheter tray and place it on the gurney in between the patients legs use the sterile package as an extended sterile field. Open the iodine/chlorhexidine preparatory solution and pour it onto the sterile cotton balls. Open a sterile lidocaine 2% lubricant with applicator or a 10-mL syringe and sterile 2% lidocaine gel and place them on the sterile field. See the image below.

Using a syringe with no needle, instill 5-10 mL of lidocaine gel 2% into the urethra. Place a finger on the meatus to help prevent spillage of the anesthetic lubricant. Allow 2-3 minutes before proceeding with the urethral catheterization. See the video below.

Difficulty Removing A Catheter

A less common complication is difficulty removing an indwelling urethral catheter that has an inflated cuff. Ensure that the catheter is not clamped or kinked. This can compress the cuff inflation lumen. A vacuum may have formed in the inflation lumen causing it to collapse. Attach a syringe without the plunger to the inflation port and release the vacuum followed by aspiration to deflate the balloon. Gently turn the catheter clockwise and counterclockwise as the catheter may be compressed, kinked, or twisted. Gently advance the catheter further into the bladder and attempt to deflate the balloon. Gently inject 2 to 3 mL of sterile saline through the inflation port to open the inflation lumen or unclog it. Inspection of the valve sometimes reveals the problem. One may attempt to cut proximal to the valve in hopes of evacuating the cuff contents but this is not always successful.

Place the longitudinally oriented US probe in the suprapubic area and move it from side to side to locate the largest bladder dimension. To deflate a Foley catheter balloon, make sure there is sufficient fluid in the bladder. If necessary, fill the bladder with enough sterile saline through the Foley catheter to make the bladder easily visible on ultrasound. Clamp the Foley catheter to retain the saline within the bladder. Instruct an assistant to apply gentle traction to the external portion of the Foley catheter to fix the balloon against the bladder neck.

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Slide : Hygiene And Standard Precautionscatheter Insertion Procedure23

• Don sterile gloves.
• Cover resident’s lower abdomen and upper thighs with dignity cover.
• Organize contents of tray on sterile field
• Pour antiseptic solution over swabs in tray compartment.
• Squeeze sterile catheter lubricant onto tray.

2. Gould CV, Umscheid CA, Agarwal RK, et al. Centers for Disease Control and Prevention. Guidelines for prevention of catheter-associated urinary tract infections 2009. Atlanta, GA: US Department of Health and Human Services, CDC 2009. Accessed January 28, 2016.3. Willson M, Wilde M, Webb M, et al. Nursing interventions to reduce the risk of catheterassociated urinary tract infection: part 2: staff education, monitoring, and care techniques. J Wound Ostomy Continence Nurs. 2009 36:137-54. PMID: 19287262.

Types Of Urinary Catheter

There are 2 main types of urinary catheter:

• intermittent catheters catheters that are temporarily inserted into the bladder and removed once the bladder is empty
• indwelling catheters catheters that remain in place for many days or weeks and are held in position by a water-filled balloon in the bladder

Many people prefer to use an indwelling catheter because it’s more convenient and avoids the repeated catheter insertions associated with intermittent catheters. However, indwelling catheters are more likely to cause problems such as infections .

Inserting either type of catheter can be uncomfortable, so anaesthetic gel is used to reduce any pain. You may also experience some discomfort while the catheter is in place, but most people with a long-term catheter get used to this over time.

Read more about the risks of urinary catheterisation

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Slide : Learning Objectives

Upon completion of this session, licensed staff who insert or assist in the insertion of urinary catheters will be able to

• Explain the similarities and differences between the four different types of urinary catheters
• Prepare for and insert an indwelling urinary catheter using aseptic technique and
• Summarize effective strategies in preventing CAUTIs.

Slide 1: Female Catheter Insertion Procedure

• Using gloved nondominant hand, identify urethra by spreading the labia
• Spread inner labia slightly with gentle traction and pull upwards toward resident’s head.
• Clean periurethral area and urethral opening using antiseptic soaked swabs using tongs, in expanding circular motion. Discard used swabs away from sterile field.

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Preventing Infections And Other Complications

Having a long-term urinary catheter increases your risk of developing urinary tract infections , and can also lead to other problems, such as blockages.

You will be advised about measures to take to minimise these risks, such as:

• regularly washing your hands, body and catheter with warm water and soap its particularly important to clean your hands before and after touching your equipment
• ensuring you stay well hydrated you should aim to drink enough fluids so that your urine stays pale
• preventing constipation staying hydrated can help with this, as can eating high-fibre foods such as fruits, vegetables and wholegrain foods
• avoiding kinks in the catheter and making sure any urine collection bags are kept below the level of your bladder at all times

Read more about the risks of urinary catheterisation.

Slide : Catheter Insertion Kit Contents3

• Drape with opening, sterile gloves.
• Antiseptic solution for periurethral cleaning before insertion, swabs and tongs to use for applying antiseptic solution.
• Single-use packet of lubricant.
• Single-use dose of topical lidocaine jelly.
• Sterile urinary catheter, of smallest size effective for patient connected to tubing and bag.
• Catheter securing device.

3. Willson M, Wilde M, Webb M, et al. Nursing interventions to reduce the risk of catheter-associated urinary tract infection: part 2: staff education, monitoring, and care techniques. J Wound Ostomy Continence Nurs. 2009 36:137-54. PMID: 19287262.

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Direct Drainage Of The Urinary Bladder

in with a self-retaining device for short- term drainage , or left indwelling for long-term drainage in patients with chronic urinary retention. Patientsof all ages may require urethral catheterization, but those who are elderly or chronically ill are more likely to require indwelling catheters, which carry their own independent risks

Slide : Prepping For Catheter Insertion Procedure3

• Cleanse hands and don gloves
• Get your buddy to help at the bedside
• Place resident in the supine position
• For a femaleapply topical lidocaine jelly if needed for comfort
• Inspect catheter kit and remove it from its outer packaging to form a sterile field
• Remove gloves and wash hands!

3. Willson M, Wilde M, Webb M, et al. Nursing interventions to reduce the risk of catheterassociated urinary tract infection: part 2: staff education, monitoring, and care techniques. J Wound Ostomy Continence Nurs. 2009 36:137-54. PMID: 19287262.

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How Do I Perform Self

Regardless of gender, the steps for performing self-catheterization are generally the same. Females may find it helpful at first to use a mirror to find the urethral opening where urine comes out. To perform self-catheterization:

• Sit on the toilet .
• Use firm, gentle pressure to insert the lubricated end of the catheter into the urethra.
• Hold the other end of the catheter over the toilet bowl or container.
• Slowly slide the catheter until it reaches the bladder and urine starts to flow out of the tube.
• Continue inserting the catheter another inch or two.
• Hold the catheter in place until the bladder empties.
• Slowly and gently slide out the catheter.

Slide : Alternative Catheter Types

Straight Catheters

• Inserted directly into the urethra and bladder.
• Removed after insertion and drainage of bladder.
• Used intermittently.

• Placed surgically directly through skin into the bladder.
• Connected by tubing to a bag used to collect and measure urine.

External “Condom” Catheters for Men

• Does not enter the bladder.
• Connected by tubing used to collect and measure urine output.
• Cannot be used to treat acute urinary retention.

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Insertion Of A Coud Catheter

The Coudé catheter, which has a stiffer and pointed tip, was designed to overcome urethral obstruction that a more flexible catheter cannot negotiate . To place a Coudé catheter, follow the procedure described above. The elbow on the tip of the catheter should face anteriorly to allow the small rounded ball on the tip of the catheter to negotiate the urogenital diaphragm.

Warnings And Common Errors

• Be sure to maintain strict sterile technique during the procedure to avoid urinary tract infection Introduction to Urinary Tract Infections Urinary tract infections can be divided into upper tract infections, which involve the kidneys , and lower tract infections, which involve the bladder , urethra… read more .

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Slide : Male Catheter Insertion Procedure

• Keep nondominant hand in this position, do not remove!
• Lubricate tip of catheter with sterile lubricant jelly.
• Holding the coiled catheter in dominant hand, gently introduce the catheter tip into the urethral meatus.
• If using coude catheter, point catheter tip upward to 12 o’clock position.

What Are The Potential Risks Or Complications Of Self

Inserting a catheter can raise the risk of introducing infection-causing bacteria into the body, but having an indwelling Foley catheter presents even a higher risk. So if possible, CIC is a better option than an indwelling Foley. With any type of catheter, you have a higher chance of having a:

• Bladder infection, perforation or spasms.

• Signs of urinary tract infection .
• Skin rash or sores at the site of insertion.

A note from Cleveland Clinic

Some people need self-catheterization for a short time. Depending on the cause of the bladder problem, medications or surgery may correct the problem. If you have a chronic problem or a condition that is expected to get worse over time, you may always need to use a catheter to urinate. Everyoneâs situation is different. Talk to your healthcare provider about what you can expect.

Last reviewed by a Cleveland Clinic medical professional on 10/23/2020.

References

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