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Cleansweep RN

Cleansweep RN
yinstruments used in catheterization

Urethral catheterization is a routine medical procedure that facilitates direct drainage of the urinary bladder. Urethral catheterization is a frequently performed bed side procedure; if done haphazardly it may lead to infection, particularly if the catheter is left for long periods. Urethral catheterization is done usually with a balloon tip Foley Catheter of varying sizes (8 Fr* to 26 Fr). The balloon size for most of the applications is designed to hold little over 5cc of fluid. Larger Foley catheters with balloon capacity in excess of 30 cc are available for specific urology purposes. For an average adult sizes 14 to 18 Fr catheters are usually utilized.

In the female, the vulval outlet and labia are carefully washed and painted with betadine and appropriate sterile drapes are laid. With the left hand exposing the urethral meatus by separating the labia with the thumb and index fingers the external urethral meatus is identified and previously lubricated catheter is carefully and gently advanced through it into the bladder. Care should be taken not to contaminate the catheter by touching the unprepared parts of the genitalia and the vagina. Once the catheter is well placed inside the bladder and the urine is seen coming out of the tube the balloon is distended with 5 cc of sterile water and catheter connected and fixed as described earlier.

Indications:

A. Diagnostic

  • Collection of uncontaminated urine specimen
  • Monitoring of urine output
  • Imaging of the urinary tract

B. Therapeutic

  • Acute urinary retention (blood clots)
  • Chronic obstruction that causes hydronephrosis
  • Initiation of continuous bladder irrigation
  • Intermittent decompression for nuerogenic bladder
  • Hygienic care of bedridden patients

Complications:

  • Trauma
  • Trauma can usually be avoided by using a smooth flexible catheter and good technique
  • Hematuria caused by catheterization may indicate poor equipment or technique. However, the disease process may have markedly increased the vascular supply to the bladder and/or urethra. Consider cystocentisis if this is suspected.
  • Hematuria is usually self-limiting but may interfere with interpretation of urinalysis results.
  • Trauma may predispose the patient to bacterial infection since it damages the normal host-defense mechanisms.
  • Infection
  • The distal urethra, vagina and prepuce normally contain bacteria (Staphylococci, Streptococci and Gram negative organisms) and mycoplasma.
  • Urine in the kidneys, ureters, and urinary bladder of normal dogs and cats is usually sterile.
  • Even careful catheterization may cause infection because these bacteria are carried into the bladder.
  • Consider cystocentesis for patients with pre-existing disease in the urethra and/or urinary bladder.
  • Avoid repeated catheterization and indwelling catheterization because there is an increased risk of iatrogenic infection with these procedures.

Equipments:

Commercial urinary catheterization kit

  • Povidone-iodine solution (Betadine)
  • Sterile cotton balls
  • Water-soluble lubrication gel
  • Sterile drapes
  • Sterile gloves
  • Urethral catheter
  • Prefilled saline syringe, 10 mL
  • Urinometer connected to a collection bag
  • Sterile anesthetic lubricant (lidocaine gel 2%) with a blunt-tipped urethral applicator or a plastic syringe (5-10 mL)

Catheter types and sizes

  • Adults - Foley catheter (16-18F)
  • Children - Foley catheter (5-12F)
  • Infants younger than 6 months - Feeding tube (5F) with tape

Procedures:

  1. Explain the procedure, benefits, risks, complications, and alternatives to the patient or the patient's representative.
  2. Position the patient supine, in bed, and uncover the genitalia.
  3. Open the catheter tray and place it on the gurney in between the patient's legs (use the sterile package as an extended sterile field).
  4. Open the iodine/chlorhexidine preparatory solution and pour it onto the sterile cotton balls.
  5. 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.
  6. Wear sterile gloves and use the non-dominant hand to separate the labia with the thumb and index finger.
  7. Use the sterile hand and sterile forceps to apply preparatory solution to the urethra and the surrounding vulva in circular motions with at least 3 different cotton balls.
  8. Without moving the non-dominant hand, apply the sterile drapes that are provided with the urinary catheterization tray to create a sterile field around the vulva.
  9. To anesthetize the urethra, use the commercial applicator or a syringe with no needle to instill 5 mL of lidocaine gel 2% into the urethra (The use of a urethral anesthetic is controversial; the decision to anesthetize the urethra should be made in conjunction with the patient).
  10. Place a finger on the meatus to help prevent spillage of the anesthetic lubricant.
  11. Allow 2-3 minutes for the anesthetic to take effect before proceeding with the urethral catheterization.
  12. Hold the catheter with the sterile hand or leave it in the sterile field to remove the cover. Apply a generous amount of a non-anesthetic lubricant or the remaining lidocaine gel.
  13. Slowly and gently introduce the catheter into the urethra. Continue to advance the catheter either several centimeters beyond where urine is first obtained or until the proximal Y-shaped ports are at the meatus.
  14. Wait for urine to drain from the larger port to ensure that the distal end of the catheter is in the bladder. (The lubricant jelly–filled distal catheter openings may delay urine return).
  15. If no spontaneous return of urine occurs, try attaching a 60-mL syringe to aspirate urine. If urine return is still not visible, withdraw the catheter and reattempt the procedure. (Ultrasonography may be used at this point to verify the presence of urine in the bladder).
  16. After visualization of urine return, inflate the distal balloon by injecting 5-10 mL of 0.9% NaCl (normal saline) through the cuff inflation port. (Inflation of the balloon inside the urethra will result in severe pain, gross hematuria, and, possibly, urethral tear).
  17. Gently withdraw the catheter from the urethra until resistance is met.
  18. Secure the catheter to the patient's thigh with a wide tape. (Creating a gutter with tape to elevate the catheter from the thigh may increase the patient's comfort).

Nursing Management:

Urinary Catheter Blockage

  • Maximize patient hydration
  • Consider Methanamine preparations to prevent blockage
  • Consider bladder irrigation
  • Change catheter before expected time to obstruction
  • Change catheter if no urine flow in 4 to 8 hours
  • Evaluate for UTI for more frequent catheter blockage

Urinary Catheter leakage

  • Do not increase catheter diameter
  • Evaluate for catheter blockage (above)
  • Evaluate for Urinary Catheter associated UTI
  • Consider Bladder Antispasmodic

Prevention of Urinary Catheter associated UTI:

  • Catheterize only when absolutely necessary
  • Insert catheter using sterile technique
  • Anchor catheter to prevent urethral traction
  • Tape catheter to anteromedial thigh
  • Maintain closed sterile drainage system
  • Hand washing before and after catheter care
  • Change catheter if no flow in 4 to 8 hours
  • Consider change with symptomatic UTI

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