CATHETERIZATION OF THE URINARY BLADDER
Urinary catheterization is the introduction of a tube (a catheter) through the urethra into the urinary bladder to drain the bladder
Urinary catheterization is an aseptic method of introducing the catheter into the urinary bladder through the external urethra for withdrawal of urine
Purpose
- To obtain a clear specimen for diagnostic purpose
- To relieve distension of bladder caused by retention of urine
- To determine whether the failure to void is due to retention or suppression
- To determine the amount of residual urine present in the bladder
- To empty the bladder prior to surgery, bladder, irrigation or before instillation of a drug
- To avoid soiling and infection of the wound following operations on the genital region
- To manage incontinency, when all other measures to prevent skin breakdown have failed
- To provide for intermittent or continuous bladder drainage and irrigation
- To prevent urine from passing over a wound, e.g. after repair of the perineum
Principle Involved
- Pathogenic organisms are transmitted from the source to a new host directly on by contaminated articles
- Urinary bladder is a sterile cavity and the urinary meatus act as a portal of entry for pathogenic organisms
- Cleaning an area minimize the spread of organisms
- A break in the integrity of the skin and mucus membrane provides ready entrance for microorganism
- Lubrication reduces friction
- Through knowledge of anatomy and physiology of the genitourinary system facilitates catheterization of the urinary bladder
- Systematic ways of doing saves times, energy and material
- Unfamiliar situation produce anxiety
General Instruction
- Apply all the nursing measures to induce urination before the catheterization of the bladder
- Observe strict aseptic techniques to prevent the urinary tract infection
- Catheterization should be done slowly and never use force
- Always catheterize in a good light
- Clean the perineum from the pubis downwards to the anal region
- Use one cotton ball for one swabbing
- Do not touch the portion of the catheter that is going into the urinary tract
- Lubricate the catheter well before introducing into the urinary tract
- Keep the patient relaxed by providing privacy and adequate explanations
Preliminary Assessment
Check
- Doctors order for any specific precautions
- Identify the purpose of catheterization
- Level of consciousness
- Any contraindications
- General condition of the patient
- Mental status to follow instructions
- Articles available in the unit
Preparation of Patient and Environment
- Explain the sequence of the procedure
- Arrange the articles at the bed side locker
- Provide privacy
- Position the patient in dorsal recumbent
- Place the Mackintosh and towel under the buttocks
- Provide adequate light by placing extra spotlight
Types of Urinary Catheters
- Round-ended catheter
- Double lumen catheter
- Triple lumen catheter
- Tirmann catheter
- Whistle-tipped catheter
Equipment
A sterile tray containing:
- Catheter of correct size
- Small bowl containing an antiseptic
- Cotton swabs
- Pair of gloves
- Thumb forceps and artery forceps-one each
- Sterile kidney tray – 1 prefilled syringe with sterile water
- Sterile towel, sterile drainage tubing and collection bag
- Test tube or specimen bottle
- Small cup containing lubricant
A clean tray containing
- Mackintosh and towel
- Flashlight or spotlight
- Bath blanket
- Kidney tray
- Adhesive tape and scissors
- Bed pan to empty the urine from the kidney tray
- Measuring jar
- Urobag or collection bag
Procedure
- Scrub hands as for a surgical procedures
- Lift the draping sheet back towards abdomen
- Open the sterile tray with aseptic techniques
- Place the sterile towel and the slit in position
- Place the sterile kidney tray on the sterile towel in front of the patient
- Lubricate the catheter and place it in the sterile tray ready for insertion
- Clean the perineum with the cotton balls dipped in the antiseptic lotion using the forceps
- Discard the swab in the paper bag and discard the forceps in an unutterable kidney tray
- Pick up the catheter with the gloved hand, holding it about 7.5 cm from the tip and place the distal end in the sterile kidney tray
- Gently insert the catheter about 5 to 7.5 cm (female) the urine will flow into the kidney tray
- Collect the urine specimen if required. Attach the drainage tubing if an indwelling catheter is put in
Clean the Perineum in Female Patients
- Clean only in one direction
- Use one swab for one swabbing
- Clean labia majora on both sides
- Clean the inside of the labia majora on both sides
- Clean the labia minora on the both sides
- Clean the vulva
Cleaning the Perineum for Male Patients
- Retract the foreskin during the cleaning process
- Draw the penis upward and forward at 90 degree angle to the patients leg in order to straighten the urethra before the catheter is introduced
- Foreskin is replaced as quickly as possible after the insertion of the catheter
After Care
- Wash and dry the perineum
- Remove the drapes, replace the garments and bed covers
- Place the patients comfortably
- Take all the articles to the utility room, clean it and replace it
- Send specimen to the laboratory immediately
- Wash hands
- Record the procedure in the nurse’s record sheet
Types of catheterization
- Intermittent catheterization
- Short-term indwelling catheterization
- Long-term indwelling catheterization
