Catheterization

1. Catheterization

2. Introduction
 Catheterization of the bladder involves introducing a latex or
plastic tube through the urethra and into the bladder.

3. Purpose
 Relieving urinary retention
 provides a means of assessing urine output in hemodynamically
unstable patients.
 Obtaining a sterile urine specimen
 Obtaining a urine specimen when a specimen cannot be secured
satisfactorily by other means.

4. Selecting an appropriate catheter
1. Select the type of material in accordance with the estimated length
of the catheterization period:
2. Determine appropriate catheter size
 are determined by diameter of lumen
 graded on French scale or number.
 Catheter size depends on the size of the urethral canal
 8-10 Fr – children
 14-16 Fr – female adults
 18 Fr – adult male

5. Selecting an appropriate catheter cont’d
3. Determine appropriate catheter length by the clients gender
 For adult male – 40 cm catheter
 For adult females – 22 cm catheter
4. Select appropriate balloon size
 5 ml – for adults
 3 ml – for children

6. Intermittent urethral catheters
 or straight catheters, are used to drain the bladder for shorter
periods.
Purpose
 To relieve discomfort due to bladder distention
 To assess the residual urine
 To obtain a urine specimen
 To empty the bladder prior to surgery

7. Intermittent urethral catheters cont’d
Equipment
Sterile
 Kidney dish
 Galipot
 Gauze
 Towel
 Solution
 Lubricant
 Catheter
 Syringe
 Water
 Specimen bottle
 Gloves
Clean
 Waste receiver
 Rubber sheet
 Flash light
 Measuring jug
 Screen

8. Intermittent urethral catheters cont’d
Procedure
 Prepare the client and equipment for perennial wash
 Position the patient – dorsal recumbent (pillows can be used to
elevate the buttocks in females).
 Drape the patient.
 Wash the perennial area with warm water and soap
 Rinse and dry the area

9. Intermittent urethral catheters cont’d
Procedure
 Prepare the equipment
 Create a sterile field
 Drape the client with a sterile drape
 Clean the area with antiseptic solution.
 Lubricate the insertion tip of the catheter (5-7 cm in)
 Expose the urinary meatus adequately by retracting the tissue or
the labia minora in an upward direction – female

10. Intermittent urethral catheters cont’d
Procedure
 Retract the fore skin of uncircumcised male.
 Grasp the penis firmly behind the glans and hold straighten the
down ward curvature of vertical it go to the body – male hole the
catheter 5 cm from the insertion tip
 Insert the catheter into the urethral orifice

11. Intermittent urethral catheters cont’d
Procedure
 Insert 5 cm in females and 20 cm in males or until urine comes
 Collect the urine – for specimen (about 30 ml)
 Pinch previous leakage
 Empty or drain the bladder and remove the catheter
 For adults experiencing urinary retention an order is needed on
the amount to urine to be expelled.

12. Retention (Indwelling) Catheter
 If a catheter is to remain in place for continuous drainage, an
indwelling urethral catheter is used.
 Indwelling catheters are also called retention or Foley catheters.
 The indwelling urethral catheter is designed so that it does not
slip out of the bladder.

13. Retention (Indwelling) Catheter cont’d
 The indwelling catheter has more than one lumen or open tube
within the catheter.
 In a double-lumen catheter, one lumen is connected directly to the
balloon, which is inflated with sterile water; the other is the
lumen through which the urine drains.
 The triple-lumen catheter provides an additional lumen for the
instillation of irrigating solution

14. Retention (Indwelling) Catheter cont’d

15. Retention (Indwelling) Catheter cont’d
Purpose
 To manage incontinence
 To provide for intermittent or continuous bladder drainage and
irrigation
 To prevent urine from contacting an incision after perineal
surgery (prevent infection)
 To measure urine out put needs to be monitored hourly

16. Retention (Indwelling) Catheter cont’d
Procedure
 Explain the procedure to the patient
 Prepare the equipment like:
 Retention catheter
 Syringe
Sterile water
Tape
Urine collection bag and tubing

17. Retention (Indwelling) Catheter cont’d
 Assist the patient to a dorsal recumbent position with knees
flexed, feet about 2 feet apart, with her legs abducted. Drape
patient. For male Position on his back with thighs slightly apart

18. Retention (Indwelling) Catheter cont’d
 Prepare urine drainage setup if a separate urine collection system
is to be used. Secure to bed frame according to manufacturer’s
directions.
 Open sterile catheterization tray on a clean overbed table using
sterile technique.

19. Retention (Indwelling) Catheter cont’d
 Put on sterile gloves.
 Grasp upper corners of drape and unfold drape without touching
unsterile areas.
 Fold back a corner on each side to make a cuff over gloved
hands.
 Ask patient to lift her buttocks and slide sterile drape under her
with gloves protected by cuff.

20. Retention (Indwelling) Catheter cont’d
 Based on facility policy, position the fenestrated sterile drape.
Place a fenestrated sterile drape over the perineal area, exposing
the labia. On the male over the penis

21. Retention (Indwelling) Catheter cont’d
 Use the dominant hand to pick up a cotton ball or antiseptic swab.
Clean one labial fold, top to bottom, then discard the cotton ball.
Using a new cotton ball/swab for each stroke, continue to clean
the other labial fold, then directly over the meatus

22. Retention (Indwelling) Catheter cont’d
 For male client Lift penis with non dominant hand. Retract
foreskin in uncircumcised patient.
 Be prepared to keep this hand in this position until catheter is
inserted and urine is flowing well and continuously.
 Using the dominant hand and the forceps, pick up a cotton ball or
antiseptic swab.

23. Retention (Indwelling) Catheter cont’d
 Using a circular motion, clean the penis, moving from the meatus
down the glans of the penis. Repeat this cleansing motion two
more times, using a new cotton ball/swab each time. Discard each
cotton ball/swab after one use.

24. Retention (Indwelling) Catheter cont’d
 With your uncontaminated, dominant hand, place drainage end of
catheter in receptacle.
 If the catheter is preattached to sterile tubing and drainage
container (closed drainage system), position catheter and setup
within easy reach on sterile field.
 Ensure that clamp on drainage bag is closed.

25. Retention (Indwelling) Catheter cont’d
 Using your dominant hand, hold the catheter 2 to 3 from
the tip and insert slowly into the urethra after lubricating it.
 Advance the catheter until there is a return of urine.

26. Retention (Indwelling) Catheter cont’d
 For male Use the dominant hand to pick up the catheter and hold
it an inch or two from the tip. Ask patient to bear down as if
voiding.
 Insert the lubricated catheter tip into meatus

27. Retention (Indwelling) Catheter cont’d
 Once urine drains, advance catheter another 2 to 3 (4.8–7.2 cm).
 Ask patient to breathe deeply, and rotate catheter gently if slight
resistance is met as catheter reaches external sphincter.

28. Retention (Indwelling) Catheter cont’d
Procedure
 After catheter insertion, the balloon is inflated to hold the catheter
in place with in the bladder.

29. Retention (Indwelling) Catheter cont’d
Procedure
 Tape the catheter with tape to the inside of a females thigh or to
the thigh or a body of a male client
 Restricts the movement of the catheter and irritation in the
urethra when the client moves

30. Retention (Indwelling) Catheter cont’d
Procedure
 Establish effective drainage
 The bag should be off the floor – the emptying spout does not
become grossly contaminated
 Document pertinent data

31. Retention (Indwelling) Catheter cont’d
Removal
 Withdraw the solution or air from the balloon using a syringe
 And remove gently

32. External (Condom) Catheter
 When voluntary control of urination is not possible for male
patients, an alternative to an indwelling catheter is the external
condom catheter.
 This soft, pliable sheath made of silicone material is applied
externally to the penis.

33. External (Condom) Catheter cont’d
 Most devices are self-adhesive.
 The catheter is connected to drainage tubing and a collection bag,
and can be used with a leg bag.

34. External (Condom) Catheter cont’d

35. External (Condom) Catheter cont’d
Procedure
 Bring necessary equipment to the bedside.
 Perform hand hygiene and put on PPE, if indicated.
 Identify the patient.
 Close curtains around bed and close door to room if possible.
Discuss procedure with patient. Ask the patient if he has any
allergies, especially to latex.

36. External (Condom) Catheter cont’d
Procedure
 Adjust bed to comfortable working height
 Prepare urinary drainage setup or reusable leg bag for attachment
to condom sheath.
 Position patient on his back with thighs slightly apart.
 Put on disposable gloves. Trim any long pubic hair that is in
contact with penis.

37. External (Condom) Catheter cont’d
Procedure
 Clean the genital area with washcloth, skin cleanser, and warm
water.
 If patient is uncircumcised, retract foreskin and clean glans of
penis. Replace foreskin.
 Clean the tip of the penis first, moving the washcloth in a circular
motion from the meatus outward.
 Wash the shaft of the penis using downward strokes toward the
pubic area. Rinse and dry.
 Remove gloves. Perform hand hygiene again.

38. External (Condom) Catheter cont’d
Procedure
 Roll condom sheath outward onto itself. Grasp penis firmly with
nondominant hand. Apply condom sheath by rolling it onto penis
with dominant hand. Leave 1 to 2 (2.5–5 cm) of space between
tip of penis and end of condom sheath.

39. External (Condom) Catheter cont’d
Procedure
 Apply pressure to sheath at the base of penis for 10 to 15
seconds.
 Connect condom sheath to drainage setup. Avoid kinking or
twisting drainage tubing.

40. External (Condom) Catheter cont’d
Procedure
 Remove gloves. Secure drainage tubing to the patient’s inner
thigh with Velcro leg strap or tape. Leave some slack in tubing
for leg movement.
 Assist the patient to a comfortable position. Cover the patient
with bed linens. Place the bed in the lowest position.

41. External (Condom) Catheter cont’d
Procedure
 Secure drainage bag below the level of the bladder. Check
that drainage tubing is not kinked and that movement of
side rails does not interfere with the drainage bag.
 Remove equipment. Remove gloves and additional PPE, if
used. Perform hand hygiene.
 Documentation

42. Irrigating the Indwelling
Catheter or Bladder
 The flushing of a tube, canal, or area with solution is called
irrigation.
 Natural irrigation of the catheter through increased fluid intake by
the patient is preferred.
 The purpose of an external catheter irrigation is to restore or
maintain its patency.

43. Irrigating the Indwelling
Catheter or Bladder cont’d
 A bladder irrigation rinses out the bladder and can also instill
medication that acts directly on the bladder wall.
 Routine intermittent irrigation of long-term catheters is not
recommended

44. Irrigating the Indwelling
Catheter or Bladder cont’d
 Continuous or frequent irrigations may be ordered when a blood
clot or other debris threatens to block the catheter.
 Closed system irrigation is recommended to prevent the
introduction of pathogens into the bladder.

45. Performing Intermittent Closed Catheter
Irrigation
Procedure
 Confirm the order for catheter irrigation in the medical
record.
 Bring necessary equipment to the bedside.
 Perform hand hygiene and put on PPE, if indicated.
 Identify the patient.
 Close curtains around bed and close door to room if
possible. Discuss procedure with patient.

46. Performing Intermittent Closed Catheter
Irrigation cont’d
Procedure
 Adjust bed to comfortable working height, usually elbow height
of the caregiver.
 Put on gloves. Empty the catheter drainage bag and measure the
amount of urine, noting the amount and characteristics of the
urine. Remove gloves.

47. Performing Intermittent Closed Catheter
Irrigation cont’d
Procedure
 Assist patient to comfortable position and expose access
port on catheter setup. Place waterproof pad under catheter
and aspiration port. Remove catheter from device or tape
anchoring catheter to the patient.
 Open supplies, using aseptic technique. Pour sterile
solution into sterile basin. Aspirate the prescribed amount
of irrigant (usually 30–60 mL) into sterile syringe. Put on
gloves.

48. Performing Intermittent Closed Catheter
Irrigation cont’d
Procedure
 Cleanse the access port on
catheter with antimicrobial
swab.
 Clamp or fold catheter tubing
below the access port

49. Performing Intermittent Closed Catheter
Irrigation cont’d
 Attach the syringe to the access port on catheter using a twisting
motion. Gently instill solution into catheter

50. Performing Intermittent Closed Catheter
Irrigation cont’d
 Remove syringe from access port. Unclamp or unfold tubing and
allow irrigant and urine to flow into the drainage bag. Repeat
procedure as necessary.

51. Performing Intermittent Closed Catheter
Irrigation cont’d
Procedure
 Remove gloves. Secure catheter tubing to the patient’s inner thigh
or lower abdomen.
 Assist the patient to a comfortable position. Cover the patient
with bed linens. Place the bed in the lowest position.

52. Performing Intermittent Closed Catheter
Irrigation cont’d
Procedure
 Secure drainage bag below the level of the bladder. Check that
drainage tubing is not kinked.
 Remove equipment and discard syringe in appropriate receptacle.
Perform hand hygiene.
 Assess patient’s response to procedure and quality and amount of
drainage after the irrigation.
 Documentation

53. Administering a continuous closed bladder
irrigation
Procedure
 Prepare sterile irrigation bag for use as directed by manufacturer.
 Clearly label the solution as “Bladder Irrigant.” Include the date
and time on the label.
 Hang bag on IV pole 2 1/2 to 3 above level of patient’s bladder.
Secure tubing clamp and insert sterile tubing with drip chamber
to container using aseptic technique.

54. Administering a continuous closed bladder
irrigation cont’d
 Release clamp and remove protective cover on end of tubing
without contaminating it. Allow solution to flush tubing and
remove air. Clamp tubing and replace end cover.

55. Administering a continuous closed bladder
irrigation cont’d
 Put on gloves. Cleanse the irrigation port on the catheter with an
alcohol swab. Using aseptic technique, attach irrigation tubing to
irrigation port of three-way indwelling catheter

56. Administering a continuous closed bladder
irrigation cont’d
 Check the drainage tubing to make sure clamp, if present, is
open.
 Release clamp on irrigation tubing and regulate flow at
determined drip rate, according to the ordered rate

57. Administering a continuous closed bladder
irrigation cont’d
 Remove gloves. Assist the patient to a comfortable position.
 Assess patient’s response to procedure and quality and
amount of drainage.
 Remove equipment. Perform hand hygiene.

58. Administering a continuous closed bladder
irrigation cont’d
 As irrigation fluid container nears empty, clamp the
administration tubing. Do not allow drip chamber to empty.
Disconnect empty bag and attach a new full irrigation solution
bag.
 Put on gloves and empty drainage collection bag as each new
container is hung and recorded.
 Documentation