Urinary Elimination & Catheters


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Urinary Elimination & Catheters

  2. 2. Objectives       Demonstrate correct technique for inserting indwelling and straight catheters Recognizes signs and symptoms of infection related to urinary catheters Demonstrate aseptic routine care of a patient with an indwelling catheter Demonstrate correct technique for removing an indwelling catheter. Demonstrate correct procedure for application of condom catheter Document and report to RN care related to urinary drainage
  3. 3. Anatomy Kidney - Urine p ro d uc tio n Ureters - Tube s whic h c o nne c t the kid ne y s to the bla d d e r. Bladder - Re s e rv o ir fo r urine until the urg e to vo id ta ke s p la c e . Urethra - Tube fro m the bla d d e r to the o uts id e o f the bo d y in no rm a l a na to m y . M = 20 cmlong ale F ale = 4 cmlong em
  4. 4. Anatomy     A continuous layer of mucous membrane lines the kidney pelvis, ureters, urethra & bladder Because there is no break in this lining, bacteria introduced into this normally sterile environment can quickly spread throughout the entire system When the bladder is empty it falls into folds which provide pockets where bacteria can multiply Because this membrane layer is highly vascular, bacteria can easily enter the blood stream & cause septicemia
  5. 5. Urinary Elimination System
  6. 6. Catheterization - Reasons      Collect a sterile specimen Check residual urine Inability to void related to post-op complications Before, during or after surgery to empty bladder Temporary/Permanent Incontinence: a. Total- c o ntinuo us lo s s o f urine fro m bla d d e r b. Stress- le a ka g e o f s m a ll a m o unts o f urine with p hy s ic a l s tre s s i. e . c o ug hing o r s ne e z ing
  7. 7. Catheterization - Reasons   Urge - I lunta ry p a s s a g e o f urine a fte r fe e ling nvo s tro ng ne e d to vo id . Una ble to s to p urina ting a nd c a n’ t g e t to ba thro o m o n tim e . Se e n in the e ld e rly , with UTI a nd tum o rs . s Functional - I lunta ry , unp re d ic ta ble p a s s a g e nvo o f urine re la te d to no c a ll lig ht o r im m o bility , e tc .
  8. 8. Bladder Scan     Estimates residual urine Increased use over straight catheterization 90% accuracy Decreases risk of infection and discomfort to patient
  9. 9. PRIOR to Catheterization Know and Confirm      Doctor’s order Last void Patient’s level of consciousness and understanding Mobility, physical limitations, ability to cooperate Sex, age, catheter size  Kids 6-10  Female 14-16  Male 16-18)    Allergies to antiseptics, tape, rubber, latex Adverse conditions Impaired passage such as enlarge prostate
  10. 10. Catheter Types - Condom Condom Catheter (External, Texas, Urinary Sheath)     Incontinent men Soft rubber, latex, silicone Slides over Penis Tubing connects to tip of condom and flows into collection bag.
  11. 11. Catheter Types - Condom Remove for thirty minutes each day, clean and dry penis, re-apply new catheter.  Elastic tape may be used to secure catheter in place. This tape will expand when the penis changes size.  Never use adhesive tape- cuts off blood flow which causes injury. 
  12. 12. Catheter Types - Straight Straight Catheter Removes urine from bladder aseptically due to 1. Incontinence 2. Post void residuals 3. Sterile specimen  Do e s no t a tta c h to a c o lle c tio n ba g  Co ns id e re d a s te rile p ro c e d ure 
  13. 13. Catheter Types - Indwelling Indwelling Catheter (Foley)     To remove urine aseptically Sterile procedure Has urinary collection bag May be used for extended periods of time
  14. 14. Catheter Types - Suprapubic Suprapubic     Catheter inserted into the bladder through an opening in the lower abdomen (a bo ut 1 inc h a bo ve the s y m p hy s is p ubis ) Placed under anesthesia May be left in place for long periods of time Sutured into place.
  15. 15. Rules for Catheterization 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Wash hands, use gloves Tubing without kinks/obstructions Drainage bag below bladder Attach to non-movable bed part Secure with leg strap Check system for leaks Perform perineal care BID, after all BMs &with cath care Watch I&O closely Report complaints of discomfort to nurse (pain, burning, irritation) Record amount, color, clarity, odor, particles
  16. 16. Insertion/ Application - Condom Condom Catheter  Clean gloves to remove old catheter  Wash and dry penis  Apply skin prep to penis shaft  Remove protective backing from condom exposing adhesive strip
  17. 17. Insertion/ Application - Condom Hold penis firmly. Roll condom onto penis leaving 1inch space between penis and end of catheter.  Secure condom with elastic strip in spiral manner not completely on penis  Connect condom to drainage bag  Check penis for redness and excoriation 
  18. 18. Insertion Tips – Straight/ Foley    Have patient relax by taking slow deep breaths Lubricate catheter well To find female meatus      Look for the wink Betadine pools in the meatus Ask patient to bear down as if to void If catheter enters the vagina, leave it To place catheter in an uncircumcised man – 1. Carefully pull back foreskin before cleansing
  19. 19. Insertion Tips – Straight/ Foley W hen performing straight cath  Know policy & procedure for maximum amount of urine allowed to be withdrawn.
  20. 20. Insertion of Indwelling Catheter    If indwelling catheter, GE Y tug on catheter NTL until resistance is met to insure placement in bladder Do peri care and apply leg band to secure catheter to patient’s leg Remove gloves and discard supplies properly
  21. 21. Documentation Document        Type of procedure Size of catheter and balloon Amount of fluid actually instilled into balloon Amount of urine returned Characteristics of urine (color, odor, sediment) Specimen sent if applicable How patient tolerated procedure
  22. 22. Problems During Insertion Catheter inserted into Vagina 1. Leave in place 2. Reposition fingers to re-visualize meatus 3. Use new catheter 4. Repeat procedure
  23. 23. Problems During Insertion Unable to insert into female 1. Ask patient or other team member to hold legs apart 2. Observe urethral opening (before cleansing) for movement when pressure is applied 3. Improve lighting 4. Repeat insertion procedure
  24. 24. Problems During Insertion Unable to insert catheter into male 1. Notify nurse 2. Repeat procedure but change the angle of the penis 3. Try an a coude catheter
  25. 25. Problems During Insertion Catheter comes out with balloon inflated 1. Check with nurse 2. Check for urethral trauma (pain, bleeding) 3. Monitor urine output for bleeding 4. Obtain new catheter kit & reinsert with 10 ml balloon per nurse’s instruction
  26. 26. Care of Patient with a Catheter 1. 2. 3. 4. 5. 6. 7. Keep catheter bag below level of bladder Attach drainage bag to bed frame (not side rails) Secure tubing onto bed – urine should flow freely from catheter to bag (coil tubing on bed) Empty catheter bag every 8 hours or prn Provide catheter care & pericare as needed Do not allow the drain on the bag to touch any surface Keep drainage bag off the floor
  27. 27. Catheter Removal 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Physician’s order Gather supplies- 10cc syringe, gloves, chux Deflate balloon- note amount withdrawn Avoid pubic hair Pinch catheter; pull out on exhalation steadily & gently Measure output Discard catheter bag properly Provide peri care Monitor patient for output If not voided in 4-6 hours, notify nurse
  28. 28. Following Catheter Removal 1. 2. 3. 4. 5. Patient to void within 4-6 hours Urine amount 120-240 ml (or per policy) Observe bladder for distention Monitor patient for any complaints of painful urination Monitor patient for hematuria
  29. 29. Catheter Removal Documentation Document :        Size of catheter removed Size and amount of fluid in balloon Patient tolerance Output in catheter bag Description of urine Peri care Time of removal
  30. 30. Voiding Following Catheter Removal Hints to assist patient to void after catheter removal     Encourage oral fluids Proper position to urinate Sound of running water Sitz bath
  31. 31. Catheter Specimen - Syringe
  32. 32. Urinary Diversions Definition Removal of bladder (cancer, bladder injuries) and making a new pathway for urine to exit the body. Two Ca te g o rie s 1. Continent 2. Noncontinent (incontinent)
  33. 33. Continent Urinary Diversions  Surgery creates an internal pouch where urine is stored (Kock or Indiana Pouch)  Do not need to wear an appliance  Taught to insert catheter into the stoma several times a day to drain the urine
  34. 34. Noncontinent Urinary Diversions  Patient cannot control urine  Must wear an external urinary ostomy pouch Types of non-continent urinary diversions 1. Ureterostomy
  35. 35. Ureterostomy Ureterostomy The s urg ic a l c re a tio n o f a n a rtific ia l o p e ning be twe e n the ure te r a nd the a bd o m e n.  Both ureters may be brought through the skin onto the abdomen  Drains urine
  36. 36. Ileal Conduit  A small section of the ileum is resected from the intestine  One end is sutured closed  Ureters are implanted in the other end Open end of the ileum becomes the stoma Drains urine
  37. 37. Ureterostomies