4. CATHETERIZATION
Catheterization is accomplished by inserting a
catheter (a hollow tube, often with and inflatable
balloon tip) into the urinary bladder
An invasive procedure that should only be
carried out by a qualified competent health care
professional using aseptic technique.
5. INDICATIONS
Used for diagnostic purposes (to help determine
the etiology of various genitourinary conditions)
For investigations
Therapeutically (to relieve urinary retention,
instill medication, or provide irrigation).
To accurately measure the urine output
6. INDICATIONS
To drain the bladder prior to, during, or after
surgery(following surgical procedures to the
urethra, in unconscious patients (due to surgical
anesthesia, coma, or other reasons
To relieve urinary incontinence when no other
means is practical
7. To drain the bladder prior to,
during, or after surgery
For investigations
To relieve retention of urine
To accurately measure the urine
output
To relieve urinary incontinence
when no other means is practical
8. • The balloon holds the catheter in place for a
duration of time. Catheterization in males is
slightly more difficult and uncomfortable than in
females because of the longer urethra.
9. Catheterization of the urinary tract should only
be done when there is a specific and adequate
clinical indication, as it carries a high risk of
infection.
Routine medical procedure that facilitates direct
drainage of the urinary bladder.
10. Catheters may be inserted as an in-and-out
procedure for immediate drainage.
Left in with a self-retaining device for short-term
drainage (as during surgery), or left indwelling
for long-term drainage in patients with chronic
urinary retention.
11. Patients of 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
12. RELEVANT ANATOMY
The developed female urethra is a 4-cm tubular
structure that begins at the bladder neck and
terminates at the vaginal vestibule.
It is a richly vascular spongy cylinder and is
designed to provide continence.
15. NURSING
RESPONSIBILITIES
1. Explained procedure to the child and the
parents and obtain consent.
2. The bed is screened to ensure privacy
3. Keep the child warm at all times
4. Ensure adequate light source
16. EQUIPMENTS
• Dressing trolley
• Catheterization pack and drapes
• Sterile gloves
• Appropriate size catheter (see catheter size guideline below)
• Xylocaine jelly syringe (plain sterile lubricant for infants)
• Sterile water for balloon
• 10 ml Syringe
• Specimen jar
• Antiseptic solution.
• Tape to secure catheter to leg
• Drainage bag
• Urine bag holder
17. CATHETER SIZE GUIDELINE
Use the smallest bore that will allow good
drainage to minimize bladder and urethral
trauma
Consider silicone catheter if for long term use
20. SPECIAL PRECAUTIONS
• Rapid drainage of large volumes of urine
from the bladder may result in
hypotension and/or haemorrhage
• Clamp catheter if the volume seems
excessive. Release clamp after 20
minutes to allow more urine to drain
• For post obstructive diuresis IV
replacement of electrolytes may be
required
22. • Amount of water in balloon
• Any problems with insertion
• Description of urine, colour
and volume
• Specimen collected
• Review date
23. ONGOING NURSING MANAGEMENT
1. Measure urine output hourly and
document
• Normal urine output is 0.5-
1ml/kg/hr. Report any variation
from this
• If oliguric ensure catheter is not
blocked (see trouble shooting
below)
24. 2. No routine change of urinary
catheter or drainage bag is
necessary. Change for clinical
indicators if infection, obstruction
or if system disconnects or leaks.
Replace system and/or catheter
using aseptic technique and sterile
equipment
25. 3. Maintain unobstructed
urine flow. Gravity is
important for drainage and
prevention of urine
backflow. Ensure the
drainage bag is below the
level of the bladder, is not
kinked and is secured
26. 4. Urine for urinalysis or culture
should be collected fresh from
sampling port of catheter tubing
(not drainage bag). Clean port
with disinfectant first
5. Drainage system
• Adherence to a sterile continuously closed method
of urinary drainage has been shown to markedly
reduce the risk of acquiring a catheter associated
infection
27. 6.Hygiene
• Daily warm soapy water is
sufficient meatal care or PRN if
build up of secretions is evident
• Uncircumcised boys should
have the foreskin gently eased
down over the catheter after
cleaning
28. Infection surveillance
• Consider daily the need for the IDC to
remain insitu. Remove as soon as no
longer required to reduce risk of UTI
• Cloudy, offensive smelling or unexplained
blood stained urine is not normal and
needs further investigation
29. • Full Ward Test (dipstick) should be done
each day. This test can detect urinary
protein, blood, nitrates (produced by
bacterial reduction of urinary nitrate) and
leucocyte esterase (an enzyme present in
White Blood Cells)
• Specimen collection
• § Large volumes e.g. 24hr collection, can be
collected from drainage bag
30. • Record fluid balance. A fluid
balance which keeps the urine
dilute will lessen the risk of
infection. This may not be
possible due to the clinical
condition of the child
31. • Catheter not draining/ patient oliguric
• Check catheter/tubing not kinked
• Check catheter is still secured to patient leg and
hasn't migrated out of bladder
• Checking patency by irrigating catheter with 2-3ml
of sterile 0.9% normal saline. Do not use force to
instil fluid. This is an aseptic procedure
• Catheter leaking
• Remove catheter. If indication for IDC remains
follow insertion procedure with new catheter
32. REMOVAL OF INDWELLING
CATHETER
Purpose:
To discontinue the use of an indwelling catheter upon physicians order.
To change the indwelling catheter.
Equipment:
Syringe without needle
Clean gloves
Protective pad
Bedpan/ urinal
33. • Inspect catheter for intactness. Report if not
intact
• Dispose of catheter and drainage system in
appropriate waste
• Remove gloves & perform social hand wash
• Document catheter removal in patient notes
• Observe for urine output post catheter
removal
