This document provides an overview of urinary elimination and catheterization. It begins with learning objectives on anatomy, physiology, urine composition and factors influencing urination. It then reviews kidney anatomy and function, as well as the ureters and bladder. Urine formation and characteristics are described. Types of urine specimens and diagnostic tests are listed. Methods of facilitating urine elimination like catheters are explained, including purposes, types, and procedures for insertion and care.

1. BY,
MR. BASAVARAJ
NURSINGTUTOR,
NAVODAYACON RAICHUR.

2. LEARNING OBJECTIVES
• Review of anatomy and physiology
• Composition and characteristics of urine.
• Factors influencing Urination
• Alteration in Urinary Elimination
• Types and Collection of urine specimen, Observation, urine testing
• Facilitating urine elimination: (assessment, types, equipment's,
procedures and special considerations)
• Providing urinal/bed pan, Condom drainage.
• Catheterization, Care of urinary drainage, and perineal care.

3. INTRODUCTION
• Urinary elimination is defined as expulsion of waste products from
the body through the urinary system.
• It is essential to maintain homeostasis of the body.
• It helps in removal of metabolic waste products from the body.

4. Review of anatomy and physiology
Organs of urine elimination
• Kidney:
• Ureters
• Urinary Bladder
• Urethra

5. Kidney
• Kidney: there are two kidneys present retroperitoneally in each side
• It consists of two parts i.e Medulla and cortex.
• Nephron is the Structural and functional unit of urinary system.
• Blood supply is by Renal artery and venous blood
is drained to renal vein.
• Renal pelvis is the point where renal artery enters
the kidney, and renal vein and ureters leave
the kidney.

6. Functions of kidney
1.Excratory function:
• Excretion of metabolites.
• drugs and
• Toxins from the body.
2. Homeostatic function:
• Maintenance of water balance.
• Maintenance of electrolyte balance.
• Maintenance of acid-base balance.
3. Endocrine (Hormonal) function.
• Renin secretion by JG cells.
• Secretion of Erythropoietin Hormone.
• Secretion of prostaglandins.
4. The kidney converts Vitamin D3 active 1,25-dihydroxycholecalciferol.

7. Ureters:
• There are two ureters descends from each kidney.
• They are made-up of Smooth muscles and inner lining is by transitional
epithelium.
• These ureters carries the urine from kidney to urinary Bladder.
• Each ureters are around 10 to 12 (20 to 30cm) inch longer.
• Upper half of the ureter located in Abdominal cavity and lower half is present in
Pelvic cavity.
Clinical significance
• Ureteral stones
• Reflux of Urine
• Congenital malformation
• Ca ureters

8. Urinary Bladder
• It is a hallow muscular organ
present in pelvic cavity which store
the urine produced by kidney before
eliminating.
• Superiorly connected to ureters
and inferiorly to Urethra.
• Ca bladder, cystitis, incontinence,
retention and Spastic bladder are
the main clinical significance.

9. Mechanism of urine formation

10. Nephron structure

11. Composition of urine
• 95% of volume of normal urine is due to water.
• Organic components
Urea (end product of protein metabolism)
Uric acid (end product of purines)
Creatinine
Amino acids
Metabolites of Hormones
• In-organics
Cations: Na2+, K+, Ca2+ etc
Anions: Cl-, SO4
2-, HCO3
- etc

12. Characteristic of Urine
Physical characters
• Color : pale yellow to deep Amber
• Odor : odorless
• Volume : 1 to 2 liters per 24 hours
• Specific gravity : 1.003-1.032 (1.010)
Other characters
• pH : 4.5 to 8.0 (6.8)
• Blood cells : nil
• Protein : nil
• Glucose : nil
• Ketone bodies : nil

13. Factors influencing urination
• Lifestyle
• Fluid and food intake
• Environment
• Psychological factor
• Medications
• Muscle tone and activity
• Pathological condition
• Surgical and diagnostic procedures

14. Alteration in urine elimination
• Polyuria: urine volume in excess of 3L/day.
• Oliguria : urine volume less than 500 ml/day.
• Anuria : urine volume less than 100 ml/day.
• Nocturia : frequent night time urination.
• Dysuria :difficulty in urination/ burning maturation.
• Enuresis :bed wetting.
• Urinary incontinence and :involuntary dribbling of urine.
• Urinary retention : inability to void the urine/ empty the bladder
completely.

15. Cont……..
• Haematuria : blood in the urine.
• Proteinuria : presence of protein in the urine.
• Glycosuria : presence of glucose in urine.

16. Urine specimen collection
• Proper collection of specimen is important to maximize the
outcome of laboratory test for the diagnosis of infectious
diseases.
• A variety of laboratory test can be performed to make a
presumptive or definitive diagnosis so that therapy can begin.

17. Types of urine specimen collection
• Random specimen collection.
• First morning specimen.
• Clean catch or midstream urine.
• Urine sample collection from catheter.
• Supra pubic aspiration.

18. Diagnostic tests
• Routine urine analysis.
• Blood test (BUN and Creatinine Clearance).
• Cystoscopy.
• Intravenous pyelogram IVP.
• Urine culture and sensitivity.
• CT Scan.

19. Facilitating urine elimination
• Providing urinal/bed pan,
• Condom drainage.
• Catheterization,
• Care of urinary drainage, and perineal care.

20. Catheterization
“Urinary catheterization is the insertion of a hollow tube through the
urethra into the bladder for removing urine”.
• It is a aseptic procedure for which sterile equipment's are required
Size of the catheter used
8-10 f are used for children's.
12-14 are used for female adults.
14,16, and 18 are used for male adults.

21. Purposes of urinary catheter
• To relieve from urinary retention.
• To obtain a sterile urine specimen.
• To measure residual urine.
• To empty the bladder before, during and after the surgery.
• To measure the urine output accurately.

22. Types of catheterization
• Intermittent catheter: an intermittent
catheter is used to drain the bladder for
short period or at once. It will have only
single lumen.
• Indwelling/retention catheter:
This type of catheter placed in to bladder
and secured there for a period of time.
• Supra pubic catheterization:
In this catheter is used to bladder by making
a small incision above the pubic area.

23. Procedure of catheterization
• Preparation .
• Insertion of catheter.
• After care and removal of urinary catheter.

24. Preparation
Preparation of patient:
• Prepare the patient mentally by explaining the procedure to gain cooperation.
• Prepare the part (urethral opening).
• Provide privacy and position the patient.
Prepare the articles:
• Catheter
• Bladder wash set
• 10cc/20cc syringe
• Sterile water
• Cotton balls with betadine
• Lubricant
• Sterile gloves
• Urine bag
• Micropore

25. Procedure of inserting catheter
• Explain the procedure to the patient.
• Provide privacy and adequate lightening and collect all articles.
• Position the male patient in supine position and female patient in
dorsal recommend position.
• Wash the hands.
• Drape the perineal area.
• Open the sterile catheter kit, using sterile technique.
• Put on the sterile gloves.
• Lubricate the catheter with sterile lubricant.
• Retract the foreskin of the penis in male and open the labial folds in
female.

26. Continued……..
• Clean the urethra in a circular manner from inside to outer.
• Hold the penis in 900 angle, insert the catheter and allow urinary
sphincter to relax.
• Lower the catheter and continue to advance the catheter.
Note: never force the catheter to advance and discontinue the
procedure if there is resistance.
• When the catheter reaches bladder urine starts to flow, gently insert
until 1-2 inches beyond where urine is noted.
• Inflate the balloon, using correct amount of sterile liquid.

27. Continued………
• Gently pull the catheter until inflation balloon is sung against bladder
neck, and connect the catheter to drainage system.
• Fix the tube with micropore and keep bag below the bladder level.
After care of procedure and articles
• Discard the waste, Remove gloves and replace the articles.
• Wash hands, and document the procedure.

28. Catheter care
• Fix the catheter to thigh or abdominal wall of the patient.
• Always keep urine bag below the bladder level.
• Everyday morning catheter care should be given with aseptic
techniques.
• Maintain close drainage system.
• Irrigate bladder with antimicrobials.
• Routinely examine for any signs of infection.
• Don’t collect urine sample from urine bag or catheter directly.
• Provide Perineal care.
• Don’t allow the faecal matter to contaminate the catheter.

29. Removal of Urinary catheter
• Once patient got relieved from the condition physician can plan to
remove the catheter.
• Take a Sterile 10/20cc syringe.
• Deflate the catheter.
• Pull the catheter gently until catheter come out.
• Discard the catheter, wash hands and document the procedure.