This document provides information on urinary elimination and catheters. It discusses catheter types including condom, straight, indwelling, and suprapubic catheters. Proper technique is outlined for inserting and removing catheters as well as caring for a patient with a catheter. Complications during insertion and their management are also reviewed.

1. URINARY ELIMINATION
& CATHETERS

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. Urinary Elimination System

4. Anatomy
Kidney - Urine p ro duc tio n
Ureters - Tube s which c o nne c t the kidne y s to the
bla d d e r.
Bladder - Re s e rvo 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 .
Male = 20 cm long
Female = 4 cm long

5. Anatomy Facts
 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

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 sm a ll am o unts o f urine with
phy s ic a l s tre s s i. e . c o ug hing o r s ne e z ing

7. Catheterization - Reasons
 Urge - Invo lunta ry p a s s a g e o f urine a fte r fe e ling
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 UTIs a nd tum o rs .
 Functional - Invo lunta ry , unp re d ic ta ble p a s s a g e
o f urine re la te d to no c a ll lig ht o r im m o bility , e tc .

8. Alternative to Catheterization
 Bladder Scan
 Estimates residual urine
 Increased use over straight catheterization
 90% accuracy
 Decreases risk of infection and discomfort to patient

9. PRIOR to Catheterization
KKnnooww aanndd CCoonnffiirrmm
 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. Catheter Types - Condom
CCoonnddoomm CCaatthheetteerr
(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. 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. Catheter Types - Straight
SSttrraaiigghhtt CCaatthheetteerr
 Removes urine from bladder aseptically due to
1. Incontinence
2. Post void residuals
3. Sterile specimen
 Do e s no t a tta ch to a c o lle c tio n ba g
 Co ns id e re d a s te rile p ro c e dure

13. Catheter Types - Indwelling
Indwelling CCaatthheetteerr ((FFoolleeyy))
 To remove urine aseptically
 Sterile procedure
 Has urinary collection bag
 May be used for extended periods of time

14. Catheter Types - Suprapubic
SSuupprraappuubbiicc
 Catheter inserted into the bladder through an
opening in the lower abdomen (a bo ut 1 inch
a bo ve the s ym phy s is p ubis )
 Placed under anesthesia
 May be left in place for long periods of time
 Sutured into place.

15. Rules for Catheterization
1. Wash hands, use gloves
2. Tubing without kinks/obstructions
3. Drainage bag below bladder
4. Attach to non-movable bed part
5. Secure with leg strap
6. Check system for leaks
7. Perform perineal care BID, after all BMs &with cath care
8. Watch I&O closely
9. Report complaints of discomfort to nurse (pain, burning,
irritation)
10. Record amount, color, clarity, odor, particles

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. 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. 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

19. Insertion of Indwelling Catheter
 If indwelling catheter, GENTLY tug on catheter
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

20. Other Considerations
When performing straight cath
 Know policy & procedure for maximum amount
of urine allowed to be withdrawn.
To place catheter in an uncircumcised man
 Carefully pull back foreskin before cleansing

21. Documentation
DDooccuummeenntt
 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. Problems During Insertion
Catheter inserted iinnttoo VVaaggiinnaa
1. Leave in place
2. Reposition fingers to re-visualize meatus
3. Use new catheter
4. Repeat procedure

23. Problems During Insertion
Unable to iinnsseerrtt iinnttoo ffeemmaallee
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. Problems During Insertion
Unable to insert ccaatthheetteerr iinnttoo mmaallee
1. Notify nurse
2. Repeat procedure but change the angle of the
penis
3. Try an a coude catheter

25. Problems During Insertion
Catheter comes out with bbaalllloooonn iinnffllaatteedd
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. Care of Patient with a Catheter
1. Keep catheter bag below level of bladder
2. Attach drainage bag to bed frame (not side rails)
3. Secure tubing onto bed – urine should flow freely
from catheter to bag (coil tubing on bed)
4. Empty catheter bag every 8 hours or prn
5. Provide catheter care & pericare as needed
6. Do not allow the drain on the bag to touch any
surface
7. Keep drainage bag off the floor

27. Catheter Removal
1. Physician’s order
2. Gather supplies- 10cc syringe, gloves, chux
3. Deflate balloon- note amount withdrawn
4. Avoid pubic hair
5. Pinch catheter; pull out on exhalation steadily &
gently
6. Measure output
7. Discard catheter bag properly
8. Provide peri care
9. Monitor patient for output
10. If not voided in 4-6 hours, notify nurse

28. Following Catheter Removal
1. Patient to void within 4-6 hours
2. Urine amount 120-240 ml (or per policy)
3. Observe bladder for distention
4. Monitor patient for any complaints of painful
urination
5. Monitor patient for hematuria

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. Voiding Following Catheter
Removal
Hints to assist patient to void aafftteerr ccaatthheetteerr
rreemmoovvaall
 Encourage oral fluids
 Proper position to urinate
 Sound of running water
 Sitz bath

31. Catheter Specimen - Syringe

32. Urinary Diversions
DDeeffiinniittiioonn
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. 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. Noncontinent Urinary Diversions
 Patient cannot control urine
 Must wear an external urinary ostomy
pouch
Types of non-continent uurriinnaarryy ddiivveerrssiioonnss
1. Ureterostomy

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. 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. Ureterostomies