Catheterization: NCM 107 Lab

NCM 107 LAB
CATHETERIZATION
FACTORS AFFECTING VOIDING
A. Developmental Factors
1. Infant – urinate as often as 20 times a day
- without urinary control
- colorless and odorless
- specific gravity 1.008
2. Pre-schooler – independent toileting
- Need instructions and assistance in wiping
3. School-age children – elimination system reaches maturity
- Urinates 6-8 times a day
- Common problems: a. enuresis b. nocturnal enuresis
4. Elders – 30% of nephrons are lost at age 80
B. Psychological Factors – set of conditions that help stimulate and micturition reflex
- The person is unable to relax abdominal and perineal muscles and the external urethral sphincter
C. Fluid and Food Intake
- Balance between the amount of food and fluid ingested and the amount to be eliminated
D. Medication
- Increase urine output and affects the color
E.
F. Muscle Tone – bladder muscle tone serves for filling and emptying urine normally
G. Pathologic Condition – disease of the kidney
- Heart and circulatory disorders
- Urinary stones
H. Surgical and Diagnostic Procedure
- Spinal anesthesia
- Cystoscopy
ALTERATION OF URINE PRODUCTION
 POLYURIA
- Abnormally large amount of urine output
 OLIGURIA
- Low urine output – 500ml/day or 30ml/hour
 ANURIA
- Lack of urine output
URINARY CATHETERIZATION
- the introduction of a catheter to the urethra into the urinary bladder

- usually performed when necessary
- allows the patient to drain urine freely from the urinary bladder for collection
URNARY CATHETERS
- made of plastics or rubbers or latex, or silicone, polyvinylchloride

- the larger the number, the larger the lumen
- TYPES
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Catherine Prado BSN II-B
NCM 107 LAB
o Straight Catheter – a single lumen tube with a small eye or opening about 1 ¼ cm from
insertion tip
o Retention Catheter or Foley Catheter – double lumen catheter
- used to inflate balloon
ALTERATIONS OF URINARY ELIMINATION
 Urinary Frequency
 Nocturia
 Dysuria
 Enuresis
 Urinary Incontinence
 Urinary Retention
 Neurogenic Bladder
TYPES OF FOLEY CATHETERS
 Robinson one-way catheter (straight cath)

 Robinson two-way catheter silicon
 Coude two-way catheter latex
 Robinson three-way catheter latex
TYPES OF URINARY CATHETER
There are three main types of catheters:
 Indwelling Catheter
 Condom Catheter
 Intermittent (short-term) catheter
Three-way Foley Catheter- used for patient who require continuous bladder irrigation
Third Lumen – where the sterile irrigating solution flows into the bladder
- The fluids then exits the bladder through the drainage lumen along with the urine
SELECTING APPROPRIATE CATHETER
 Select the type of material in accordance with the estimated length of the catheterizing periods
a. Use plastic cath for short period only
b. Use a rubber cath for periods of 2-3 weeks
c. Use silicone cath for long-term use
d. Use PVC cath for 4-6 weeks
CATHETERIZING THE FEMALE URINARY BLADDER
 Equipment
o Sterile catheter kit
- Sterile gloves
- Sterile drapes
- Sterile catheter
- Antiseptic solution
- Lubricant
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NCM 107 LAB
- Cotton balls or Gauze square
- Forceps
- Prefilled Syringe
- Basin
- Specimen container
- Flashlight or lamp
- Waterproof disposable pod
- Disposable urine collection bag and drainage tubing
- Velcro leg strap or tape
 Procedure
o Assemble equipment
o Perform hand hygiene
o Explain the procedure
o Provide for good light
o Provide privacy by closing the curtains or door
o Assist patient to dorsal recumbent position with knees flexed at about 2 feet apart
o Drape the patient
o Slide waterproof drape under the patient
CATHETERIZATION
 Done gloves. Spread the labia well with fingers, and clean area at vaginal orifice with washcloth and warm water
using a different corner of the washcloth with each stroke. Wipe from above the orifice downward toward the
sacrum. Rinse and dry. Remove gloves. Perform hand hygiene again
 Prepare urine drainage, set up if indwelling catheter is to be inserted and if a separate urine collection system is
to be used. Secure to bed frame according to manufacturer’s directions.
 Open the catheterization tray in a clean overbed table using sterile technique
 Put on the sterile gloves. Grasp upper corner 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 with her gloved protected cuff.
 A fenestrated sterile drape may be placed over the perineal are exposing the labia.
 Place sterile tray on drape between patient’s thighs.
OPEN ALL SUPPLIES IF:
 If catheter is to be indwelling test catheter balloon. Remove protected cap on tip of syringe prefilled with sterile
water to injection port. Inject appropriate amount of fluid. If balloon inflates properly, withdraw fluid and leave
syringe attached to port.
 Using cotton balls held with forceps, move cotton ball from above meatus down toward rectum discarding each
cotton ball after one downward stroke.
 Clean both labia folds and directly over the meatus, discarding each cotton ball after one downward stroke
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NCM 107 LAB
 With uncontaminated gloved hand, place drainage end of catheter in receptable
 For insertion of indwelling catheter that is pre-attached to sterile tubing and drainage container, position
catheter and set up within easy reach on sterile field
 Ensure that clamp on drainage bag is closed
 Insert catheter tip into meatus 5 to 7.5 cm or until urine flows. Do not force catheter through urethra into
bladder
 Ask patient to breath deeply, and rotate catheter gently if slight resistance is met as catheter reaches external
sphincter
 For an indwelling catheter, once urine drains, advance another 2.5 – 5 cm
 Hold catheter securely with non-dominant hand while bladder empties
 Collect a specimen if required, specimen should be caught in middle of flow. After 50-100mL or urine is drained,
place specimen collection device under opening of the catheter and allow urine to drain into container
 When enough urine has been caught, remove specimen container
 Continue drainage according to agency policy
 Remove catheter smoothly and slowly if a straight catheterization was ordered
 If catheter is to be indwelling:
o Inflate balloon according to manufacture’s recommendations. Inject entire volume supplied in prefilled
syringe.
o Tug gently on catheter after balloon is inflated to feel resistance
o Attach catheter to drainage system if necessary
 Secure to upper thigh with Velcro leg strap or tape. Leave some slack in catheter for leg movement
 Check that drainage tubing is not kinked and that movement of side rails does not interfere with catheter to
drainage bag
 Remove equipment and make patient comfortable in bed. Care of equipment according to agency protocol.
Send the urinary specimen to the laboratory promptly.
 Perform perineal care as described in action 5
 Remove gloves from inside out. Perform hand hygiene
 Record the time of catheterization, size of catheter, and balloon, amount of urine removed, urine appearance
whether a specimen was sent, and patient’s reaction in the medical record, also document urine amount on
intake and output flow sheet.
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NCM 107 LAB

ALTERATION OF URINE PRODUCTION

- the introduction of a catheter to the urethra into the urinary bladder

- made of plastics or rubbers or latex, or silicone, polyvinylchloride

ALTERATIONS OF URINARY ELIMINATION

TYPES OF FOLEY CATHETERS

 Robinson one-way catheter (straight cath)

TYPES OF URINARY CATHETER

There are three main types of catheters:

SELECTING APPROPRIATE CATHETER

CATHETERIZING THE FEMALE URINARY BLADDER

 Place sterile tray on drape between patient’s thighs.

OPEN ALL SUPPLIES IF:

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