Urinary catheterization is the process of inserting a fine latex or silicon catheter into the urinary bladder to aid urine flow or keep the urethra open. This procedure is mostly done for patient/client who have urinary condition that affects their micturition. It is also passed for patients who are to undergo major surgical procedures. It is an invasive procedure which requires strict aseptic technique. There are two main types of catheters namely: indwelling (Two-way and three-way) and external (Condom).
Aims
· Drain urine to keep patient dry
· Diagnostic purpose
· Treatment of urinary bladder conditions
· Assess urine output
Requirements
1. A trolley containing the following:
a. Top Shelf: A sterile pack or field containing the following:
· Two gallipots
· Three sterile drape, one sterile fenestrated drape
· Sterile cotton wool swabs
· Artery forceps
· Kidney dish
b. Bottom Shelf: Various catheters of different sizes used
· 14" and 16" for female
· 18" and 20" for male
· 8" and 10" for children
· Lubricant (e.g. K.Y. or xylocaine jelly)
· Diluted antiseptic solution
· Receiver for used swabs
· Mackintosh and dressing towel
· Urine bag
· Sterile water
· Specimen bottles if necessary
· Hypo-allergic tape or plaster
· Light source
· Sterile gloves
· 10-20mls syringe and needle
· Spigot if necessary
· Jug of warm water and bowel/bucket
· Bedpan
· Soap and towel
· Intake and output chart (manual or electronic)
2. Condom catheter
3. Urinal
Steps
1. Review doctor/physician’s order for catheterization
2. Establish rapport with patient (Refer to steps)
3. Explain procedure to patient (Refer to steps)
4. Provide privacy
5. Perform hand hygiene
6. Prepare and send trolley to the bedside
7. Protect bed with mackintosh and dressing towel
8. Perform hand hygiene and wear gloves
9. Instruct assistant to place patient in the supine position with knees flexed and legs separated
10. Cover patient’s upper body with a top sheet and fold the down over to expose the penis
11. Place bedpan under patient, wash and dry perineal area thoroughly with soap and water
12. Where necessary retract the prepuce so that the urethral meatus is exposed
13. Clean patient and remove bedpan
14. Remove the gloves and perform hand hygiene
15. Open the packs of sterile dressing and catheter container and place the contents onto the sterile field
16. Drape with a sterile towel and place the fenestrated drape over the penis exposing the urinary meatus
17. Wear new sterile gloves
18. Clean the area with antiseptic lotion wiping with backward motion from the urethral meatus
19. To straighten the urethra, lift the penis to an angle of 90°
20. Lubricate catheter with K.Y. or xylocaine jelly
21. Insert the catheter gently for about 16cm or until urine begins to flow leaving the open end in the receiver between the patient’s thighs
22. Inflate the balloon of the catheter with the sterile water according to manufacturer’s direction when urine flows out
23. Collect a urine specimen if necessary and allows 20 – 30mls to flow into bottle without bottle touching the catheter
24. Note: Slight resistance will often be met as the catheter encounters the external sphincter, therefore paus briefly and encourage the patient to breathe in deeply resulting in sufficient relaxation for the catheter to be passed readily for the urine to flow
25. Connect catheter to urine bag
26. Hang urine bag to the bed and secure in position
27. Observe colour and note amount of urine
28. Remove drapes, mackintosh and dressing towel
29. Remove gloves and perform hand hygiene
30. Assist patient into a desirable position
31. Dispose off used items, decontaminate and trolley
32. Perform hand hygiene
33. Document the procedure, urine output and any abnormalities in the nurses’ note, intake and output chart (manual or electronic)
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