Catheterization

Catheterization
Catheterization is accomplished by inserting
a catheter (a hollow tube, often with and
inflatable balloon tip) into the urinary
bladder

Aninvasive procedure that should only be

carried out by a qualified competent health
care professional using aseptic technique.
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
Indications
Todrain 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

Torelieve urinary incontinence when no

other means is practical
 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
 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.
 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.

 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.
 Patientsof 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
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.
EXTERNAL GENITALIA
EXTERNAL GENITALIA
Aim

Toensure the insertion and care of the

urinary catheter is carried out in a manner
that minimizes trauma and infection
risks.
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
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
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
Age Weight Foley

Neonate < 1200g 3.5Fr umbilical catheter

Neonate 1200-1500g 5Fr umbilical catheter
Neonate 1500-2500g 5Fr umbilical catheter or size 6 Foley
0-6 3.5-7kg 6
months
1Y 10kg 6-8
2Y 12kg 8
3Y 14kg 8-10
5Y 18kg 10

6Y 21kg 10

8Y 27kg 10-12

12Y Varies 12-14

Procedure
Procedure
1.Gather the equipments needed.
2. Identify the client and explain
the procedure.
3. Wash hands.
4. Assists the client to an
appropriate position and drape all
areas except the perineum.
a. Female-dorsal recumbent
b. Male- supine with legs slightly
abducted.
5. Established adequate lighting.
6.Open the catheterization set and
arranges the sterile field.
Rationale
To promote efficiency in the
procedure.
To alley fear and anxiety of the
patient regarding his condition
and the procedure.
For infection control.
To relax muscles and allow
visualization of the area to
facilitate the insertion of the
catheter.
Good lighting is necessary to see
the perineum clearly.
Placement of equipment in order of
use increases the speed of
performance and decrease the risk
of contamination.
Procedure
7. Set up receptacle for soiled
cleaning swabs.
8. If drainage bag is in separate
bag, open and attach to the bed.
9.Put on sterile gloves.
10. For an Indwelling catheter,
attach syringe and test balloon by
instilling sterile water and
deflating balloon by withdrawing
the water.
11. If drainage bag is in set,
connect distal end of catheter to
drainage tubing.
Rationale
To facilitates systematic action.
To reduce the risks of infection
by keeping the bag off the flow
because the flow is grossly
contaminated.
To prevent contamination.
To check for the balloon
patency and for a defect in
catheter.
To prevent urine spilling from a
collecting container while
performing the procedure.
Procedure
12. Clean urinary meatus with
antiseptic solution using downward
stroke.
13. Lubricate the distal portion of
the catheter and place it on a
nearby sterile field.
14. Insert the catheter gently, in
rotating motion. Instruct the client
to take a slow deep breath upon
insertion. For male patient , hold
the penis at 45 degree angle until
urine flows.
a. Length of catheter insertion
male: 6-9 inches
15. Inflate the retention balloon
with sterile water.
16.Tape the catheter to the thigh of
a female patient and to the lower
abdomen for a male patient.
Rationale
To remove dirt and minimize the
risk of urinary tract infection by
removing surface pathogens.
To reduce friction and possible
irritation as catheter inserted.
To relax the sphincter , in order
to facilitate the insertion of
catheter.
To straighten the urethra and
facilitate the insertion.
To prevent the catheter from
slipping out of position.
To prevent pull on the neck of the
bladder as the patient moves.
Procedure Rationale
17. Secure the drainage tubing To allow the bladder to drain
and place drainage bag below freely by gravity.
the level of the bladder.

18. Assist the client to a To provide comfort and safety.

comfortable position.

19. Gather and discard To prevent contamination.

disposable equipment.

20. Wash hands. To prevent the transmission of

microorganisms.

21. Document the procedure. Provides accurate data in the

care of the client.
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
Documentation
Indication for catheterization
Time and date of procedure
Type of catheter.
Size of catheter
Expiry date of catheter
 Amount of water in balloon
Any problems with insertion
Description of urine, colour and
volume
Specimen collected
Review date
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)
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
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
 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
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
 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
 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
 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
 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
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
 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
Complications

Inability to catheterize
Urethral injury from trauma sustained during
insertion or balloon inflation in incorrect position
Haemorrhage
False passage
Urethral strictures following damage to urethra. This
may be a long term problem
 Infection
Psychological trauma
Paraphimosis due to failure to return foreskin to
normal position following catheter insertion
 Bulb Suctioning an Infant
Definition
It is the aspiration of secretion through the use of bulb
syringe.

Purpose
To clear air passages of infant.
To maintain patent airway.

Equipment
Sterile bulb syringe
Clean diaper or towel
Small Container
Clean gloves
PROCEDURE RATIONALE
1.) Assess the rate and depth of the o Provides assessment data;
infants respiration as well as the
determines the need of
breathing sounds and chest movement.
Note also the pulse rate and the skin color. suctioning. Usually doctors
Check the mouth and nose for the order is not needed.
presence of secretions.
2.) Wash hands o To limit the transfer of
microorganisms.
3.) Assemble the equipment. o To promote efficiency.
4.) Identify the client. Explain the o To gain cooperation of each
procedure to the mother or the member of the family.
family.
5.) Put on clean gloves. o To protect against secretions.
6.) Position the infant. Wrap the o Gravity will help move
infant with a small sheet if secretions from the back of the
necessary. The infants head throat to the mouth, where
should be flat on the surface of they can be suctioned more
the crib. A newborn can be held in readily.
a football fashion, with the held
slightly downward.
 PROCEDURE
8.) Insert the syringe tip into the
mouth and release the bulb.
9.) Remove the syringe and
compress the bulb, expressing
the contents into the basin.
10.) Repeat steps 7 to 9 until the
infants checks and mouth are
clear.
11.) Carefully suction the nostril,
placing the syringe tip just at
each opening.
12.) Remove gloves and discard
them appropriately.
13.) Place the infant on the side
after suctioning.
14.) Wash your hands.
15.) Record the procedure.
RATIONALE
o To aspirate or suck secretions from
the mouth.
o Clear bulb from secretions
o To ensure thorough draining of
secretions.
o To prevent irritation on the nausea
passages.
o To prevent contact with the
secretions.
o To drain remaining secretions.
o To limit the transfer of
microorganisms.
o To provide accurate data in the
care of client.