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    Urinary Elimination 26

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    Mitul Peter
    Nursing care for clients with indwelling catheters focuses on preventing urinary tract infections through encouraging fluid intake, monitoring intake and output, and maintaining catheter and drainage system integrity. Key aspects include changing the catheter and tubing as needed, ensuring unobstructed drainage, and teaching clients self-care measures. Assessment focuses on checking for obstructions, tension, or leaks in the system and monitoring urine output.

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    Urinary Elimination 26

    Uploaded by

    Mitul Peter
    22 views1 page
    Nursing care for clients with indwelling catheters focuses on preventing urinary tract infections through encouraging fluid intake, monitoring intake and output, and maintaining catheter and drainage system integrity. Key aspects include changing the catheter and tubing as needed, ensuring unobstructed drainage, and teaching clients self-care measures. Assessment focuses on checking for obstructions, tension, or leaks in the system and monitoring urine output.

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    Urinary Elimination

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    Nursing care for clients with indwelling catheters focuses on preventing urinary tract infections through encouraging fluid intake, monitoring intake and output, and maintaining catheter and drainage system integrity. Key aspects include changing the catheter and tubing as needed, ensuring unobstructed drainage, and teaching clients self-care measures. Assessment focuses on checking for obstructions, tension, or leaks in the system and monitoring urine output.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    22 views1 page

    Urinary Elimination 26

    Uploaded by

    Mitul Peter
    Nursing care for clients with indwelling catheters focuses on preventing urinary tract infections through encouraging fluid intake, monitoring intake and output, and maintaining catheter and drainage system integrity. Key aspects include changing the catheter and tubing as needed, ensuring unobstructed drainage, and teaching clients self-care measures. Assessment focuses on checking for obstructions, tension, or leaks in the system and monitoring urine output.

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    CHAPTER 48 / Urinary Elimination 1309

    Nursing Interventions for Clients with Indwelling Catheters


    Nursing care of the client with an indwelling catheter and continuous drainage is largely directed toward preventing infection of the urinary tract and encouraging urinary flow through the drainage system. It includes encouraging large amounts of fluid intake, accurately recording the fluid intake and output, changing the retention catheter and tubing, maintaining the patency of the drainage system, preventing contamination of the drainage system, and teaching these measures to the client.

    BOX 48-4 Ongoing Assessment of Clients with Indwelling Catheters


    b Ensure that there are no obstructions in the drainage. Check that there are no kinks in the tubing, the client is not lying on the tubing, and the tubing is not clogged with mucus or blood. m Check that there is no tension on the catheter or tubing, that the catheter is securely attached to the thigh or abdomen, and that the tubing is fastened appropriately to the bedclothes, si Ensure that gravity drainage is maintained. Make sure there are no loops in the tubing below its entry to the drainage receptacle and that the drainage receptacle is below the level of the client's bladder. ss Ensure that the drainage system is well sealed or closed. Check that there are no leaks at the connection sites in open systems. m Observe the flow of the urine every 2 or 3 hours, and note color, odor, and any abnormal constituents. If sediment is present, check the catheter more frequently to ascertain whether it is plugged.

    FLUIDS. The client with a retention cathctcr should drink up to 3,000 mL per day if permitted. Large amounts of fluid ensure a large urine output, which keeps the bladder flushed out and decreases the likelihood of urinary stasis and subsequent infection. Large volumes of urine also minimize the risk of sediment or other particles obstructing the drainage tubing. DIETARY MEASURES. Acidifying the urine of clients with a retention catheter may reduce the risk of urinary tract infection and calculus formation. Foods such as eggs, cheese, meat and poultry, whole grains, cranberries, plums and prunes, and tomatoes tend to increase the acidity of urine. Conversely, most fruits and vegetables, legumes, and milk and milk products result in alkaline urine. PERINEAL CARE. No special cleaning other than routine hygienic care is necessary for clients with retention catheters, nor is special meatal care recommended. Agency practices regarding catheter care vary considerably. The nurse should check agency practice in this regard.
    CHANGING THE CATHETER AND TUBING.
    R o u t i n e c h a n g i ng

    REMOVING

    INDWELLING

    CATHETERS.

    Indwelling

    catheters

    are removed after their purpose has been achieved, usually on the order of the primary care provider. If the catheter has been in place for a short time (e.g., a few days), the client usually has little difficulty regaining normal urinary elimination patterns. Swelling of the urethra, however, may initially interfere with voiding, so the nurse should regularly assess the client for urinary retention until voiding is reestablished. Clients who have had a retention catheter for a prolonged period may require bladder retraining to regain bladder muscle tone. With an indwelling catheter in place, the bladder muscle does not stretch and contract regularly as it does when the bladder fills and empties by voiding. A f e w days before removal, the catheter may be clamped for specified periods of time (e.g., 2 to 4 hours), then released to allow the bladder to empty. This allows the bladder to distend and stimulates its musculature. Check agency policy regarding bladder training procedures. To remove a retention catheter, the nurse follows these steps: w. Obtain a receptacle for the catheter (e.g., a disposable basin); a clean, disposable towel; clean gloves; and a sterile syringe to deflate the balloon. The syringe should be large enough to withdraw all the solution in the catheter balloon. The size of the balloon is indicated on the label at the end of the catheter. m Ask the client to assume a supine position as for a catheterization. j Optional: Obtain a sterile specimen before removing the catheter. Check agency protocol. Remove the tape or catheter securing device attaching the catheter to the client, put on gloves, and then place the towel between the legs of the female client or over the thighs of the male. m Insert the syringe into the injection port of the catheter, and withdraw the fluid from the balloon. If not all of the fluid can be removed, report this fact to the nurse in charge before proceeding. a D o not pull the catheter while the balloon is inflated; doing so may injure the urethra.

    of catheter and tubing is not recommended. Collection of sediment in the catheter or tubing or impaired urine drainage are indicators for changing the catheter and drainage system. When this occurs the catheter and drainage system are removed and discarded, and a new sterile catheter with a closed drainage system is inserted. Guidelines to prevent catheter-associated urinary tract infections are given in Practice Guidelines. Ongoing assessment of clients with retention catheters is a high priority (see Box 4 8 - 4 ) .

    PRACTICE GUIDELINES Preventing Catheter-Associated Urinary Infections


    H a v e an established infection control program. Catheterize clients only w h e n necessary, by using aseptic technique, sterile equipment, and trained personnel. Maintain a sterile closed-drainage system. Do not disconnect the catheter a n d drainage tubing unless absolutely necessary. R e m o v e the catheter as soon as possible. Follow a n d reinforce good hand washing technique. Provide routine perineal hygiene, including cleansing with soap and water after defecation. Prevent contamination of the catheter with feces in the incontinent client.

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