Urinary Catheterization

Types of Catheter
Foley catheter Robinson catheter Coud catheter irrigation catheter external Texas or condom catheter

A Foley catheter is retained by means of a balloon at the tip which is inflated with sterile water. The balloons typically come in two different sizes: 5 cc and 30 cc. They are commonly made in silicone rubber or natural rubber.

A Robinson catheter is a flexible catheter used for short term drainage of urine. Unlike the Foley catheter, it has no balloon on its tip and therefore cannot stay in place unaided.

A Coud catheter is designed with a curved tip that makes it easier to thread the catheter pass the prostate or obstructions in the urethral canal. A Coud catheter tip may be provided with a balloon or not.

An irrigation catheter has a separate lumen to carry irrigation fluid into the bladder. This is useful following endoscopic surgical procedures or in the case of gross hematuria.

An external Texas or condom catheter is used for incontinent males and carries a lower risk of infection than an indwelling catheter.

Catheterization is the introduction of catheter

through the urethra into the urinary bladder Purposes

To relieve discomfort due to bladder distention or provide gradual decompression of a distended bladder. To assess the amount of residual urine if the bladder empties incompletely.

 To obtain a urine specimen To facilitate accurate measurement of urinary output for critically ill clients whose output needs to be monitored hourly To provide for intermittent or continuous bladder drainage and irrigation.

Purposes
To prevent urine from contacting an incision after perineal surgery To manage incontinence when other measures have failed

Assessment
Determine the most appropriate method of catheterization based on the purpose such as total amount of urine to be removed or size catheter to be used. Use straight catheter if only a spot urine specimen is needed if amount of residual volume is being measured. Use an indwelling/retention catheter if the bladder must remain empty or continuous urine measurement/collection is needed.

 Assess the clients over all condition Determine when the client last voided or was last catheterized. Percuss the bladder to check for fullness or distension. Equipment Catheterization kit or sterile individual sterile items. 1-2 pair sterile gloves Rubber sheet Antiseptic solution

Cleansing balls Forceps Urine receptacle Water soluble lubricant Specimen container 10 cc syringe Distilled water Clean gloves Bath blanket or sheet for draping the client Adequate lighting ( obtain flashlight or lamp if necessary)

Preparation
If using a catheterization kit, read the label carefully to be sure all necessary items are included. Perform routine perineal care to cleanse the meatus from gross contamination. For women, use this time to locate the urinary meatus.

Procedure
Explain the procedure to the client. Do hand washing. Provide for client privacy. Place the client in the appropriate position and drape all areas except the perineum. a. Female: dorsal recumbent b. Male: supine, legs slightly abducted 5. Establish adequate lighting. 1. 2. 3. 4.

6. Open the drainage package and place the end of

the tubing within the reach. 7. If agency policy permits, apply clean gloves and inject 10 15 ml of xylocaine gel into the urethra. Male client, wipe the underside of the shaft to distribute the gel up to the urethra. Wait at least 5 minutes for the gel to take effect. 8. Open the catheterization kit. Place a waterproof drape under the buttocks without contaminating the center of the drape with your hands. 9. Apply sterile gloves 10. Organize the remaining supplies. a.Saturate the cleansing balls with antiseptic sol.

b. Open the lubricant package. c. Remove the specimen container and place it nearby with the lid loosely on top 11.Attach the pre filled syringe to the indwelling catheter inflation hub and test the balloon. 12. Lubricate the catheter. For female 1 to 2 in., for males 6 to 7 in. 13. If desired, place the fenestrated drape over the perineum exposing the urinary meatus. 14. Cleanse the meatus. The non dominant hand is considered contaminated once it touches the clients skin.

15. Insert the catheter Grasp the catheter firmly 2-3 in. from the tip. Ask 2the client to take a slow deep breath and insert the catheter as the client exhales. Slight resistance is expected as the catheter passess through the sphincter. Advance the catheter 2 inches further after the urine begins to flow to ensure it is fully on the bladder. If the catheter accidentally contacts the labia or slips into the vagina, it is considered contaminated and new sterile catheter must be used.

Insertion of the catheter

16. Hold the catheter with the non dominant hand. In males, lay the penis down into the drape, be careful does not pull out the catheter. 17. Inflate the retention balloon

18. Collect a urine specimen if needed about 20 30 ml to flow into the bottle without touching the catheter to the bottle. 19. Allow the straight catheter to continue draining. Attach the drainage end of an indwelling catheter to the collecting tubing and bag. 20. Examine and measure the urine. Only 7507501000 ml of urine are to be drained one at a time

21. Remove the straight catheter when urine flow stops. Secure the catheter tubing to the inner thigh for female clients or the upper thigh/abdomen for male with enough slack to allow usual movement. Secure the collecting tubing to the bed linens and hang the bag below the level of the bladder. 22. Wipe the perineal area of any remaining antiseptic and lubricant. Return client to a comfortable position. 23. Discard all used supplies in appropriate receptacle and wash your hands.

24. Document catheter procedure including size

Normal characteristics of the stool

1. 2. 3. 4. 5. 6. Color yellow or golden brown Odor aromatic upon defecation Amount approx. 150-300g per day 150Consistency soft, formed Shape cylindrical Frequency variable usual range 1-2/day 1-

Alteration on the characteristics of stool

1. 2. 3. 4. Acholic stool gray, pale or clay colored stool Hematochezia stool with bright red blood Melena black tarry stool Steatorrhea greasy, bulky, foul smell stool

Types of enemas
1. Cleansing enema a. High enema 1000 ml instilled to the colon b. Low enema 500 ml of fluid id used, prepackaged disposable enema 2. Oil retention small volume enema that soften hard stool 3. Medicated enema 4. Return flow enema used to remove flatus and stimulate peristalsis often done after surgery

Solution used
Tap water a hypotonic solution that may be drawn into the body cells and cause water toxicity, electrolyte imbalance and circulatory overload. 500-1000ml 500 Normal saline isotonic solution that considered safe ( 9ml of NaCl to 1000ml of water Hypertonic prepackaged small volume enemas used to draw fluid from the body to moisten the stool ( Fleet enema)

Soap solution very irritating to the colon rarely used (20 ml of castile soap in 500 1000 ml) Oil moisten hardened stool(90-120 ml of stool(90mineral, olive or cottonseed oil) Carminative provides relief from gas ( MGW solution)

Enema
Purposes 1. To relieve constipation and fecal impaction 2. To relieve flatulence 3. To administer medication 4. To evacuate feces in preparation for diagnostic procedure or surgery.

Assessment
When was the last bowel movement and the amount, color, consistency of the feces. Presence of abdominal distention Whether the client can use a toilet or commode or must remain in bed and use a bedpan

Equipments
Absorbent pad Bedpan or commode Clean gloves Ky jelly Paper towel Enema can Correct solution, amount and temperature IV pole Prepackaged container of enema solution

Preparation
Lubricate about 5 cm ( 2 in.) of the rectal tube. Lubrication facilitates insertion through the sphincters and minimizes trauma. Prime the tubing and the rectal tube to expel air then close the clamp. Air instilled into the rectum can cause distention.

Procedure
1-3 4. Assist the client to left lateral position with the right leg acutely flexed and the absorbent pad under the buttocks. This position facilitates the flow of the solution by gravity into the sigmoid and descending colon. Having the right leg acutely flexed provides for adequate exposure of the anus.

5. Insert the rectal tube

Lift the buttocks to ensure visualization of the anus. Insert the tube smoothly and slowly into the rectum, directing it towards the umbilicus. Slow insertion prevents spasm of the sphincter. Insert the tube 7-10 cm(3-4 in.) 7- cm(3 If resistance is encountered, at the internal sphincter, ask the client to take a deep breath then run small amount of fluid to relax the internal anal sphincter.

 Never force tube or solution entry. If instilling small amount does not permit the tube to be advanced, withdraw the tube. Check for stool that may have blocked the tube during insertion. Digital rectal examination to determine impaction. If resistance persists, end the procedure and report to the physician. 6. Slowly administer the enema solution Raise the solution container and open the clamp to allow fluid flow.

 Low enema- hang the enema container no enemahigher than 30 cm ( 12 in.) above the rectum. High enema- hang enema container about 45 enemacm ( 18 in.) The fluid must be instilled farther to clean the entire bowel. Administer solution slowly. If client complains of fullness or pain, use the clamp to stop the flow for 30 seconds, then restart the flow at slower rate. After all solution has been instilled or when the client cannot hold and feels the urge to defecate, close the clamp and remove rectal tube.

 Place the rectal tube in a disposable towel as you withdraw. 7. Encourage the client to retain the enema Ask the client to remain lying down. Request to retain the solution for:
Cleansing enema 5-10 minutes 5 Retention enema- 30 minutes enema-

8. Assist the client to defecate

Assist the client to sitting on a bedpan, commode or toilet

 Ask the client not to flush. The nurse needs to observe the feces. If specimen is needed, ask the client to use bedpan or commode Return flow enema 100- 200 ml for adult 100 Instilled into rectum and sigmoid colon Container is lowered so that fluid flows back out, pulling the flatus Process repeated 5-6x to stimulate peristalsis and 5expulsion of flatus 9. Documentation