Urinary Catheter

Urinary Catheter

1. Indweling catheter

   • Inserted in the urethra via the urinary meatus, process called transurethral catheterization
   • EX: Foley Catheters
     • Continuous drainage of urine
       • Double lumen, 40cm in length, made of latex, sillicone or polyurethane. Sizes from 14-48Fr
         • The bigger the number, the bigger teh diameter
         • One lumen to drain urine, other to inflate balloon with sterile water. NS crystalizes and impeded balloon removal
           • Tripple lumen if continuous bladder irrigation is needed
           • Adults: 14-18Fr. Adults with gross hematuria:20-30Fr Adult males with prostatic obstruction: coude tip >18Fr
             • gross means you can see the blood

2. Transurethral catheterization

   • Aseptic technique. Catheter inserted via urethral meatus, advanced in urethra until tip is i bladder. Inflate baloon, drainage bag, secure below level of bladder to drain by gravity.
     • To measure urine output or residual bladder volume.
     • Collection of sterile urine
       • intermittent catheter it it's the only goal
     • DX
       • where bladder needs to be filles Males: pelvic u/s, cytoscopy
     • Decrompress bladder in urinary retention
       • acute or chronic obstruction or neurogenic bladder.Urinary retentionc na lead to hydronephrosis (distentiona dn dilation of renal pelvices and calyses as urin back up in kidnye), can cause infection
     • Incontinence
     • Irrigation
       • after TURP- TRANSURETHRAL RESECTION OF PROSTATE

3. Contraindications

   • Trauma to lower urinary tract
     • suspected extraperitoneal injury is not a contraindication, intraperitoneal is 
   • No pre inflating balloon, deflating can create crease that can lead to urethral trauma

4. Pre insertion

   • MALE URETHRA: preprostatic (between the bladder and the prostate), prostatic (lies within the prostate gland and includes the terminus of the ejaculatory ducts), membranous (between the prostate and the bulb of the penis), and spongy (through the penis)
   • Know type, size and reason for FC before insertion
   • Manufacturer's instruction
   • Review pt renal hx
   • Allergies
   • Lab values (CBC, PTT...)

5. Supplies

   • Non sterile gloves
   • Absorbent pad
   • Bath basin with warm soapy water and washcloth
   • Patient label and biohazard bag if urine specimen is indicated
   • Sterile glove, Fc of good size, square drape, fenestrated drape, antiseptic (providone-iodine of chlorhexidine if allergic).
   • Sterile swabs, forceps, cotton balls
   • Lubricant, 10mL syringe with prefilled sterile water. Drainage bag and facility approved securement device.

6. Insertion

   • males: ontinue to advance the catheter until the Y-shaped distal ports are near the urethral orifice, ~ 18–20 cm /7–8 inches in adult males or until urine begins to flow. Once urine appears, continue to advance the catheter an additional 2.5–5 cm/1–2 inches to make certain that the catheter tip rests within the bladder
   • HH, Identify pt, privay
     • Explain procedure, may need to couhg or bare down to allow insertion, it will be lubricated, may be uncomfortable, cna stop anytime, feel bit pressure
   • Don't force catheter if there is obstruction, ask pt to deep breathe if not notify physician
     • Securement according to protocole
       • or reverse gutter technique on piece of tape horizontal, 2 pieces vertical on each side, rmemeber tug catheter make sure it's in place until meetign resistance Youc an also use hydrocolloidal dressing and tape

7. Document

   • Date, time of procedure
   • Procedure: size catheter,volume of sterile water, analgesic, anesthetic..
     • Assessment findings
       • pain level voluem and charac of urine  analgesic used change in bladder distention record ins and out
     • Patient tolerance
     • Teaching
     • Unexpected events