FOLEY CATHETERIZATION USING STERILE TECHNIQUE N1300: SUMMER 2010 JAMIE JONES, RN BRIEF A&P REVIEW: URINARY SYSTEM

EM URINARY ELIMINATION

RED-RUBBER

CATHETERS, SINCE MANY ARE MADE FROM RED RUBBER

o FOLEY CATHETER ALSO KNOWN AS AN INDWELLING OR RETENTION CATHETER

BECAUSE IT REMAINS IN THE BLADDER FOR A PERIOD OF TIME TO HOLD IT IN PLACE) O

(HAS

A BALLOON

COUDE

MORE RIGID THAN OTHER CATHETERS AND HAS A TAPERED, CURVED

O O

URINARY IF

ELIMINATION IS ESSENTIAL TO HEALTH

TIP THAT IS USED FOR MEN WITH ENLARGED PROSTATES

THERE IS A FAILURE IN URINARY ELIMINATION, ALL BODY SYSTEMS CAN BE

WHEN
O

DO WE INSERT A

FOLEY?

AFFECTED

ONLY

WHEN ABSOLUTELY NECESSARY! IS DANGER OF INTRODUCING MICROORGANISMS

THE

NURSES ROLE: PREVENT PROBLEMS OR RECOGNIZE PROBLEMS AND ACT O

QUICKLY TO MINIMIZE DAMAGE O O

THERE

(GERMS)

INTO THE

DEPENDS URINE

ON FUNCTION OF KIDNEYS, WHICH REMOVE WASTE FROM BLOOD O

BLADDERTHEN UP THE URETERS AND INTO THE KIDNEYS

DANGER

OF INFECTION IS STILL PRESENT EVEN AFTER THE CATHETER IS IN

IS FORMED IN KIDNEYS AND TRAVELS DOWN URETERS INTO THE

PLACE BECAUSE THE PATIENT ISNT REGULARLY FLUSHING GERMS OUT

URINARY BLADDER, WHERE IT IS HELD UNTIL PRESSURE STIMULATES SPECIAL SENSORY NERVE ENDINGS IN THE BLADDER WALL FOR AN ADULT), CAUSING A NEED TO URINATE O O

(AROUND 250-450 MLS

WE

MIGHT INSERT A

FOLEY

WHEN

BLADDER LEAVES

CAN HOLD APPROXIMATELY

600 MLS

o THE PATIENT HAS URINARY RETENTION, AND ALL MEASURES FAIL TO INITIATE
VOIDING

BODY THROUGH URETHRA

o EMPTYING URINARY BLADDER = MICTURATION, VOIDING, URINATION

O

ALL

ORGANS MUST BE FUNCTIONAL AND INTACT FOR SUCCESSFUL REMOVAL O

ACCUMULATION OF URINE IN THE BLADDER, BECOMES DISTENDED PRESSURE DISCOMFORT TENDERNESS

BLADDER STRETCHES WALLS OF

OF WASTE

THE PATIENT IS UNDERGOING A SURGICAL PROCEDURE AND WILL BE

WHAT
O

IS URINARY CATHETERIZATION?

RECEIVING A GENERAL ANESTHETIC, OR IF THE PATIENT IS CRITICALLY ILL AND URINE OUTPUT MUST BE CLOSELY MONITORED

THE

INTRODUCTION OF A URINARY CATHETER INTO A PATIENTS BLADDER TO

ALLOW FOR THE PASSAGE OF URINE OUT OF THE BODY, OR TO INSTILL FLUID INTO THE BLADDER

PATIENT LOSES ALL VOLUNTARY URINARY CONTROL URINE OUTPUT MUST BE MONITORED CLOSELY

URINARY CATHETERIZATION
O

WHAT
O

ARE THE TYPES OF CATHETERS?

WHEN MOST

PROBLEMS OCCUR, INDWELLING CATHETERS ARE FREQUENTLY INSERTED ARE INSERTED BY NURSES USING STERILE TECHNIQUE TO PROTECT

STRAIGHT BALLOON) IN

OR INTERMITTENT

CATHETERS

DO NOT STAY IN THE BLADDER

(NO

PATIENT FROM INFECTION O

AND OUT CATHS, SINCE THEY DO NOT STAY IN THE BLADDER

FAILURE

TO ADHERE TO PROPER INSERTION TECHNIQUE CAN CAUSE SERIOUS

PROBLEMS O

PRIOR

TO SETTING UP THE STERILE FIELD:

HAZARDS ASSOCIATED WITH CATHETERIZATION

O

URINARY TRACT INFECTIONS (UTIS) INTRODUCTION OF BACTERIA INTO URINARY TRACT ONE OF THE MOST COMMON HEALTH-CARE ASSOCIATED (40% OF ALL HEALTHCARE-RELATED INFECTIONS!) URETHRAL TRAUMA ESPECIALLY
URETHRA

GRAB

A PARTNER IF YOU MIGHT NEED HELP, OR IF YOU NEED

ADDITIONAL LIGHTING STANDING LIGHT) INFECTIONS

(IF

YOUR NURSING UNIT DOES NOT HAVE A

DO

YOU NEED TO WASH AND DRY THE PERINEAL AREA USING SOAP

AND WATER?

(MAKE

SURE TO WASH YOUR HANDS AGAIN AFTER

CLEANSING THE PERINEAL AREA) FOR MALES, INSERT ALONG THE NORMAL CONTOUR OF THE

PLACE
FIELD

A PLASTIC BAG OR A TRASH CAN IN AN AREA THAT WILL ALLOW

FOLEY FACTS

MALE

URETHRA IS NORMALLY CURVED, BUT CAN BE GENTLY TO URETHRA CAN OCCUR IF THE CATHETER IS FORCED

YOU TO THROW THINGS AWAY WITHOUT REACHING OVER YOUR STERILE

STRAIGHTENED DURING INSERTION

DAMAGE

THROUGH STRICTURES

(TIGHT

PLACES) OR AT AN INCORRECT ANGLE O O O

SET

HAVE

EXTRA CATHETER AND GLOVES HANDY

UP STERILE FIELD AND MAINTAIN IT THROUGHOUT THE PROCEDURE STERILE GLOVES, AND BEGIN ORGANIZING SUPPLIES THE

o MOST ADULT FOLEY CATHETERS HAVE A BALLOON SIZE OF 10 ML THIS WILL

BE IMPORTANT WHEN REMOVING A O

DON

FOLEY

A NOTE ABOUT DO IF

DRAPES

SIZED

BY DIAMETER USING THE

FRENCH

SCALE

(FR) -

THE LARGER THE

NUMBER, THE LARGER THE LUMEN O

YOU USE THEM OR NOT?

TYPICAL

ADULT SIZE IS

ON SIZE OF URETHRAL

#14 FR TO #16 FR, SOMETIMES #18 FR CANAL (SMALLER FOR CHILDREN)

BASED

YOU CAN USE THEM EFFECTIVELY

WITHOUT

CONTAMINATING

YOUR STERILE FIELD, THEN USE THEM

INSERTING FOLEY CATHETER

O

IF

YOU

CANNOT

USE THEM WITHOUT CONTAMINATING YOUR FIELD,

DO NOT USE THEM

PAGES 32-37
PATIENT.

IN

FOR INSERTING A

N1300 COURSE HANDBOOK LIST STEP-BY-STEP PROCEDURE FOLEY CATHETER INTO A FEMALE PATIENT AND A MALE

DO IF

YOU NEED ALL OF THE SUPPLIES LOCATED IN THE KIT?

ALL

STEPS SHOULD BE STUDIED BY THE STUDENT IN ORDER TO NOT, THROW THEM AWAY! JUST MAKE SURE YOU DO NOT CONTAMINATE YOUR STERILE FIELD WHEN YOU DO SO.

UNDERSTAND THIS FREQUENTLY UTILIZED STERILE PROCEDURE.

WHAT DO I NEED
O

TO

KNOW

FOR

CHECK OFFS?

KNOW YOUR SIX RIGHTS OF PROCEDURES YOU CAN EITHER STATE THEM OR ACT THEM OUT POSITION PATIENT PROPERLY FEMALE: DORSAL RECUMBENT (ON BACK, KNEES FLEXED, FEET FLAT ON THE BED, RELAXED THIGHS) MALE: DORSAL SUPINE (ON BACK, LEGS STRAIGHT, AND SLIGHTLY APART)

o FEMALE: WITH NON-DOMINANT HAND, EXPOSE THE URINARY MEATUS AND

CLEANSE THE PERINEAL AREA USING ONE STROKE FOR EACH AREA WITH DOMINANT HAND.

CLEANSE

IN THIS ORDER: INSIDE FAR LABIUM, INSIDE NEAR

LABIUM AND DIRECTLY DOWN THE CENTER OF THE URINARY MEATUS. FIELD. O

WHEN

THROWING AWAY USED SWABS, DO NOT MOVE THEM ACROSS THE STERILE

ONE

STROKE FOR EACH AREA AND SWAB.

MALE:

WITH NON-DOMINANT HAND, GRASP THE PENIS, EXPOSE THE MEATUS.

WITH

DOMINANT HAND, CLEANSE GLANS IN CIRCULAR MOTION IN EVER-

WIDENING CIRCLES, BEGINNING AT THE MEATUS. FOR EACH AREA. O

ONE

STROKE AND ONE SWAB

AGAIN,

DO NOT BRING USED SWABS OVER THE STERILE FIELD.

MAINTAINING HOLD ON PATIENT WITH NON-DOMINANT HAND, PICK UP LUBRICATED FOLEY CATHETER NEAR THE TIP WITH THE DOMINANT HAND AND CAREFULLY INSERT THE END OF THE CATHETER INTO THE MEATUS. CONTINUE GENTLE INSERTION UNTIL URINE FLOWS (FEMALE: 2-3 INCHES; MALE: 7-9 INCHES) AND THEN ADVANCE THE CATHETER AN ADDITIONAL 1-2 INCHES. HOLD
THE CATHETER SECURELY WITH THE NON-DOMINANT HAND AND WITH THE

DOMINANT HAND, PICK UP THE STERILE WATER-FILLED SYRINGE AND INFLATE THE CATHETER BALLOON. O

USING

TAPE, SECURE THE CATHETER TO THE THIGH

(MALES

AND FEMALES) AND

HANG DRAINAGE BAG ON THE SIDE OF THE BED, BELOW THE LEVEL OF THE BLADDER. O

DO NOT

HANG DRAINAGE BAG ON BED RAILS.

COMPLETE

PROCEDURE IN A TIMELY FASHION

(20

MINUTES).

REMEMBER
O

THAT RISK OF INFECTION? EVIDENCE SAYS

THE

WASH
ASEPSIS

YOUR HANDS BEFORE INSERTING A CATHETER AND USE STRICT

USE

THE SMALLEST AND SOFTEST CATHETER THAT WILL STILL ALLOW

FOR ADEQUATE DRAINAGE

DOCUMENTATION

SECURE THE CATHETER TO THE LEG WITH A SECURING DEVICE AT THE Y-PORT, BECAUSE THE CATHETER IS MORE RIGID THERE USE A CLOSED DRAINAGE SYSTEM MAKE SURE URINE FLOW IS UNOBSTRUCTED (THE PATIENT SHOULDNT LIE OR SIT ON THE TUBING, THE TUBING SHOULD NOT BE KINKED) POSITION THE COLLECTION BAG BELOW THE LEVEL OF THE BLADDER,
BUT NOT ON THE FLOOR

EMPTY THE COLLECTION BAG FREQUENTLY, WHEN IT IS HALF-WAY OR TWO-THIRDS FULL DO NOT ALLOW THE SPIGOT TO BECOME CONTAMINATED INFLATE THE BALLOON WITH 10 ML OF STERILE WATER (NOT AIR OR SALINE SOLUTION) AND DO NOT PLACE A FOLEY UNLESS ABSOLUTELY NECESSARY!!!