Urinary Catheterization

Purposes:

To relieve bladder distention or to provide
gradual decompression of a distended bladder
To instil medication into the bladder
To irrigate the bladder
To measure hourly urine output accurately
To collect urine specimen

To measure residual urine Residual Urine, is
the amount of urine retained in the bladder
after forceful voiding
To maintain continence among incontinent
clients
To prevent urine from contracting an incision
after perineal surgery
To promote healing of the genito-urinary
structures postoperatively

Types:
Straight Catheter - use for a spot urine
specimen - amount of residual urine is being
measured - temporary decompression /
emptying of the bladder is required.
Indwelling/Retention Catheter - if the bladder
must remain empty or continuous urine
measurement and collection is needed

Nursing Interventions for Client with
Indwelling/Retention Catheter

Practice asepsis. Proper handwashing should be
done before and after manipulating the device.
To prevent infection
Increase fluid intake. To enhance excretion of
microorganism and body wastes
Acidify urine ( diet: meat,fish.eggs and cereals)
Acidic urine inhibits proliferation of
microorganism.
Maintained closed drainage system. Do not
detach catheter from the connecting tubing,
unnecessarily.
Meticulous perineal care. To prevent ascending
UTI
Ensure patency of urinary catheter. Avoid kinks.
Irrigate with sterile PNSS as ordered.
Ensure that gravity drainage of urine is
maintained. Hold the urinary drainage bag below
the level of bladder when ambulating
Monitor I & O
Change urinary catheter, tubing and bag when
sediments accumulates, if leakage is present or if
a strong odor is evident.


Nursing responsibilities after removal
of IFC and RC

Voiding should be expected within 6 8 hours
from the time of removal of catheter. Some
dribbling of urine may be experienced.
Continue to assess I & O
If the client has not voided in 8 hours, assess for
urinary retention
If the client has difficulty establishing voluntary
control of voiding, notify the physician. It may be
necessary to reinsert the catheter or to perform
in and out ( intermittent ) catheterization

Urinary Elimination
Characteristics of Normal and Abnormal urine

Characteristics Normal Abnormal
Amount in 24
hours
1, 200 1,500 ml (
30 ml/hr)
Under 1,200 ml A
large amount over
intake
Color, clarity Straw, Amber
(Clear )
Dark Amber
Cloudy Dark
Orange Red/Dark
Brown Mucous
plugs, viscid,thick
Odor Faint Aromatic Offensive
Sterility No Microorganism Microorganism
Present
pH 4.5 8 Over 8 Under 4.5
Specific Gravity 1.010 1.025 Over 1.025 Under
1.010
Glucose Absent Present
Protein Absent Present
Ketones Absent Present
Pus Absent Present
Blood Absent Present
Alteration on Urinary Elimination:
Alteration on Urinary Elimination Problem Definition
Polyuria ( diuresis) Production of excessive amount of urine (>
100ml/hr or >2500 ml/day)
Oliguria Production of decreased amount of urine
(<30ml/hr or <500ml/day)
Anuria Absence of production of urine by the
kidneys such as 0-10 ml/hr
Urinary Frequency Voiding in frequent interval
Nocturia Increased urination at night
Urinary Urgency The strong feeling that the person wants to
void.
Dysuria Voiding that is either painful or difficult
Hesitancy Difficulty in initiating voiding
Enuresis Bed wetting, repeated involuntary voiding
beyond 4-5 years of age
Total Incontenence

A continuous and unpredictable loss of urine
Stress Incontenence

Leakage of less than 50ml of urine as a sudden
increase in entra abdominal pressure
Urge Incontenence

Follows a sudden strong desire to urinate and leads
to involuntary detrusor contraction.
Functional Incontenence Involuntary unpredictable passage of urine
Urinary Retention The accumulation of urine in the bladder with
associated inability of the bladder to empty itself.
Note: 250-450 ml. of urine in the bladder triggers
micturition reflex Clinical Signs of Urinary
Retention:
Discomfort in pubic area
Bladder distention

- smooth firm, ovoid mass at the supra pubic area -
mass arising out of the pelvis - dullness on
percussion
Inability to void or frequent voiding of small
volumes
Increasing restlessness and feeling of need to void
A disproportionately small amount of output in
relation to fluid intake

Nursing Interventions for Clients with
Urinary Incontenence

Bladder Retraining Program. Determine the
clients voiding pattern or establish a regular
voiding time.
Lengthen the intervals of voiding once the clients
voiding can be controlled.
Regulate fluid intake
Avoid large amounts of fruit juices and
carbonated beverages.
Schedule diuretics in the morning.
Adequate fluid intake in the morning.

Nursing Interventions to induced
voiding

Provide privacy
Provide fluids to drink
Assist the patient in the anatomical position of
voiding
Serve clean, warm and dry bedpan (female) or
urinal (male)
Allow the client to listen to the sound of running
water
Dangle fingers in warm water

Pour warm water over the perineum
Promote relaxation
Provide adequate time for voiding
Perform Credes Maneuver as ordered ( this is
done by applying pressure on the suprapubic
area)
Last resort: URINARY CATHETERIZATION