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Urinary Catheterization

Angkatan 14
Pembimbing : drg. David Kamadjaja,
Sp.BM

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DEFINITION

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Urinary Catheterization

 Urinary catheterization is done when a person


is unable to urinate using a toilet, bedpan,
urinal, bedside commode, or when accurate
urinary output is required

 A urinary catheter is a tube that is inserted


into the bladder through the urethra to allow
the urine in the bladder to drain out
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ANATOMY AND PRINCIPLES

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Anatomy

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Principles of Catheterisation

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INDICATION

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Indications for a Foley Catheter
• Retention of urine leading to urinary hesitancy, straining to urinate, decrease in
size and force of the urinary stream, interruption of urinary stream, and sensation
of incomplete emptying

• Obstruction of the urethra by an anatomical condition that makes it difficult to


urinate: prostate hypertrophy, prostate cancer, or narrowing of the urethra

• Urine output monitoring in a critically ill or injured person

• Collection of a sterile urine specimen for diagnostic purposes

• Nerve-related bladder dysfunction, such as after spinal trauma, or intractable


incontinence.

• Imaging study of the lower urinary tract

• After surgery to monitor urine output


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CONTRAINDICATION

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Contraindications
• Use cautiously in patients with a history of pelvic
or perineal trauma associated with perineal
bruising and swelling and/or blood at the meatus
• Use cautiously in patients with a history of
urethral strictures or anatomically false passages.

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RISKS

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Risks
• The balloon can break while the catheter is being
inserted. In this case, remove all the balloon fragments.
• The balloon does not inflate after it is in place. Check
the balloon inflation before inserting the catheter into
the urethra. If the balloon still does not inflate after its
placement into the bladder, then insert another Foley
catheter.
• Urine stops flowing into the bag. Check for correct
positioning of the catheter and bag or for obstruction of
urine flow within the catheter tube.

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Risks
• Urine flow is blocked. Change the bag or the Foley catheter
or both.
• If the patient’s urethra begins to bleed,monitor the
bleeding.
• The Foley catheter may introduce an infection into the
bladder. The risk of infection in the urine increases with the
number of days the catheter is in place.
• If the balloon is opened before the Foley catheter is
completely inserted into the bladder, bleeding, damage and
even rupture of the urethra can occur. In some individuals,
long-term permanent scarring and strictures of the urethra
could occur
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TYPES

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Types of catheters
 A condom catheter, consists of a soft plastic or rubber sheath, tubing,
and a collection bag for the urine. The sheath is placed over the penis
and the collection bag is attached to the leg. Collects urine when there is
no need for catheter insertion.

 A straight catheter, is used when the catheter is to be inserted and


removed immediately.

 An indwelling catheter, also known as Foley catheter, is left inside the


bladder to provide continuous urine drainage.

 A suprapubic catheter is a type of indwelling catheter. The suprapubic


catheter is inserted into the bladder through a surgical incision made in
the abdominal wall, right above the pubic bone.

 A 3-way catheter for continuous bladder irrigation (CBI) is a type of


indwelling catheter. It is inserted to irrigate the bladder to prevent
obstruction (i.e bleeding)

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Catheters

Straight

Condom

Suprapubic Indwelling

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3-way
CBI
Irrigations performed
on intermittent or
continuous basis to
maintain catheter
patency. A closed
system can provide
continuous or
intermittent irrigation
without disrupting
sterility

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Catheter types
short term
Catheter Duration Comments
material
PVC 14 days Rigid, painful
Latex 14 days Can cause discomfort
and tissue trauma due
to high surface friction
Teflon-coated 28 days Smoother, resistance to
latex encrustations

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Catheter types
longer term
Catheter Duration Comments
material

Silicone 12 weeks Resistance to bacterial


elastomer- adherence
coated latex
Silicone 12 weeks Smooth, resistance to
encrustations, non-
inflammatory

Hydrogel- 12 weeks Resistance to bacterial


coated latex adherence, improved
patient comfort, non-
inflammatory
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Catheter sizes
• Catheters are available in both different sizes and
lengths
• Variation in length is due to the difference in length
of the male and female urethra
• Male catheters are 41 – 45 cm in length
• Female catheters are 20 – 25 cm in length
• The size is the measure of the internal lumen of the
catheter and is measured in Charriere (Ch)

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PREPARATION

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Prepare patient
• Explain the reason for the procedure to the patient and/or family
• Explain the steps of the procedure to the patient and/or family
• Answer any questions the patient and/or family may have regarding the
procedure
• Check for allergies to latex and iodine
• Wash your hands
• Provide privacy
• Raise bed, stand on left side of bed if right handed (right side if left
handed)
• Arrange equipment
• Water proof pad under client
• Position & drape client

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Catheter Equipment
 Equipment: (check packages and expiry dates)
– Catheter tray (with drapes, fenestrated drape, cotton balls, forceps)
– Catheter (14-16 Fr (for women) 12 Fr for young girls
(16-18 Fr (for men)
– Sterile drainage tubing with collection bag
– Correct size syringe (check catheter balloon)
– Water for injections to inflate catheter ballon
– Cleansing solution / Antiseptic solution
– Lubricant
– Sterile gloves
– Specimen container
– Tape to anchor tubing
– Bath blanket

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FEMALE CATHETERISATION

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Noted : about female catheterisation
• Remember to use the smallest size catheter possible
for the purpose it is needed for
• If anaesthetic gel is used this should be placed into
the urethra 5 minutes prior to catheterisation
• Two pairs of sterile gloves should be used to avoid
cross contamination when cleansing and instilling
gel. The outer pair is removed after cleansing and
prior to catheter insertion

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Noted : about female catheterisation
• If the catheter is accidentally inserted into the
vagina, leave it in place to prevent it
happening again
• Use a new catheter
• Once this is successfully in place remove the
first catheter from the vagina

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Procedure
(female)

• Explain the procedure to the patient and gain


informed consent
• Take the pre prepared trolley to the bedside and
place on left or right depending on nurses dominant
hand
• Raise the bed to an appropriate height and ensure a
good light source
• Expose the genital area with consideration for
patient dignity and place a disposable pad beneath
the patient
• Wash and dry hands
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Procedure : Position Female Patient
• The female urethra is short compared to the male
urethra. Insertion of the catheter is facilitated by
having the patient on her back
• Adequate exposure of the urethra is obtained by
flexing her knees, separating them and placing her
feet flat on the bed about two feet about (frog-
legged position)

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• Place the sterile dressing
towel between the patients
legs and over the patients
thighs
• Using a gauze swab and the
non dominant hand retract
the labia minora to expose
the urethral meatus. This
hand is used to maintain
labial separation until
procedure is completed
• Clean the perineal area
using a new gauze swab for
each stroke cleansing from
the front towards the anus

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• Place the receiver holding
the catheter on the sterile
towel between the
patients legs
• Expose the tip of the
catheter by pulling off the
top of the wrapper at the
serrated edge
• Lubricate the catheter tip
with anaesthetic or
lubricating gel (2.5 to 5
cm for women)

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• Hold the catheter so the
distal end remains in the
receiver
• Gradually advance it out
of the wrapper into the
urethra in an upward and
backward direction for
approximately 5-7cm or
until urine flows
• Advance a further 5 cm,
do not force the catheter

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• Inflate the balloon with
the correct amount of
water
• Attach the catheter
drainage bag and
position so there is no
pulling on the catheter

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MALE CATHETERISATION

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Noted : about Male catheterisation
• Ensure the patient has no history of prostatic
hypertrophy
• Assess any risk factors such as anti coagulant therapy
• It is important to hold the penis at 60 to 90 degrees
to the body, this reduces the risk of strictures

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Noted : about Male catheterisation
• Anaesthetic lubricating jelly should be placed
into the urethra and the practitioner must
wait 5 minutes for this to be effective
• If the patient complains of any severe
discomfort during the procedure then the
procedure should be stopped immediately
• If resistance is felt increasing the traction on
the penis may reduce the spasm of the
external sphincter
• Encouraging the patient to cough may also
ease the passage of the catheter
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Procedure
(male)

• Explain the procedure to the patient and gain


informed consent
• Take the pre prepared trolley to the bedside and
place on left or right depending on nurses dominant
hand
• Raise the bed to an appropriate height and ensure a
good light source
• Expose the genital area with consideration for
patient dignity and place a disposable pad beneath
the patient
• Wash and dry hands
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Procedure : Position Male Patient
• The male urethra is long compared to the female
urethra.
• A catheter is placed while lying down with legs
extended and flat on the bed or in the frog-
legged position.

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Procedure
• Place the sterile
dressing towel between
the patients legs and
over the patients thighs
• Using a gauze swab and
the non dominant hand
retract the fore skin to
expose the urethral
meatus.
• Clean the area using a
new gauze swab for
each stroke

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Procedure
• Hold the penis at 60-90
degrees to the body
• Warn the patient the
anaesthetic gel may sting
and instil the gel via the
urethral meatus (12.5 to
17.5 cm for men)
• Place a finger over the
meatus and hold penis at
same angle for 5 minutes
to allow the gel to work
• Place the receiver holding
the catheter on the sterile
towel between the
patients legs
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• Expose the tip of the catheter
by pulling off the top of the
wrapper at the serrated edge
• Hold the catheter so the
distal end remains in the
receiver
• Gradually advance it out of
the wrapper into the urethra
until urine flows (insert 17 to
22.5 cm)
• Advance a further 5 cm to
bifurcation, do not force the
catheter
• Inflate the balloon with the
correct amount of water
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• Attach the catheter
drainage bag and
position so there is no
pulling on the catheter

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Urinary Catheterization - Emptying Urine
Drainage Bags
 Urine drainage bags are routinely emptied and the
urine measured at the end of each shift.

 Urine drainage bags should also be emptied if they


are full.

 Leg bags need to be emptied frequently because


they are smaller, and hold less urine.

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COMPLICATIONS

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Complications associated with urethral
catheterisation
• Urinary tract infection
• Encrustation and blockage
• Bypassing
• Tissue damage
• Patient discomfort

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EVALUATION

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Document
 Report and record type and size of catheter

 Amount of fluid used to inflate balloon

 Characteristics of urine, amount, reason for


catheter, specimens, client’s response

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 Be sure to monitor urine output
– Amount
– Characteristics (color, clarity, sediment, hematuria,
odor)

 less than 30 ml/hr of urine indicates a


problem

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Thank You…

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