ELIMINATION THRU
© 2008 Catheterization by Guiomar Goransson, RN, CHPN
ELIMINATION THRU
© 2008 Catheterization by Guiomar Goransson, RN, CHPN
TECHNIQUE:
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Clean aseptic technique (hand washing) |
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Emptying Bag |
CLEAN technique |
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*DO NOT DELEGATE this to aide |
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*LPN can do this |
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*Find out if person has an allergy to LATEX |
Need for Catheterization
Straight Cath. Or Intermittent Cath. ~ Insert, drain, pull right back out. This is used to see what’s left in bladder; for overextended bladder; woman in labor; spinal cord injury specimen.
Short Term therapy ~ Post surgery; for few days to ascertain in case of major trauma; can assess for heart sufficiency; if there is an obstruction to flow of urine; enlarged prostate; clot obstruction.
Long Term therapy ~ if unable to do in & out quickie caths. Seen frequently in terminally ill. If order for residual kind says, “If....(eg. “you get 50cc”) then....” type order may be short or long term. Use Foley (w/balloon). That way you can leave it in if needed.
MALES can use TEXAS CATH!
Purposes:
Empty bladder
Collect urine specimen
Check for residual urine
Instill medications
Assessment of urine output
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Assessment |
| 1. Check Orders: type - indwelling or intermittent? |
| 2. Tell patient |
| 3. Assess patient: what will you need |
| 4. Check for latex allergy |
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Contraindications |
| Blood at meatus |
| Scrotal hematoma |
| Obstruction: prostate |
Gather Equipment
Available in 5-30 French
Larger the #, the larger the cath
Children: 6-10 Fr
Female: 14-16 Fr
Male: 16-18 Fr
Single lumen (only for intermittent use), double lumen, or triple lumen
Complications
INFECTION
#1 Nosocomial is Bladder/Cath
3 WAYS IT HAPPENS...
1. time of catheterization ~ from shoddy sterile technique - this is STERILE procedure!
2. spigot or emptying port ~ when emptying bag don’t lay bag on floor because bacteria enters thru port. If it touches floor, WASH HANDS, wear gloves, wipe w/alcohol. Bacteria travels back up when turning pt (raising cath above bladder), contaminating bladder. If moving cath from one side of bed to other, CLAMP IT!
3. when catheter slides in and out ~ sloppy positioning of cath. It slides back and forth. When washing body, treat cath as extension of body.
TAPE cath to keep from moving.
On FEMALE tape to inner THIGH 
On MALE..depends on natural angle penis lies at. If upwards, tape to abdomen. If down, tape to thigh.
Prevention
At placement: Sterile technique
Cath. Care: Good clean aseptic technique (hand washing)
Don’t allow back flow
Secure catheter
Placement
Female 
Male
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STEPS TO CATHING |
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1. Explain to pt - why, what to expect. |
| 2. Is this intermittent or indwelling? |
| 3. Balloon on end to hold between urethra and bladder. Balloon itself holds 5 mL but use 8-10 cc of fluid to inflate because you have to fill uptake. |
| 4. Get extra gloves, diapers, bath, blanket. |
| 5. Wash hands w/soap & water |
| 6. Wash pt |
| 7.Open sterile field |
 Male: Should glide easily with lubrication. If met with resistance, give a few seconds to relax. Try again, but if it won’t go in, stop. Try coude catheter (tip is more pointed and curved and does not have a ballon, therefore it can not be used for indwelling.) May be obstruction. Call physician. Back off with resistance.
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 Male: Insert to the bifurcation.
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| Female: Find meatus (orifice between clitoris and vagina. Ask pt to cough. It might open. If there’s blood at meatus, do not insert because it could be a clot. It might dislodge. Insert until urine seen plus 1-3 inches |
 When cathing, if you see a stream of yellow and you get a lot of urine - about 1000cc, STOP! CLAMP! Because bladder is deflating too quickly and can go into spasms. Wait 1/2 hour and unclamp.
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Irrigation
Open
Closed
Three-Way Irrigation
Determine the amount of irrigation used (the sterile fluid)
Determine the amount of fluid in the collection bag (irrigation and urine)
Subtract the irrigation amount from the amount in bag = urine produced