URINARY CATHETERIZATION
OBJECTIVES
After completing this lesson, the
students should be able to:
Mention the purposes of urinary catheterization
Mention the appropriate instrument / equipment /
medical supplies used in catheterization
Explain the procedure in catheterization
VOCABULARY
Incontinent (adj.) Tdk dpt menahan pipis
Incapable (adj.) Tdk mampu
Urinal (n) Alat utk BAK utk pria
Bedpan (n) Alat utk BAK utk wanita
Commode (n) Alat utk BAB
Spread (v) Melebarkan, menyebarkan
Bend (v) Menekuk
Hold breath (v. phrase) Menahan napas
Tube (n) Selang
Insert (v) Memasukkan
Inject (v) Menkosongkan, kosong
Empty (v, adj.) Menyuntikkan
Roll (v) Menggulung
Reach (v) Mencapai, menjangkau
Drape (n) Kain penutup, duk
Secure (v) Mengamankan
Attach (v) Melekatkan
Anchor (v) menjangkarkan
URINARY CATHETERIZATION
FEMALE MALE
DEFINITION
Urinary catheterization is the insertion of a
hollow tube through the urethra (urinary
opening) into the bladder for removing urine.
Catheterization is a way of completely draining urine
from your bladder. This
keeps urine from sitting in your bladder. If urine sits
in your bladder too long, it
can cause a bladder or kidney infection.
Indwelling Urinary catheterization is the permanent
catheterization for a period of time
PURPOSES OF
URINARY CATHETERIZATION
To relieve urinary (urine) retention
To obtain a sterile urine specimen from a
patient
To empty the bladder (before, during, or after
surgery)
To measure residual urine rest
TYPES OF URINARY CATHETERS
The catheters most
commonly used are made
of plastic.
Each type of catheter
(figure 3-1) has a rounded
tip to prevent injury to the
meatus or the urethra.
The Foley catheter is
frequently used. It is usually
inserted by the nurse.
PARTS OF BODY
Inflatable balloon
for catheterization
Equipment
Disposable indwelling catheter kit. The kit contains the
required equipment needed for catheterization and is
packaged to ensure that the equipment is sterile. The kit
includes the catheter, a drape, a receptacle/container to
receive urine, materials to clean the area of insertion, a
lubricant, a specimen container, and sterile gloves.
Urine collection bag (to collect urine)
Tape (to secure the position of the catheter tube on the
thigh)
Disposal bag (waste/rubbish bin)
Rubber mat (waterproof pad)
PREPARING FOR CATHETERIZATION
A catheter should be used only when absolutely necessary and
the catheterization procedure itself should be done only by
trained personnel under sterile conditions. Infection is a major
risk of urinary catheterization.
1. Gather All Equipment.
Disposable indwelling catheter kit. The kit contains the
required equipment needed for catheterization and is
packaged to ensure that the equipment is sterile. The kit
includes the catheter, a drape, a receptacle/container to
receive urine, materials to clean the area of insertion, a
lubricant, a specimen container, and sterile gloves.
Lamp.
Urine collection bag.
Velcro leg strap or anchoring tape.
Disposal bag.
Waterproof pad.
2. Explain the procedure to the patient. Advise the patient that he
may feel a burning sensation and pressure as the catheter is
inserted, and that he will feel that he needs to void after the
catheter is in place. Do not suggest to the patient that he may
feel pain; however, introducing a catheter in swollen or injured
tissue may cause discomfort.
3. Provide for Privacy and Adequate Lighting.
Close the door or pull the curtain surrounding the patient's bed
and position the lamp at the end of the bed.
Position the female patient in a dorsal recumbent position with
the knees flexed and the feet about two feet apart. Place Chux®
under the patient's buttocks. Cover the upper body and each leg.
Place the catheter set between the female patient's legs.
Position a male patient in a supine position. Place Chux® under
the patient's buttocks. Drape the patient so that only the area
around the penis is exposed. Place the catheter set next to the
legs of the male patient.
1
INSERTING THE FOLEY CATHETER IN A
FEMALE PATIENT
1. The following procedures are used to insert the Foley catheter
in a female patient.
2. Wash the area around the meatus with warm soap and water.
Rinse and dry.
3. Wash your hands.
4. Open the sterile catheterization kit, using sterile technique.
5. Put on sterile gloves.
6. Place the fenestrated drape on the patient with the hole over the
female genitalia.
7. Apply sterile lubricant liberally to the catheter tip. Lubricate at
least three inches of the catheter for the female. Leave the
lubricated catheter over the cotton balls.
8. Place the urine specimen collection container within reach.
1
INSERTING THE FOLEY CATHETER IN A FEMALE PATIENT
9. Place the thumb and forefinger of your nondominant hand
between the labia minora, spread and separate upward. The
gloved hand that has touched the patient is now
contaminated.
10. Using the forceps, pick up a cotton ball saturated with
antiseptic solution. Use one cotton ball for each stroke. Swab
from above the meatus downward toward the rectum.
11. Keeping the labia separated, cleanse each side of the meatus
in the same downward manner (figure 3-5). Do not go back
over any previously cleansed area.
12. Deposit each cotton ball into the disposal bag. After the last
cotton ball is used, deposit the forceps into the bag as well.
13. Continue to hold the labium apart after cleansing. Insert the
lubricated catheter into the female patient's urinary meatus
(figure 3-6).
14. Angle the catheter upward as it is advanced. If the catheter
will not advance, instruct the patient to inhale and exhale
slowly. This may relax the sphincter muscle. Do not force the
catheter.
2
INSERTING THE FOLEY CATHETER IN A FEMALE PATIENT
15. When urine starts to flow, insert the catheter
approximately one inch further. Place the cup under
the stream of flowing urine to obtain a sterile specimen
if required.
16. Hold the catheter in place while the urine drains into
the collection container.
NOTE: If the catheter is unintentionally placed in the
patient's vagina, leave it in place temporarily. Insert
another catheter properly by repeating the entire
procedure using another sterile set; then remove the
catheter from the vagina.
17. Attach the syringe to the balloon port of the catheter.
Inject the water slowly to inflate the balloon. If the
water will not inject easily or the patient complains of
pain, deflate the balloon completely and advance the
catheter further, then re-inflate.
18. Remove the syringe. To position the balloon correctly,
pull on the catheter gently until you feel resistance. 3
INSERTING THE FOLEY CATHETER IN A
FEMALE PATIENT
19. Connect the drainage bag to the catheter. Secure the
catheter to the inner aspect of the female patient's thigh
(figure 3-7).
20. Attach the urinary drainage bag to the bed, below the level of
the bladder but off the floor. Coil any extra tubing on the bed.
21. Remove any lubricant or antiseptic on the patient's skin.
Remove your gloves, the drapes and the Chux® from around
the patient.
22. Discard disposable equipment and return reusable equipment
to the appropriate area.
23. Record the time that the procedure was done and by whom,
the patient's reaction to the procedure, all patient teaching
done, and the patient's level of understanding. Report
observations to the charge nurse to include:
- The amount, color, and clarity of the urine.
- Any difficulty with the procedure.
- The presence of blood in the urine. 4
Figure 3-5. Washing the female meatus Figure 3-7. Securing (female)
indwelling catheter
On Female
Figure 3-6. Inserting the catheter in a female
Figure 3-2. Cleansing the male meatus Figure 3-4. Anchoring (male) indwelling
catheter
ON MALE
Figure 3-3. Positioning the penis at
a 90-degree angle
Procedure of Male Catheterization
1. Greet and inform the patient about what you’re going to
do to him.
2. Advise the patient that he may feel a burning sensation
and pressure as the catheter is inserted, and that he
will feel that he needs to void after the catheter is in
place.
3. Close curtain.
4. Wear gloves.
5. Position a male patient in a supine position.
6. Shave the perineum (for female patients), if necessary.
7. Cover the genital area with sterile drape (linen) with a
hole for the penis.
8. Cleanse the tip of the penis (meatus) with wet sterile
cotton balls.
9. Disinfect the penis gland with Betadine and rinse it with
sterile water (aquades). 1
Procedure 1
10. Lubricate the catheter with jelly (avoid the holes).
11. Hold the penis upward at 90o angle.
12. Gently insert the catheter through the urethra 15-20 cm
after the patient takes a deep breath.
13. Inject the water 15-20 ml slowly to inflate the balloon.
14. Let all urine flow out from the bladder through the tube
into the urinary bag.
15. After emptying the bladder, deflate the balloon by
withdrawing the water (for temporary catheterization).
16. Remove the tube from the urethra slowly (for temporary
catheterization)..
17. Remove the drape.
18. Anchor/attach the catheter tube to the thigh/femur with
tape (figure 3-4).
19. Connect the catheter to the urinary bag.
20. Tidy all instruments. 2
21. Confirm the patient’s comfort.
Procedure 2
Prepare equipment.
Wash hands with soap and water.
Encourage the patient to urinate.
Ask the patient to stand, sit or lie down, whichever is easier for him.
Hold penis up with one hand and cleanse the tip with a cotton ball
moistened with soap and water. Wash in a circular motion starting at
the urethra and working outward.
Lubricate the catheter end that will be going into the urethra.
Lubricant must be water-soluble.
Hold the penis upward, gently insert the catheter through the
external meatus.
Once you have passed one half length of the catheter through
external meatus, lower the penis and slide the catheter the rest of
the way into the bladder until urine flows.
Allow the bladder to empty completely.
To remove the catheter, slowly rotate it as you withdraw it. Stop
each time more urine drains.
To completely remove the catheter, pinch off the end and pull it out.
This will prevent urine from flowing back into the bladder.
Check for any unusual odor and/or cloudy hazy urine. Be aware of
any changes that need to be reported to your physician.
THANKS for your attention
