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Thursday, February 5, 2015

Catheter Fundamentals for Nursing Students

Catheter, Fundamentals, Nursing Students, Prostate, Foley, Indwelling, Straight, Bladder, Procedure, Management

Catheters 101

Catheters are used to relieve urinary retention, obtain sterile urine specimen, measure residual urine volume, surgery, or managing incontinent patients (such as a spinal cord injury, etc).

CATHETERS ARE A LAST RESORT!

But sometimes catheters are needed, so this post is here to help you with tips on how to insert, care, and remove urinary catheters.

Know Your Equipment


No, not that equipment. Get your head out of the gutter.

Well, while we're there..... Men and women are different, er, down there. So here are some things no one told me during school that you need to know.

Women: you should select catheters between the size 14-16 Fr.

Men: select a size 16-18 Fr.

Children: 8-10 Fr.

Anything bigger than an 18 may cause damage and will be uncomfortable. 

There are several types of catheters:
  • Indwelling/Foley catheters- As the name suggests, these stay in place vs the straight caths that are a one time use.
  • Straight/Intermittent catheters- A single use catheter. You can repeat catheterization many times but keep in mind every time you straight cath someone you are introducing them to a possibility of infection.
  • Condom Catheter- Just like a condom, so you can only use it on males. (Personally, they're not too common in my area. I've only ever seen one. Just know that there is another option for your male patients.)

Always make sure you have an order. 

Always use sterile technique.

Inserting Straight or Indwelling Catheter


  • Wash your hands. (Just always wash those hands. Constantly.)
  • Make sure your patient has privacy. This is a big pet peeve of mine. HUGE! pet peeve. I don't want my bare bottom on display for the world- No one does. Make sure to close the door, curtains, etc so your patient has privacy.
  • Position your patient:
    • Women: Dorsal Recumbent position, knees flexed. (Tip: use pillows to support knees)
    • Men: Supine, thighs abducted
  • Drape your patient with a towel in case we have some "spillage"
  • Open your catheter kit.
  • Apply sterile wrap/drape to your patient.
  • Don your sterile gloves.
  • Apply fenestrated drape (or throw it over your shoulder like I do because I don't use it and find it to be another step for me to accidentally break my sterile field, and it's just not worth the hassle to me personally, but you do you. If you want that diamond drape, you go for it, Glen Coco).
  • Move sterile tray onto your sterile field- So you have on your sterile gloves, and you DO NOT want to break your sterile field by touching the sides of the tray- Use your hands to brace against the inside of the tray (because it is sterile, and so are you, so go crazy- touch, touch, touch, touch, touch, touch) I'll post a video. It's hard to describe in text.
  • Place the end of the catheter in the lube.
  • Here it's going to get tricky!
  • Clean the urethral meatus- now you're going to have one sterile hand and one non-sterile hand. Your NONdominant hand becomes your NON-sterile hand. Your nondominant hand will be the hand that touches the patient.
    • Women: Spread the labia to visualize the urethral meatus. Use whatever antiseptic cotton ball/swap/q-tip that your kit comes with to clean the area in a front to back motion. Repeat 3 times. 
    • Men: Retract foreskin, if applicable. Use cotton ball/swab/q-tip whatever is in the kit in a circular motion starting at the urethra and moving down the shaft. Repeat 3 times.
  • Pick up catheter with STERILE hand, while maintaining your hold/position with your non-sterile hand on the patient. I'm not very coordinated but I can still pull this off, so so can you!
  • Insert catheter in the urethra until you have urine.
  • Now you collect your urine for your specimen, or you allow the bladder to empty for a straight cath, and then you pull the catheter out, unless you're inserting a Foley (Durrr).
  • If you're inserting a Foley, now you advance the catheter a little bit more inside the bladder and now you get to inflate the balloon.
  • Make sure you've inserted the correct amount of sterile water into the balloon that it is marked to hold. It should be written on the kit's label.
  • Anchor the indwelling catheter to the top of the thigh using whatever do-hickey your hospital has.
  • Great job! Now you can clean up!

Tips 


You can have the doctor order lidocaine. It'll be in syringe, you inject the gel inside the urethra and give it a couple minutes to numb things up, then proceed with inserting the catheter.

Monitor your patient for urinary retention after using a straight cath or after removing a foley. After a foley is removed the patient needs to void in 6 hours or you will have to straight cath the patient until they can void on their own. You might even have to possibly insert another foley. :(

When you remove a foley, I always watch for the tubing to collapse in on itself to let me know that I've deflated the balloon. Of course I also check to see how much fluid I have in the syringe. Which means it is important to know how big that balloon is to begin with.

Monitor for a spike in temp- Patient may have a UTI from the catheterization.

Clean your Foley catheter to hospital policy- could be soap and water, or it might be chlorhexidine wipes, etc.

Monitor urine output- We want to see more than 30 mL per hour.

Note the volume and character of the urine output. Color? Smell? Viscosity? 

Monitor Input and Output- but you already do that don't you. Good job!

Signs of infection- abnormal temp, cloudy urine, burning sensation.

Know your hospitals policies on how long a catheter can be in. You might have to request the doctor to write a new order.

Advocate for your patient. The longer that catheter is in there the more likely your patient will get a UTI. So advocate for catheters to be removed as soon as possible- I mean sometimes we need them, but sometimes we don't need them any longer. Discontinuing that catheter should be high on your priority list- when possible.


Now you know the FUNdamentals of catheterization!! Yay!!

(Yes, I just could not help myself. I am fully aware my humor is sick and twisted.)


What are some tips that you use when your patient has a catheter? Let us know in the comments below!!

Xoxo,

Nightingale



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