Basic procedures in healthcare 1 (SOL / VCA81) TOPICS: 12a) Emptying of the bladder 12b) Urine sampling and its examination 12c) Bladder catheterization

Basic procedures in healthcare 1 (SOL / VCA81)

TOPICS:

12a) Emptying of the bladder12b) Urine sampling and its examination12c) Bladder catheterization in women and men

• urination

• factors affecting micturition

• diuresis

• fluid balance

• monitoring of urine (quantity, colour, odour… )

• urinary voiding disorders

12a) Emptying of the bladder


Urination (micturition)

The excretion of urine by the urinary system – kidneys, ureters, urinary bladder and urethra.


Factors affecting the micturition:

growth and development,

psychosocial factors,

food and fluid intake,

drugs,

muscle tone,

pathologies (hypertrophy of the prostate, kidney… ),

surgery (e. g. cystoscopy… ).


Diuresis

the definitive amount of urine produced by the kidneys per unit time (usually one day), an average of 1,5 liters per day,

↓ when the lack of fluids and renal impairment (compare to anuria, oliguria),

↑ e. g. at increased fluid intake, diuretic and when DM (compare to polyuria),

the dieresis monitoring is important in many diseases and acute conditions (shock, heart and renal failure with swelling and others).


Fluid balance

- measuring and recording fluid intake and output over 24 hours,

use urine bottles, bedpans,sampling containers for urinein case there is not introducedperipheral urinary catheter,

remember to write – infusion,sauces, compotes, vomit,waste drain, diarrhoea,excessive sweating etc..


Monitoring of urine – quantity

physiological quantity = 1000 – 2000ml / 24hrs

Disorders of urine:

polyuria – ↑ urine,

> than 3 000ml / 24 hrs

oliguria – ↓ urine,

100 - 500ml / 24 hrs

anuria – urine

< than 100ml / 24 hrs


Monitoring of urine – colour

physiological – straw yellow,

dark yellow, reddish = increased concentration of bile pigments,

blood in the urine = haematuria,

opacity = proteins, mucus, pus.

*


Monitoring of urine - odour

fresh urine - an aromatic odour

older urine - sharp pungent odour

acetone - metabolic acidosisindication urine papers


Urinary voiding disorders

retention – urinary retention without the ability to emptying, the arrest of urination

pollakiuria – frequent urge to urinate, accompanied by a small amount of urine (frequent symptom of the urinary tract inflammation)

nocturia - increased frequency of urination at night

dysuria – pain during urination

stranguria – cutting, burning during urination

urgent urination – a strong sense of urgency with little urine

enuresis nocturna – bedwetting in older children

incontinence – spontaneous loss of urine

• general principles of urine sampling

• physical examination of urine

• specific weight of urine

• biochemical urinalysis

12b) Urine sampling and its examination

General principles of urine sampling

usually morning urine is sampled,

genital organs hygiene before sampling – washing the urethral orifice with water,

sampling into pre-labeled containers, clean, dry, sterile (should consider the possibility of „staining“ with the container during sampling),

properly completed requisition.

Specifics of sterile urine sampling

midstream of urine = it means first wash the genital by water, then urinein a toilet part of the urine, catch the midstream into the sterile containerand the rest of urine pee in the toilet,

urine obtained during catheterization.



Physical examination of urine

the colour, turbidity, foam, odour, pH, specific weight is evaluated,

physiological pH of urine – normal 5,0 - 7,0,

aciduria – lower than 5,0,

alkaluria – higher than 6,5 - 7,0.

Specific weight of urine - value 1,010 - 1,025g/cm3

dependent on the amount of dissolved solids (especially chlorides, urea)and the amount of discharged fluid,

measurement in the morning with calibrated hydrometer (urometer),

100 ml urine in graduated cylinder.


hydrometer hydrometer in graduated cylinder


Biochemical urinalysis

determination of values: protein, glucose, ketone bodies, bile pigments, haemoglobin, amino acids, amylase, creatinine, inorganic compounds, nitrogen balance, osmolality, hormone levels, medications…

*


Biochemical urinalysis

pyuria - pus in the urine,

proteinuria - protein in the urine,

glycosuria - carbohydrates in the urine,

acetonurie - ketone bodies in the urine.


Individual biochemical examination methods:

urinary sediment (urine + sediment),

urinary sediment according to Hamburger,

balance sampling for the waste ions, urea, uric acid, protein, creatinine, glycosuria,

Bence-Jones protein,

creatinine clearance,

oestriols,

vanillylmandelic acid (VMA),

toxicology urine examination.

• definition

• indication

• types of catheterization

• types of urinary catheters

• tools

• preparation of a patient

• single catheterization procedure of woman with simultaneous sampling of urine for examination

• single catheterization procedure of man with simultaneous sampling of urine for examination

• indications for the introducing of a permanent urinary catheter (PUC)

• tools

• procedure in introducing of PUC

• complication while introducing PUC

12c) Bladder catheterization


Catheterization - introducing a sterile catheter (catheter) through the urethra into the bladder.

Indication:

emptying the bladder when retention,

emptying the bladder before the examination, surgery, parturition etc.,

taking the sterile urine sample to test for cultivation and sensitivity,

introducing of a permanent urinary catheter (PUC),

detection of residual urine,

bladder instillation (irrigation).


Types of catheterization

Disposable - in order to release disposable bladder content(the introduction of a catheter, drain urine, removal of catheter, finish the procedure).

Permanent – in order toensuring intermittentand permanent urinarydiversion. Functionalcharacter of catheterscorresponds with this purpose.

urinary catheters


Types of urethral catheters

a) Nelaton catheter - straight; used in children and women, rarely in men,

b) Tiemann catheter - straight with curved conical beak; used in men,

c) Foley catheter – permanent urinary catheter, most commonly used for chronic urine drainage into a collection bag; plasticor silicone; it includes balloon to fix urinary catheter, the balloon is filled with saline.

The catheter must be sterile and not damaged. Catheters are aseptically stored in a sealed plastic bag.

PUC marking - indicate the numbers expressing the girth and average.


disposable catheter


disposable catheter

Tiemann catheterNelaton catheter


Permanent catheters

Foley catheters


Tools:

permanent Foley catheter,

saline 1/1,

syringe according to the size of the balloon 5 - 20 ml,

urine sampling bag, a sterile tube,

sterile swabs, sterile tweezers,

disinfectant solution for periurethral disinfection (Octenisept),

lubricant and aesthetic, e. g. Mesocain gel, Instillagel,

vomit bowls,

disposable sterile gloves.

The possibility of using other tools according to the standardsand practices of staff.


Preparation of the patient

familiarization with procedure,

ensure privacy,

appropriate position – on the back in a slightly raised position, man's lower limbs lying in bed, woman´s lower limb are bent at knees slightly apart from each other,

genital hygiene.


The procedure for a single catheterization of women with simultaneous sampling urine tests:

tools preparation,

hygienic hand disinfection,

the patient is lying on your back with bent lower limbs,

inserting vomit bowls next to the legs of the patient,

use of sterile gloves (or 1 glove on nondominant hand if we use sterile tweezers to the genital disinfection),

draping the genitals,

disinfection of the urethral meatus,

antiseptic swab hold in sterile tweezers and use it only once,


open female labia with forefinger and thumb of one hand,

with the second hand, in whichwe hold sterile tweezerswith sterile swabsand disinfectant,we gradually disinfectthe orifice of urethraand its surroundings(3 swans – right, lestside and centre),

we disinfect alwaysin one direction – fromthe top down (ventrodorsal)– and we never go back!

disinfect the orifice of urethra


we put used swabs into the vomit bowls,

we remove the catheter from the prepared package,

we use to removal either a sterile tweezers or the second nurse helps us or we have everything prepared on the sterile surface,

we apply Instillagel (Mezocain gel) on the tip of the catheter,

we gently introduce the catheter into the bladder,

we are introducing, until the urine starts leaking into vomit bowls from the other end of the catheter,

we let the first stream to drop into the vomit bowl, and then we let the next one (midstream) flow into a sterile test tube,

we let the rest of the urine to flow into the vomit bowls or bedpans.


after bladder emptying, we gently pull the catheter from the urethra,

we dry the genital using swabs,

we adjust the patient´s position and bed,

we arrange cleaningthe tools,

we send a urinesample to the laboratory,

we record it inthe documentation.

bladder catheterization on a model


The procedure for a single catheterization of men with simultaneous sampling urine tests:

a physician puts on sterile gloves,

we prepare a tube for sampling urine, sterile tampon in a disinfectant solution and sterile disposable catheter,

we place vomit bowls in a bed of the patient,

the physician pulls the foreskin and he disinfects opening of the urethra using 3 swabs - a circular motion from the orifice of the urethra below,

we prepare Instillagel or Mesocain gel,

we give aseptically sterile urinary catheter to the physician,

the physician pulls the curved end of the catheter in sterile swab with prepared Mesocain (the physician applies Instillagel directly into the orifice of the urethra),

Instillagel - gel in a sterile syringe with local anestheticand disinfectant antibacterial effect (for introducing of PUC)


the physician slowly introduces a catheter into the urethra, the leaking urine is caught in vomit bowls and bedpans,

midstream urine is caught in a test tube,

the rest of the urine is let to flow into the vomit bowls and bedpans,

after emptying of the bladder, the physician gently pulls the catheter from the urethra,

we clean the urethral meatus from excess of lubricant,

we adjust the position of a patient and the bed,

we arrange cleaning the tools,

we send a urine sample to the laboratory,

we record it in the documentation.

bladder catheterization on a model


Indications of introduction of permanent catheter:

urine retention,

macro-haematuria (bleeding when bladder tumours, prostatic adenoma, carcinoma),

after cystoscopy,

postoperative catheter introduction (prostate, bladder, urethra surgery),

measurement of diuresis (postoperative renal insufficiency, cardiac decompensation).


Tools:

- the same as in single catheterization,

- plus:- syringe,- saline,- collecting bag,- hinge on the bed.

urine collection bagwith plastic hinge

Procedure for permanent catheterization:

the same as when single catheterization,

nurse assists to the doctor in the introduction of permanent catheterin a male, another nurse assistance is possible when introducingof permanent catheter in a female,

it is appropriate to connect the catheter with collecting bag,before the introduction of urinary catheter,

after the introduction of urinary catheter, we drop all the urine and we introduce the catheter by about 2,5 - 5 cm away from the place where urine begins flow so we can fill the balloon with saline,

we apply the saline with syringe (the amount of the catheter indications) into the other catheter entrance which leads to the intravesicalend of the catheter,

we perform a leak test by pulling urinary catheter – GENTLY!



we communicate with the patient during a performance,

dry genitals,

adjust the bedafter the procedure,

we arrange cleaningthe tools,

we record it inthe documentation.

introduced catheter in men


Videos

Single catheterization with the collection of urine tests:

- https://www.youtube.com/watch?v=vtZL2t7SP0w

Women catheterization with permanent urinary catheter:

- https://www.youtube.com/watch?v=R1gaOOJ5XgI

Removing the permanent urethral catheter:

- https://www.youtube.com/watch?v=vuH1fygkYsc


Complications of catheterization:

infection when violation of the principles of antisepsis,

traumatic damage to the urethra during rough introduction,

inability to introduce the catheter due to urethral anomalies.

!!! IT IS NECESSARY TO FOLLOW THE PRINCIPLESOF ANTISEPSIS DURING THE INTRODUCTION !!!

Revision:

Name the defects of urine creation.

How do we monitor the fluid balance?

What are the guidelines we follow for the urine sampling?

Name the type of bladder catheterization.

What kinds of catheters do you know?

List the tools to catheterization.

List at least 3 indications for PUC introduction.

Describe the single catheterization procedure of women.

What complications can occur during catheterization?

About what will you educate mobile patient with PUC?

*

Reference:

MIKŠOVÁ, Zdeňka, Marie FROŇKOVÁ, Renáta HERNOVÁ a Marie ZAJÍČKOVÁ, kapitoly z ošetřovatelské péče 1. Aktualiz. a dopl. vyd. Praha: Grada, 2006, 90s. ISBN 80-247-1442-6

VELKÝ LÉKAŘSKÝ SLOVNÍK [online]. 2015 [cit. 2015-03-27]. Dostupné z: www.lekarske.slovniky.cz

VOŠ ZDRAVOTNICKÁ A STŘEDNÍ ZDRAVOTNICKÁ ŠKOLA HRADEC KRÁLOVÉ. Ošetřovatelské postupy – zavedení permanentního katetru [online].2015 [cit.2015-04-08]. Dostupné z http://ose.zshk.cz/vyuka/osetrovatelske-postupy.aspx?id=15

PICTURES * (if it is not stated differently): google.com (key words: „tubes“,„urine for testing“, „catheters“… )

Documents

Basic procedures in healthcare 1 (SOL / VCA81) TOPICS: 12a) Emptying of the bladder 12b) Urine sampling and its examination 12c) Bladder catheterization