URINARY CATHETER and GASTRO-INTESTINAL TUBE CARE

BY: JANET BOTHAH/NHHCS TABUK

URINARY CATHETER AND

GASTRO-INTESTINAL TUBE CARE

JANET BOTHA

OBJECTIVES

Encourage all health care workers to avoid urinary catheterization unless clinically indicated

Ensure the benefits outweigh the disadvantages and INFORMED consent is obtained

Encourage health education to avoid complications

TOPICS

- CONSIDERATIONS AND CLINICAL INDICATIONS

- RISK ASSESSMENT- EDUCATION AND CONSENT- CATHETER CARE AND PREVENTION

OF INFECTION- OBSERVATION- DOCUMENTATION

CONSIDERATIONS

Must benefit the patient NOT for the convenience of the caregiver

Complications Informed consent Patient cognitive status and agitated

patient Time frame of catheterization

CLINICAL INDICATIONS

Acute urinary retention Bladder irrigation or instillation of

medication Monitoring renal function during

critical illness For a variety of reasons pre-and post

operatively Pressure Ulcers – delayed healing

4 degreePressure ulcer

Healed Ulcer

RISK ASSESSMENT AND POSSIBLE COMPLICATIONS

Allergy Infection Trauma Recent UT surgery Medication Obstruction Pain, discomfort and emotional wellbeing Diabetes or Chemotherapy Patient with only one functional kidney or

CKD

POSSIBLE COMPLICATIONS

UTI Serious complications:- pyelonephrites, bacteremia,

bladder cancer Chronic obstruction due to urinary

calculi and in male patients, epididymites

Drug resistance due to chronic use of anti-biotics

Urethral necrosis or pressure ulcers

CONSENT

Verbal, written and demonstrative education on total care, regardless of type of catheterization

Informed consent Risks involved – advantages,

disadvantages, complications, and expected timeframe

EDUCTION

Total care Infection prevention Obtaining of materials Care and storage ID any possible problems –S&S Where and when to get help by

giving contact numbers

SUPRAPUBIC CATHETER

No risk of urethral trauma or

necrosis Greater comfort Patient can remain sexually active Micturition still possible

INSERTION OF SUPRA PUBIC CATHETER

-Insertion can be done under general or local anesthesia.

-A small incision or puncture is made above the pubis and the catheter is inserted.

-It could be temporarily or permanent – needs to be changed at 6-12 week intervals.

Supra-pubic

catheter

INTERMITTEND SELF-CATHETERIZATION

Reduced infection rate compare to indwelling catheters

Good cognitive ability Self motivated Less restriction to movement Socially more accepted No visible devices to carry

PROCEDURE

- Patient is educated :

- Verbal and by demonstration- Correct aseptic technique- Cleansing and storage if the catheter

is not disposable- to perform this procedure at 4 hourly

intervals- Where to obtain the supplies

Intermittent

Selfcatheteriza

tion

INDWELLING CATHETER

LONG AND SHORT TERM

Possibility of urethral trauma Increased risk of infection Patient needs to carry collection

bag Can impede on emotional wellbeing Can aid in pressure ulcer healing

PROCEDURE

Use STERILE materials for insertion - Sterile catheter – correct size- Sterile catheter tray- Sterile urine collection bag- Use aseptic technique for inserting

catheter Hand wash Gown and gloves Collection bag must be positioned

lower than the patient bladder

INFECTION PREVENTION GUIDELINES

o Hand washing before and aftero Aseptic technique with sterile

material when inserting a cathetero Change/removal of catheter at given

dateo Changing collection bag every 3

dayso Good personal hygieneo Adopting closed method of urinary

drainage

HANDWASHING

INFECTION PREVENTION GUIDELINES

Maintaining an aseptic technique when bladder irrigation, medication instillation or collecting of a urine sample is done

Ensuring unobstructed urine flow Emptying collection bag when it is 1/3 full Correct positioning of urine collection bag Traction free urinary catheter Meatal care Adequate fluid intake

ADEQUATE FLUID INTAKE

Specimen collection urine bag emptying when 1/3 filled

OBSERVATIONS

Patient health status Affectivity of antibiotics used Allergy and tolerance of urinary

catheter Renal status Ensure that urine flows from

catheter into collection bag

OBSERVATIONS

Urine bypassing the catheter Trauma Heamaturia, bleeding of the meatus Erosion, swelling, discharge Color, odor and volume of urine

Volume, Colour, odor

DOCUMENTATION

Physicians Order Indication, type, and brand of catheter Informed consent Cognitive state of patient Date inserted, removal/change Problems during insertion Procedures: specimen, irrigation,

medication Fixation Volume, color, and odor Education

Gastro-IntestinalTube Care

GASTRO-INTESTINAL TUBE CARE(naso-gastric tube for feeding)

INDICATION ADVANTAGES CONSIDERATIONS COMPLICATIONS RISK REDUCTION MEDICATION ADMINISTRATION EDUCATION AND MANAGEMENT DOCUMENTATION

GASTRO-INTESTINAL TUBE CARE(NASO-GASTRIC TUBE for feeding)

INDICATIONS

• Blockage in the esophagus• Problems swallowing

Tube feedings are given when oral intake is inadequate or not possible and the GI tract is functioning normally.

(This procedure is a short term solution to ensure complete nutrition and hydration)

Adult or Pediatric?

ADVANTAGES

To preserve GI integrity by delivery of nutrients, fluids and medications

To preserve the normal sequence of intestinal and hepatic metabolism

To maintain fat metabolism and lipoprotein synthesis

To maintain normal insulin/glucagon rations

To maintain normal hydration

CONSIDERATIONS

Patient nutritional and hydration status

Is the digestive tract and kidneys functioning

Patient dietary and fluid needs (30-40ml/kg body mass)

Metabolic disorders Medication in use

CONSIDERATIONS

Informed consent Responsible caregiver Cognitive status of patient – restraint Age and duration Patient environment

NUTRITIONAL REQUIREMENTS

NUTRIENTS INCLUDES:- Protein- Fat Carbohydrates- Vitamins- Minerals- Fiber

COMPLETE NURTRITION

COMPLICATIONS

Aspiration PneumoniaAccidental dislodging of feeding tubeDifficulty in inserting the tube –

epistaxisHerniation of esophageal varicesRegurgitation and aspirationnausea

COMPLICATIONS

Pressure ulcer formationConstipation or diarrheaDehydration or over-hydrationDifficulty in cleaning the nasal cavityPain and discomfortHyperglycemia

INSERTION

Use correct size tube Measure - tip of nose to earlobe and

from earlobe to xiphi sternum and mark the tube

Ensure the nasal cavity is clean Position the patient Lubricate the tube Insert and check position Fix to nose or convenient area

MEASURING A NGT

RISK REDUCTION

ASPIRATION PNEUMONIA- Checking NGT is in correct position before

any fluid is given- Correct placement of feed- Proper positioning of patient - (semi-fowlers with head elevated at least 30-45 degrees)

- Maintaining this position for at least one hour after the feed

- Monitor residual volumes before every feed- If aspiration is suspected, stop feed

immediately and suction patient in R lateral position

RISK REDUCTION

DEHYDRATION- Monitor hydration carefully ( patient can in most situation not verbalize thirst)

- Water should be given between feeds

- Checking of mucous membranes, decreased urine output

- Monitor intake and output

Prevent dehydration

RISK REDUCTION

BLOCKING OF TUBE- Tube must be flushed with warm

water after every feed- Medication must be crushed into

powder form and dissolved in warm water and tube flushed thereafter

- Water to be given between feeds- Change tube

MEDICATION ADMINISTRATION Use medication in liquid form where

possible Ensure whether medication should be

given before or after meals Simple compressed tablets – crush and

dissolve in water Buccal or sublingual tablets must be

given as prescribed Soft gelatin capsules filled with liquid –

cut opening and squeeze out contents

Crushing of Medication

MEDICATION ADMINISTRATION Enteric-coated tablets – do not crush,

change in form is required Timed-release tablets – do not crush,

check with pharmacist for alternative Timed-release capsules or sustained-

release capsules – some can be opened and contents added to water – but only after pharmacist was consulted

NEVER mix medication with feed

EDUCATION AND MANAGEMENT

All members of the clinical team is responsible to decide if a NGT is appropriate for the patient – Physician, Nurse, Dietician, Pharmacist, Speech Therapist.

Education given to the caregiver must be complete and be done verbally and by demonstration to ensure the caregiver is comfortable with the patient and the feeding regime, and know to check if NGT is intact.

CLINICAL TEAM DISCUSSION

MANAGEMENT

o Patient must be referred to dieticiano Feed formula will be calculated

according to blood works, weight, and nutritional needs

o Possible restrainto NGT placement and attachment to

be checked before any fluid is giveno Check pH from aspirate – pH5 or less

Correct formula

MANAGEMENT

o Medication should be checked with pharmacist to ensure it is appropriate for NGT patient

o If NGT should be re-inserted after third time, PEG-tube insertion should be considered and discussed with the family

o Before initial insertion, patient should be weighed and thereafter on a weekly basis

MANAGEMENT

o Swallowing assessments should be undertaken by qualified staff

o If the NGT is to be discontinued, wean the patient and the family must be educated accordingly

o Oral hygiene- at least 4x per dayo Good hygiene – environment,

handling and administering feed

MANAGEMENT

o Hygiene of nasal cavityo NGT should be placed in alternative

nostril when changedo If NGT is dislodged, no feed should be

given until correctedo Check for pressure ulcero If NGT is to be removed, patient must

be monitored and weighed weeklyo Accurate documentation

DOCUMENTATION

Physicians order Informed consent from family Patient’s initial weight and weekly weight Prescribed feeding formula, volume,

frequency and strength Date and time of insertion and date due

for change/removal Size of NGT and fixation method Education and demonstration Problems during insertion

THANKYOU