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COLEGIO DE SAN JUAN DE LETRAN- CALAMBACOLEGIO DE SAN JUAN DE LETRAN- CALAMBANURSING DEPARTMENTNURSING DEPARTMENTCALAMBA CITY, LAGUNACALAMBA CITY, LAGUNA
Urine CatheterizationUrine Catheterization(male)(male)
Reported byReported by
Stephen Rae S. SilladorStephen Rae S. Sillador
Urinary Catheterization- Urinary Catheterization- is the is the introduction of a catheter through introduction of a catheter through the urethra into the urinary the urethra into the urinary bladder. It is the passage of a bladder. It is the passage of a catheter into the bladder for the catheter into the bladder for the drainage of urine. It is the passage drainage of urine. It is the passage of a slender tubular device into of a slender tubular device into the bladder or kidney for the the bladder or kidney for the drainage of urine or diagnostic drainage of urine or diagnostic purposes. A plastic tube known as purposes. A plastic tube known as a urinary catheter (such as a Foley a urinary catheter (such as a Foley catheter inserted into a patient's catheter inserted into a patient's bladder via their urethra.bladder via their urethra.
• Complications of catheter use may Complications of catheter use may include: include: urinaryurinary tract or kidney tract or kidney infections, blood infections (sepsis), infections, blood infections (sepsis), urethral injury, skin breakdown, urethral injury, skin breakdown, bladder stones, and blood in the bladder stones, and blood in the urine (hematuria). After many years urine (hematuria). After many years of catheter use, bladder cancer may of catheter use, bladder cancer may also develop.also develop.
• PurposesPurposes• To relieve discomfort due to bladder To relieve discomfort due to bladder
distention or to provide gradual distention or to provide gradual decompression of a distended bladder.decompression of a distended bladder.
• To assess the amount of residual urine if the To assess the amount of residual urine if the bladder empties in completely.bladder empties in completely.
• To obtain a urine specimen.To obtain a urine specimen.• To empty the bladder completely prior to To empty the bladder completely prior to
surgery.surgery.• To facilitate accurate measurement of To facilitate accurate measurement of
urinary output for critically ill clients whose urinary output for critically ill clients whose output needs to be monitored hourly.output needs to be monitored hourly.
• To provide intermittent or continuous bladder To provide intermittent or continuous bladder irrigation.irrigation.
• To prevent urine from contacting an incision To prevent urine from contacting an incision after perineal surgery.after perineal surgery.
• To manage incontinence when other To manage incontinence when other measures have failed.measures have failed.
EquipmentsEquipments• sterile gloves sterile gloves • antiseptic cleansing solution antiseptic cleansing solution • cotton balls cotton balls • water-soluble lubricating jelly water-soluble lubricating jelly • forcepsforceps• prefilled syringeprefilled syringe• drape drape • indwelling catheter with indwelling catheter with
drainage tubing and collecting drainage tubing and collecting bagbag
•Equipments
Performing Urinary Performing Urinary CatheterizationCatheterization
PreparationPreparation• 1. Assess:1. Assess:• The clients overall conditionThe clients overall condition• If the client is able to cooperate and hold still If the client is able to cooperate and hold still
during the procedureduring the procedure• If the client can be positioned supine, with If the client can be positioned supine, with
head relatively flathead relatively flat• When the client last voided or was last When the client last voided or was last
catheterizedcatheterized• Percuss the bladder to check for fullness or Percuss the bladder to check for fullness or
distentiondistention• 2.2. Determine:Determine:• The most appropriate method of The most appropriate method of
catheterizationcatheterization
• 3. Assemble equipment and supplies:3. Assemble equipment and supplies:• Sterile catheter of appropriate size. An extra catheter should also be at Sterile catheter of appropriate size. An extra catheter should also be at
hand.hand.• Catheterization kit or individual sterile items;Catheterization kit or individual sterile items;• 1-2 pair sterile gloves1-2 pair sterile gloves• Waterproof drape(s)Waterproof drape(s)• Antiseptic solutionAntiseptic solution• Cleansing ballsCleansing balls• ForcepsForceps• Water-soluble lubricantWater-soluble lubricant• Urine receptacleUrine receptacle• Specimen containerSpecimen container• For an indwelling catheter:For an indwelling catheter:• Syringe prefilled with sterile water in amount specified by catheter Syringe prefilled with sterile water in amount specified by catheter
manufacturermanufacturer• Collection bag and tubingCollection bag and tubing• 2% Xylocaine gel( if agency permits)2% Xylocaine gel( if agency permits)• Disposable clean glovesDisposable clean gloves• Supplies for performing perineal cleansingSupplies for performing perineal cleansing• Bath blanket or sheet for draping the clientBath blanket or sheet for draping the client• Insure that there is adequate lighting—obtain a flashlight or lamp, if Insure that there is adequate lighting—obtain a flashlight or lamp, if
necessary.necessary.• 4. Perform routine perineal care to cleanse the meatus from gross 4. Perform routine perineal care to cleanse the meatus from gross
contaminationcontamination
• ProcedureProcedure• 1. Explain to the client what you are going to do, why it is 1. Explain to the client what you are going to do, why it is
necessary, and how he or she can cooperate.necessary, and how he or she can cooperate.• 2. Wash hands and observe other appropriate infection control 2. Wash hands and observe other appropriate infection control
procedures.procedures.• 3. Provide for client privacy.3. Provide for client privacy.• 4. Place the client in the appropriate position and drape all areas 4. Place the client in the appropriate position and drape all areas
except the perineumexcept the perineum• (Male: supine, legs slightly abducted)(Male: supine, legs slightly abducted)• 5. 5. Establish adequate lighting. Stand on the client’s right if you Establish adequate lighting. Stand on the client’s right if you
are right-handed, on the client’s left if you are left-handed.are right-handed, on the client’s left if you are left-handed.• 6. 6. If using a collecting bag not contained within the If using a collecting bag not contained within the
catheterization kit open the drainage package and place the end catheterization kit open the drainage package and place the end of the tubing within reach.of the tubing within reach.
• 7.7. If agency policy permits, apply clean gloves and inject 10-15 If agency policy permits, apply clean gloves and inject 10-15 ml Xylocaine gel into the urethra. In the male, wipe the ml Xylocaine gel into the urethra. In the male, wipe the underside of the shaft to distribute the gel up the urethra. Wait underside of the shaft to distribute the gel up the urethra. Wait at least 5 minutes for the gel to take effect before inserting the at least 5 minutes for the gel to take effect before inserting the catheter.catheter.
• 8. 8. Open the catheterization kit. Place a waterproof drape under Open the catheterization kit. Place a waterproof drape under the penis without contaminating the center of the drape with the penis without contaminating the center of the drape with your hands.your hands.
• 9. 9. Apply sterile gloves.Apply sterile gloves.• 10. 10. Organize the remaining supplies.Organize the remaining supplies.
• - Saturate the cleansing balls with the antiseptic - Saturate the cleansing balls with the antiseptic solution.solution.
• - Open the lubricant package.- Open the lubricant package.• - Remove the specimen container and place it - Remove the specimen container and place it
nearby, with the lid loosely on top.nearby, with the lid loosely on top.• 11. 11. Attach the prefilled syringe to the indwelling Attach the prefilled syringe to the indwelling
catheter inflation hub and test the balloon.catheter inflation hub and test the balloon.• 12. 12. Lubricate the catheter and place it with the Lubricate the catheter and place it with the
drainage end inside the collection container.drainage end inside the collection container.• 13. 13. If desired, place the fenestrated drape over If desired, place the fenestrated drape over
the perineum, exposing the urinary meatus.the perineum, exposing the urinary meatus.• 14.14. Cleanse the meatus Cleanse the meatus• Use your nondominant hand to hand to grasp the Use your nondominant hand to hand to grasp the
penis just below the glans. If necessary, retract the penis just below the glans. If necessary, retract the foreskin. Hold the penis firm upright, with slight foreskin. Hold the penis firm upright, with slight tension.tension.
• Pick up a cleansing ball with the forceps in your Pick up a cleansing ball with the forceps in your dominant hand and wipe from the center of the dominant hand and wipe from the center of the meatus in a circular motion around the glans.meatus in a circular motion around the glans.
• Use a new ball and repeat three more times.Use a new ball and repeat three more times.• 15.15. Insert the catheter. Insert the catheter.• Grasp the catheter firmly 2-3 inches from the tip. Grasp the catheter firmly 2-3 inches from the tip.
Ask the client to take a sleep deep breath, and Ask the client to take a sleep deep breath, and insert the catheter as the client exhales.insert the catheter as the client exhales.
• Advance the catheter 2 inches further after the Advance the catheter 2 inches further after the urine begins to flow through it.urine begins to flow through it.
• 16. 16. Hold the dominant hand with the nondominant hand. Lay the penis down onto drape, Hold the dominant hand with the nondominant hand. Lay the penis down onto drape, being careful that the catheter does not pull out.being careful that the catheter does not pull out.
• 17. 17. For an indwelling catheter, inflate the retention balloon with the designated volume.For an indwelling catheter, inflate the retention balloon with the designated volume.• Without releasing the catheter, hold the inflation valve between two fingers of your Without releasing the catheter, hold the inflation valve between two fingers of your
nondominant hand while you attach the syringe and inflate with your non dominant hand nondominant hand while you attach the syringe and inflate with your non dominant hand • If the client complaints of discomfort, immediately withdraw the instilled fluid, advance the If the client complaints of discomfort, immediately withdraw the instilled fluid, advance the
catheter further, and attempt to inflate the balloon againcatheter further, and attempt to inflate the balloon again• Pull gently on the catheter until resistance to felt, to insure that the balloon has inflated and Pull gently on the catheter until resistance to felt, to insure that the balloon has inflated and
to place it in trigone of the bladder.to place it in trigone of the bladder.• 18. 18. Collect a urine specimen if needed. Allow 20-30 ml to flow into the bottle without Collect a urine specimen if needed. Allow 20-30 ml to flow into the bottle without
touching the catheter to the bottle.touching the catheter to the bottle.• 19. 19. Allow the straight catheter to continue draining. If necessary, attach the drainage end Allow the straight catheter to continue draining. If necessary, attach the drainage end
of an indwelling catheter to the collecting tubing and bag.of an indwelling catheter to the collecting tubing and bag.• 20. 20. Examine and measure the urine. In some cases, only 750-1000ml of urine are to be Examine and measure the urine. In some cases, only 750-1000ml of urine are to be
drained from the bladder at one time.drained from the bladder at one time.• 21. 21. Remove the straight catheter when the urine flow stops.Remove the straight catheter when the urine flow stops.• For an indwelling catheter, secure the catheter tubing to the upper thigh with enough slack to For an indwelling catheter, secure the catheter tubing to the upper thigh with enough slack to
allow usual movement.allow usual movement.• Also secure the collecting tubing to the bed linens and hand the bag below the level of the Also secure the collecting tubing to the bed linens and hand the bag below the level of the
bladder. No tubing should fall below the top of the bag.bladder. No tubing should fall below the top of the bag.• 22. 22. Wipe the perineal area of any remaining antiseptic or lubricant. Return the client to a Wipe the perineal area of any remaining antiseptic or lubricant. Return the client to a
comfortable position.comfortable position.• 23. 23. Discard all used supplies in appropriate receptacles and wash your hands.Discard all used supplies in appropriate receptacles and wash your hands.• 24. 24. Document the catheterization procedure, including catheter size and results, in the Document the catheterization procedure, including catheter size and results, in the
client record.client record.