Urinary Catheters


Chapter 25

Urinary Catheters





Key Abbreviations
















BM Bowel movement
IV Intravenous
mL Milliliter
UTI Urinary tract infection

A catheter is a tube used to drain or inject fluid through a  body opening. Inserted through the urethra into the bladder, a urinary catheter drains urine. Catheterization is the process of inserting a catheter. With proper training and supervision, some states and agencies let nursing assistants insert and remove urinary catheters.


See Focus on Surveys: Urinary Catheters.


See Promoting Safety and Comfort: Urinary Catheters.




Promoting Safety and Comfort


Urinary Catheters






Safety


Urinary catheter procedures often involve exposing and touching the perineum. Sexual abuse has occurred in health care settings. The person may feel threatened or actually may be abused. He or she needs to call for help. Keep the call light within the person’s reach at all times. And always act in a professional manner.


Urine may contain microbes and blood. Follow Standard Precautions and the Bloodborne Pathogen Standard when performing the procedures in this chapter.



Purposes and Types of Catheters


These types of catheters are common.



A straight catheter drains the bladder and then is removed.


An indwelling catheter (retention or Foley catheter) is left in the bladder. Urine drains constantly into a drainage bag. A balloon near the tip is inflated with sterile water after the catheter is inserted. The balloon prevents the catheter from slipping out of the bladder (Fig. 25-1).



See Figure 25-2 for parts of an indwelling catheter. Tubing connects the catheter to the urine drainage bag. See Figure 25-3 for the parts of the urine drainage system.




Catheters create a risk for UTIs. However, they are used:



Catheters do not treat the cause of incontinence. They are a last resort for incontinence.



image Catheter Care


You will care for persons with indwelling catheters. The risk of UTI is high. Follow the rules in Box 25-1 to promote safety and comfort.



Box 25-1


Indwelling Catheter Care




The Drainage System



Allow urine to flow freely through the catheter and drainage tube. Tubing should not have kinks. The person should not lie on the tubing.


Keep the catheter connected to the drainage tube. Follow the measures on p. 412 if the catheter and drainage tube are disconnected.


Keep the drainage tube and bag below the bladder. This prevents urine from flowing backward into the bladder. When transferring the person to or from the bed or chair, keep the drainage bag lower than the bladder. Secure the drainage bag to the bed or chair after the transfer. See Figure 25-4.



Move the drainage bag to the other side of the bed when the person is turned and re-positioned on his or her other side.


Hang the bag from the bed frame, back of the chair or wheelchair, or lower part of the IV (intravenous) pole.


Do not hang the drainage bag on a bed rail. Otherwise the bag is higher than the bladder when the bed rail is raised.


Hold the bag lower than the bladder when the person walks.


Do not let the drainage bag touch or rest on the floor. This can contaminate the system.


Position drainage tubing in a straight line or coil the drainage tubing on the bed. Secure it to the bottom linens (Fig. 25-5, p. 410). Follow the nurse’s directions and agency policy. Use a clip, bed sheet clamp, tape, or other device as the nurse directs. Tubing must not loop below the drainage bag.






See Delegation Guidelines: Catheter Care, p. 410.


See Promoting Safety and Comfort: Catheter Care, p. 410.


See procedure: Giving Catheter Care, p. 411.






image Giving Catheter Care imageimageimage





Procedure



10. Practice hand hygiene. Put on the gloves.


11. Cover the person with a bath blanket. Fan-fold top linens to the foot of the bed.


12. Position and drape the person for perineal care (Chapter 22).


13. Fold back the bath blanket to expose the perineal area.


14. Ask the person to flex the knees and raise the buttocks off the bed. Place the waterproof under-pad under the buttocks.


15. Check the drainage tubing. Make sure it is not kinked and that urine can flow freely.


16. Separate the labia (female). In an uncircumcised male, retract the foreskin (Chapter 22). Check for crusts, abnormal drainage, or secretions.


17. Give perineal care (Chapter 22). Keep the foreskin of the uncircumcised male retracted until step 25.


18. Apply soap to a clean, wet washcloth.


19. Hold the catheter at the meatus. Do so for steps 20 through 24.


20. Wash around the catheter at the meatus. Use a circular motion (Fig. 25-7, A, p. 412).



21. Clean the catheter from the meatus down the catheter at least 4 inches (Fig. 25-7, B, p. 412). Clean downward, away from the meatus with 1 stroke. Do not tug or pull on the catheter. Repeat as needed with a clean area of the washcloth. Use a clean washcloth if needed.


22. Rinse around the catheter at the meatus with a clean washcloth.


23. Rinse the catheter from the meatus down the catheter at least 4 inches. Rinse downward, away from the meatus with 1 stroke. Do not tug or pull on the catheter. Repeat as needed with a clean area of the washcloth. Use a clean washcloth if needed.


24. Pat dry the areas washed. Dry from the meatus down the catheter at least 4 inches. Do not tug or pull on the catheter.


25. Return the foreskin (uncircumcised male) to its natural position.


26. Pat dry the perineal area. Dry from front to back (top to bottom).


27. Secure the catheter. Position the tubing in a straight line or coiled on the bed. Follow the nurse’s directions. Secure the tubing to the bottom linens (see Fig. 25-5).


28. Remove the waterproof under-pad.


29. Cover the person. Remove the bath blanket.


30. Remove and discard the gloves. Practice hand hygiene.



Apr 13, 2017 | Posted by in NURSING | Comments Off on Urinary Catheters

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