Urinary Catheterisation Male and Female
Indications for urethral Catheterisation
Urethral Catheterisation is the passing of a catheter through the urethral orifice to the bladder.
- Re-establish a flow of urine in urinary retention.
- Provide a channel for drainage when micturition is impaired.
- Empty the bladder preoperatively.
- Allow the monitoring of fluid balance in a seriously ill patient.
- Facilitate bladder irrigation procedures.
- Maintain a dry environment in urinary incontinence when all other forms of nursing intervention have failed.
Equipment: Urinary Catheterisation Male and Female
- Good light source, such as spotlight or torch.
- Sterile gloves.
- Sterile catheterisation or dressings pack.
- Sterile water-based solution for cleansing the genitalia.
- Sterile anaesthetic gel if required, or water-soluble lubricant.
- Sterile receiver.
- Sterile catheter of the type and size required.
- Appropriate equipment for catheter balloon inflation for non-pre-filled catheters only, e.g. syringe, needles and sterile water.
- Sterile closed drainage system if required, or catheter valve.
- Hypoallergenic tape.
- Sterile specimen container appropriately labelled with a completed laboratory form and plastic specimen bag for transportation.
- Trolley or adequate surface for equipment.
- Receptacle for soiled disposable items.
Catheters and catheter bags
- Catheter type The reason for urinary catheterisation can dictate the type and size of catheter.
- a round-ended catheter can be used when a retained catheter is not required.
- a Foley double-lumen, self-retaining catheter can be used when a short-term retained catheter is required.
- a Foley triple-lumen, self-retaining catheter can be used when continuous bladder irrigation is required.
- a Tiemann catheter can be used when the urethral canal is narrowed, for example when a male patient has an enlarged prostate gland; the shape of the catheter tip aids the passage of the catheter.
- a whistle-tipped catheter can be used postoperatively to allow the passage of blood clots, particularly when bladder irrigation is not being utilised.
- a Silastic catheter can be used when a retained catheter is required for long-term use, as silastic is less irritant to the body tissue.
Sizes The smallest Charriere size that will drain urine should be used
- 12-14 FG is a suitable size of the catheter for female and male patients. Intermittent self-catheterisation catheters are usually 10–12 FG in size.
- larger-diameter catheters may be used when the urine has an excess of sediment and/or blood.
- catheters are manufactured in female and male catheter lengths, male catheters being approximately 42 cm long and female ones about 26 cm.
- for routine use, select a catheter with a 10 ml balloon. A 30 ml balloon may be used postoperatively.
Materials A variety of catheter materials is available, the choice being geared to the needs of the individual patient:
- a latex catheter for use up to 2 weeks.
- a PTFE-coated, latex Foley catheter for use up to 2 weeks.
- a hydrogel-coated, latex catheter for use up to 12 weeks.
- a silicone-coated, latex catheter for use up to 12 weeks.
- a 100% silicone catheter for use up to 12 weeks.
Only PVC and 100% silicone catheters contain no latex and may be used in
patients with a latex allergy.
Catheter bags: There are three elements to be considered when choosing an appropriate catheter bag: the capacity, the length of the inlet tube and the type of outlet tap for emptying. The selection depends on the rationale for catheter use, patient preference and the patient's manual dexterity. The leg bag can be supported by leg straps or by a variety of garments such as net sleeves.
A catheter valve may be preferable to a catheter bag for patients with bladder sensation and a stable bladder. The valve is released several times a day as sensation indicates.
Urinary Catheterisation Female Patients
- explain the nursing practice to the patient to obtain consent and co-operation.
- collect and prepare the equipment to ensure that all equipment is available and ready for use.
- ensure the patient's privacy to reduce anxiety.
- observe the patient throughout this activity to note any signs of distress.
- prepare and help the patient into a supine position with the knees bent the hips flexed and the feet resting on the bed approximately 70 cm apart. This position provides good access to and visualisation of the genitalia.
- place an incontinence pad or similar waterproof sheet under the patient's buttocks to prevent any spillage of fluids onto the patient's bed linen.
- arrange the lighting to assist with good visualisation of the genitalia.
- wash the hands and put on the gloves, which will act as a barrier between the nurse's skin and the patient's tissues, thus reducing the incidence of contamination.
- open and arrange the equipment, maintaining sterility to reduce contamination.
- cleanse the labia minora, swabbing from above downwards to reduce the danger of cross-infection from the anal region.
- using the non-dominant hand, separate the labia minora to reveal the urethral meatus. Hold this position until catheter insertion has been completed in order to prevent recontamination of the urethral meatus by the labia minora after cleansing.
- insert anaesthetic gel or water-soluble lubricant into the urethral meatus to ease the passage of the catheter.
- with the dominant hand, cleanse the urethral meatus to prevent the introduction of micro organisms into the urethra and/or bladder and position the sterile receiver to collect the urine from the catheter.
- insert the lubricated catheter into the urethra in an upward and backward direction, which follows the anatomical route of the female urethra.
- avoid contamination of the surface of the catheter until a flow of urine has been established, to prevent the introduction of micro-organisms.
- if it is not intended that the catheter should be left in situ, gently remove the catheter when the urine flow ceases.
- if for retention, gently advance the catheter 4-5 cm and slowly inflate the balloon according to the manufacturer's directions. The inflated balloon will maintain the catheter's position.
- a complaint of pain may suggest that the inflating balloon is still within the patient's urethra. Stop the inflation and withdraw the fluid inserted into the balloon. Advance the catheter another 4-5 cm and repeat the inflation process. The length of a patient's urethra can vary so it is important to adjust practice to meet the individual patient's needs and prevent complications.
- attach a drainage system and properly manage all potential entry points of infection to prevent the development of ascending infection.
- anchor the catheter when appropriate by supporting the catheter and drainage tubing to reduce trauma to the bladder neck and urethra, which could lead to pressure sore development.
- ensure that the patient is left feeling as comfortable as possible, thus maintaining the quality of this nursing practice.
- dispose of the equipment safely to reduce any health hazard.
- document the nursing practice appropriately, monitor the after-effects and report any abnormal findings immediately, providing a written record and assisting in the implementation of any action should an abnormality or adverse reaction to the practice be noted.
Urinary Catheterisation Male Patient
This practice is usually carried out by a medical practitioner, a male nurse or a female nurse who has achieved the required level of competence
- explain the nursing practice to the patient to obtain consent and co-operation .
- collect and prepare the equipment to ensure that all equipment is available and ready for use.
- ensure the patient's privacy to reduce anxiety.
- observe the patient throughout this activity to note any signs of distress.
- prepare and help the patient into a supine position. This position provides good access to and visualisation of the genitalia.
- place an incontinence pad or similar waterproof sheet under the patient's buttocks to prevent any spillage of fluids onto the patient's bed linen.
- arrange the lighting to assist with good visualisation of the genitalia.
- wash the hands and put on gloves, which will act as a barrier between the nurse's skin and the patient's tissues, thus reducing the incidence of contamination.
- open and arrange the equipment, maintaining sterility to reduce contamination.
- withdraw the patient's foreskin with the non-dominant hand. Maintain this position until catheter insertion has been completed in order to prevent recontamination of the urethral meatus by the foreskin after cleansing.
- with the dominant hand, cleanse the glans penis and urethral meatus to prevent the introduction of micro-organisms into the urethra and/or bladder.
- insert the lignocaine gel and leave for 2 minutes to allow the local anaesthetic to act.
- position the sterile receiver and, with the non-dominant hand, gently grasp the shaft of the penis, raising it straight up as this will aid the passage of the catheter along the length of the urethra .
- as the male urethra is longer than the female, insert the lubricated catheter into the urethral meatus for approximately 20-25 cm until a flow of urine is established.
- continue as for the female patient until the anchoring of the catheter.
- replace the patient's foreskin over the glans penis or paraphimosis may develop.
- anchor the catheter by taping it laterally to the thigh or abdomen, or use a supportive waist-belt, to reduce trauma to the urethra and bladder neck, which could cause the development of a pressure sore.
- ensure that the patient is left feeling as comfortable as possible, maintaining the quality of this nursing practice.
- dispose of the equipment safely to reduce any health hazard.
- document the nursing practice appropriately, monitor the after-effects and report any abnormal findings immediately, providing a written record and assisting in the implementation of any action should an abnormality or adverse reaction to the practice be noted.
Catheter care Male and Female Patients
Indications
Catheter care is the cleansing of the exposed part of a catheter; this may:
- help to reduce the risk of infection ascending via the catheter to other parts of the urinary system.
- remove any crusts or discharge from the catheter as these can harbour pathogenic micro-organisms.
Equipment Catheter care
- Disposable gloves.
- Disposable wipes.
- Mild soap and water.
- Tray for equipment.
- Receptacle for soiled disposable items.
Guidelines and rationale for this nursing practice
- explain the nursing practice to the patient to obtain consent and co-operation.
- collect and prepare the equipment to ensure that all equipment is available and ready for use.
- ensure the patient's privacy to reduce anxiety.
- observe the patient throughout this activity to note any signs of distress.
- help the patient into a suitable position allowing the nurse easy, comfortable access to the patient.
- wash the hands to reduce cross-infection, apply gloves, and arrange the equipment, allowing easy access during the practice.
- gently cleanse the external urethral meatus, using the swab only once and in only one direction.
- swabbing from above downwards in the female patient and away from the catheter–meatus junction to reduce the risk of cross-infection.
- in a male patient, retract the foreskin before cleansing, allowing clear access to the meatus.
- replace the foreskin following the completion of this nursing practice, preventing the development of paraphimosis.
- gently swab the shaft of the catheter away from the catheter–meatus junction, to remove any discharge away from the urethral orifice.
- ensure that the patient is left feeling as comfortable as possible, maintaining the quality of this nursing practice.
- dispose of the equipment safely to reduce any health hazard.
- document the nursing practice appropriately, monitor the after-effects and report any abnormal findings immediately, providing a written record and assisting in the implementation of any action should an abnormality or adverse reaction to the practice be noted.
Reference: Clinical and Nursing Practices
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