Care of the Catheterised Patient and Urinalysis

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1 Care of the Catheterised Patient and Urinalysis

2 Male Pelvic Anatomy

3 Female Pelvic Anatomy

4 What does a urinary catheter do?

5 Urinary Catheters

6 Urinary Catheters

7 Urinary Catheters

8 Why do patients have catheters? Short Term Long Term Surgery Immobility Fluid monitoring Acute urinary retention Bladder emptying problems Not fit for surgery Incontinence Last Resort!

9 Emptying a catheter bag Equipment Disposable gloves Urine bottle or jug Alco wipes Measuring scales or jug

10 Emptying a catheter bag Procedure Wash your hands Clean outlet with wipe Empty urine Close valve (!) Clean outlet again Measure urine then discard Wash your hands Record urine if required

11 Urine collection devices Catheter bags Drainable Non drainable Urimeters Leg bags Sporrans / belly bags

12 Catheter Valves Assessment Mental ability Bladder sensation Manual dexterity Vision Recent bladder or prostate surgery?

13 Attachment Devices All catheters should be well supported Leg straps Urisleeve G Strap

14

15 Catheter Bags Below level of the bladder Tube not kinked, twisted or looped Only empty bags when required i.e. When full or nearly full If frequent measuring is required use urimeter

16 Catheter Care Aims Minimise catheter associated complications Infection Tissue damage Pain Catheter blockage Promote dignity and comfort

17 Catheter Care Encourage self care when possible Wash daily (at least) with soap and water Bath or Shower is best Empty bag first Remove straps Dry bag afterwards If unable to bath/shower Retract foreskin Clean daily with soap and water

18 Removal of a Urethral Catheter Equipment Disposable gloves 10ml syringe Procedure Check patient! Check balloon volume in notes Explain procedure to patient Wash your hands Put your gloves on Deflate balloon

19 Removal of a Urethral Catheter Slowly and smoothly remove catheter Check catheter tip for pus, encrustation or damage if worried inform nurse and retain catheter for further inspection Discard syringe and gloves Wash your hands Record removal (and any problems) Patient may experience urgency, frequency and discomfort for hours Encourage high fluid intake Record urine output Inform nurse if fails to void or develops abdo pain

20 URINALYSIS

21 Urine 96% Water 2% Salts 2% Urea Metabolic waste produced in liver ph

22 Urine Colour Normal Pale yellow Almost clear if high intake Abnormal Dark amber bilirubin Red, brown or pink blood

23 Urine Colour Fresh beetroot Clorets Carrots Nitrofurantoin Methyldopa Rifampicin Red Green Amber Amber Black Red / Orange

24 Urine Volume Depends upon many factors Fluid intake Hydration Insensible losses Respiration Sweating Stools Kidney function

25 Urinalysis Urinalysis is the testing of the physical characteristics and composition of freshly voided urine Marsden Manual 5 th Edition 2000 Dipstick testing On admission baseline To monitor urine e.g. diabetes Screening

26 URINALYSIS SUBSTANCE CAUSES Glucose Protein Ketone Haemoglobin Bile Leucocytes Diabetes Pregnancy, HP Diet, Heart failure Hypertension, Infection Untreated diabetes, dieting, starvation Haemolytic anaemia, transfusion reaction Liver disease, jaundice (Pus cells) Infection

27 Haematuria Blood in the urine May be visible macroscopic Or invisible microscopic Common Causes Infection Urinary stones Trauma Cancer Catheter

28 Urine Specimens MSSU Mid stream specimen of urine CSU Catheter specimen of urine EMU Early morning urine 24 hour Urine Fasting urine

29 Urine Specimens Collecting an MSSU Tell patient to wash hands Void some urine into toilet Catch some of mid stream in pot Void rest of urine into toilet Wash hands again Label pot Send to lab

30 Urine Specimens Collecting a CSU Equipment Sterile gloves 10ml syringe (and needle if required) Alcowipe Procedure Wash your hands Wipe catheter specimen port Obtain urine from catheter specimen port Put urine in sample pot Wash hands Send to lab

31 Urine Specimens Collecting a 24 hour urine specimen Start patient empties bladder into toilet Note time Collect all urine in appropriate specimen bottle End exactly 24 hrs after start patient empties bladder and adds to total specimen

32 ANY QUESTIONS?

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