CATHETERISATION. East Lancashire Hospitals NHS Trust Eileen Whitehead 2010

Transcription

1 CATHETERISATION East Lancashire Hospitals NHS Trust Eileen Whitehead

2 Indications for catheterisation: A person is unable to void naturally due to injury or a disease process Diagnostic or therapeutic purposes Decompress the bladder Permit irrigation 2

3 Obtain sterile urine specimen Where output needs to be measured Measure the residual urinary volume after voiding An unconscious patient A person who has had or is going to have abdominal surgery 3

4 Different types of urinary catheters: Types of catheter Simple urethral catheter - a straight catheter designed for in and out procedures Suprapubic catheter - a catheter that is surgically inserted through the abdominal wall above the symphysis into the bladder to divert urine from the urethra 4

5 Different types of urinary catheters: Three way indwelling catheter - has a balloon in its tip that is inflated after it is inserted. It also has another lumen that can be used for continuous bladder irrigation Foley catheter (2 way) - Catheter that is placed through the urethra it has a smooth tapered tip and two outlet ports, and a balloon that is inflated after insertion so that it remains in the bladder Note: The larger port drains the urine, the other is for inflating the balloon that keeps the catheter from slipping out 5

6 Simple In and Out Catheter 6

7 Foley s Catheter (3 way) 7

8 Foley s Catheter (2 Way) 8

9 Procedure for catheterisation: Introduce yourself, check patients id, explain procedure and obtain consent Talk the patient through it in a considerate and courteous manner Review the treatment plan & individual s past history as necessary Request a chaperone 9

10 Wash hands using soap and water Obtain small trolley and clean top surface using alcohol wipes 10

11 Obtain Equipment: The bladder is sterile, so surgical asepsis must be used when performing this procedure Catheter Pack Alcogel 2 Pairs sterile gloves Cleaning solution trisept Correct Catheter and Catheter Bag Non allergic tape Sterile water for balloon Instillagel 11

12 Preparation: Assist the patient into a supine position (take care to maintain the patient s dignity) Decontaminate hands using alcogel Open the catheterisation pack taking care to maintain the sterile field. 12

13 Open onto the sterile field all sterile equipment required: Sterile gloves (both pairs); catheter; Instillagel To the side of the sterile field open the catheter drainage bag Decontaminate your hands (alcogel hand rub if hands are socially clean.) Put on sterile gloves taking care to maintain sterility 13

14 Remove the packaging from the catheter tip & the prefilled syringe Ask your assistant / chaperone to pour trisept for cleaning into the receiver of the catheterisation pack Stand to the patient s side with your non-dominant hand nearest to the patient s head 14

15 Male Using sterile gauze and the non-dominant hand gently grasp the shaft of the penis and elevate Cleanse the glans penis with separate cotton wool balls soaked in the cleansing solution (be careful to maintain a no-touch technique with the dominant hand or use forceps if supplied.) - (4 quadrants) 15

16 If uncircumcised, gently retract the foreskin for cleansing Apply the sterile drape over the penis. 16

17 Female Ask the patient to flex the knees with legs apart and heels together Using sterile gauze and the non-dominant hand gently part the outer labia 17

18 Cleanse the inner labia with separate cotton wool balls soaked in the cleansing solution using a front to back motion only (be careful to maintain a no-touch technique with the dominant hand or use forceps if supplied.) Place the sterile drape under the buttocks 18

19 Remove the first pair of gloves and put on the second pair of gloves Gently insert the Instillagel into the urethra (for males wait 5 minutes for this to have effect, holding the shaft of the penis to ensure Instillagel remains in situ. For females you do not have to wait as there is no practical way to keep the Instillagel in the urethra 19

20 Female - re-part the labia using the gauze swabs, taking care to maintain the sterility of the catheter insert the catheter into the urethra If you meet resistance entering the bladder hold the catheter against the resistance until the sphincter relaxes (5-10 seconds). Alternatively ask the patient to strain gently as if passing urine to help relax the external sphincter of the bladder. Continue to insert the catheter until urine flows freely 20

21 Male - using the non-dominant hand, re-grasp the shaft of the penis with the gauze. Apply gentle traction (with the penis perpendicular to the patient s body). Advance the catheter almost to its bifurcation With the non-dominant hand, hold the catheter s position (be careful not to touch anything other than the catheter valve.) 21

22 Inflate the balloon slowly with the recommended volume of sterile water. If the patient experiences discomfort during inflation STOP deflate the balloon, advance the catheter 3-5 cms then try again to re-inflate the balloon. Gently pull back on the catheter until the balloon rests against the bladder neck 22

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24 Collect a catheter specimen of urine if UTI suspected Return the foreskin to its normal position Connect the catheter to the drainage bag and ensure the drainage bag is lower than the level of the bladder to facilitate drainage (Do not place it directly on the floor) 24

25 Secure tubing to clients leg with tape Dispose of the equipment in the correct manner Remove gloves and wash hands Ensure client is clean, covered up and comfortable 25

26 Documents the procedure including: Date & time inserted Size and details of catheter (including lot number and expiry date) Any problems encountered Follow-up arrangements 26

27 Final Note: Some hospitals teach that you first put on both pairs of gloves and then after cleaning you remove the outer pair of gloves instead of taking one pair off and putting the second pair on. Either method is acceptable 27

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29 References: Yates, A (2009) Urinary Catheters Male and Female Catheterisation. Nursing Times. Net 29