Bladder Catheterization

Approved by: Bladder Catheterization Gail Cameron Senior Director, Operations, Maternal, Neonatal & Child Health Programs Dr. Ensenat Medical Director, Neonatology Neonatal Nursery Policy & Procedures Manual : Date Effective Next Review May, 2018 Dr. Sharif Shaik Medical Director, Neonatology Purpose Policy Statement Equipment To provide guidelines and indications for the insertion of, care and maintenance of a bladder catheter. Bladder catheterization may be indicated to obtain a specimen for culture, to quantify bladder residual, to relieve urinary retention, and to precisely monitor urine output in critically ill patients. 1. This is considered an invasive procedure therefore a written order is required. 2. A nurse may perform a bladder catheterization if the following criteria have been met: has completed basic orientation, has read the NICU Bladder Catheterization Policy & Procedure, has watched a bladder catheterization demonstration by an experienced nurse and has performed a supervised, successful return demonstration for both a male and female infant. The supervising nurse must be qualified to perform bladder catheterization in the NICU. 3. Nurses may NOT attempt a bladder catheterization on an infant who has an anatomic abnormality of the genital-urinary tract. 4. If there is difficulty catheterizing the infant s bladder, discontinue attempts to insert the catheter and inform the physician or NNP. 5. Infants who will require bladder catheterization at home will have discharge teaching instruction for parents following the procedure of Home Intermittent Bladder Catheterization. Dressing Tray/ Catheter Tray Catheter (See list for selection) Sterile Gloves Antiseptic solution Sterile Normal Saline Sterile soluble lubricant Heat source Sterile Collection Cup Sterile water(for indwelling catheterization) Urinary drainage system (for indwelling catheterization) Adhesive/ hydrocolloid dressing for securing catheter BLADDER CATHETERS - Use smallest catheter capable of providing adequate drainage. Weight Recommended Size Catheter Greater than 1800 grams Less than 1800 grams Less than 900 grams #6 Fr #5 Fr #3.5 Fr CATHETERS AVAILABLE

of 6 Type of Catheter Use Advantages Disadvantages Latex Not Recommended Allergies Silicone Indwelling Catheterization Long-term/chronic use Thinner walled with larger lumen prevents adhesion of sediment Expensive Argyle polyurethane Indwelling Catheterization to inner catheter wall Available in #3.5 Fr and 5Fr Disposable Rigid Only end hole that does not drain well. NEVER clamp a catheter lumen with a balloon tract because this may damage the lumen preventing deflation of the balloon. Procedure ACTION RATIONALE 1. Perform hand hygiene and gather equipment. Standard precautions. 2. Measure distance from the umbilicus to the urinary meatus. This measurement gives a guideline for the depth of insertion of the catheter. 3. Open sterile tray. Add collection cup, antiseptic sticks, sterile saline, catheter, syringe and lubricant if not already present on tray. 4. Position infant on back with hips abducted. 5. Don sterile gloves. 6. Remove stylet from catheter if present. Test balloon of Foley catheter to ensure it inflates and deflates correctly. 7. Lubricate the catheter tip and place connection end in sterile collection cup. Remove stylet to prevent trauma. Trauma will result if a balloon will not deflate or if it inflates unevenly. Lubrication will ease the passage of the catheter and reduce tissue trauma. 8. Drape the infant with the sterile towel. FEMALE 9. Using the non-dominant gloved hand spread the labia so that the urethral meatus is exposed. 10. Using the dominant gloved hand, wipe front to back over the perineal area with antiseptic solution. Cleanse from the introitus to the labia, to the vulva, and then to the perianal surface. 11. Repeat step 10 twice with antiseptic and once with sterile saline. The dominant hand remains sterile for insertion of the catheter. Cleansing from clean to dirty areas deters the spread of pathogens. For best germicidal effect, allow the antiseptic to remain on the body surface for several minutes. A saline rinse will prevent the introduction of antiseptic solution into the urinary tract. 12. Using the sterile hand, place the collection cup and catheter in front of the perineum.

of 6 13. With the sterile hand, grasp the catheter back from the tip and gently insert into the urethral meatus until urine starts to flow. Insert catheter an additional 2 cm before inflating balloon. Insert catheter to measured depth. Nonballoon catheters may coil and knot in the bladder if inserted too far. Ensure the balloon has passed the meatus before inflation. MALE 9. Hold the penis in the non-dominant gloved hand and gently pull the foreskin back enough to expose the urethra opening. 10. Using the dominant, gloved hand, wipe from the tip of the penis away from the urethral opening in a circular motion with antiseptic solution 11. Repeat the above step twice with antiseptic solution and once with sterile saline. The dominant hand remains sterile for insertion of the catheter. Cleansing from clean to dirty areas prevents the spread of pathogens. For optimal germicidal effect, allow the antiseptic agent to remain in contact with skin for several minutes. Rinsing with saline prevents the introduction of antiseptic solution into the urinary tract. 12. Place the cup and catheter at the perineum. 13. With the non-sterile hand, apply caudal traction to the penis. Grasp the sterile catheter back from the tip with the sterile hand and insert gently into the urethral meatus. 14. Apply light, steady pressure to advance the catheter. ****If resistance or bleeding is met during the passage of the catheter, stop advancement and report to the physician, NNP or nurse-incharge. NO other attempts to catheterize the patient are made by the nursing staff. 15. When urine starts to flow, insert the catheter an additional 5 cm before inflating the balloon. Do not inflate the balloon unless urine is obtained and you are able to advance the catheter as described. Nonballoon catheters are inserted to the measured depth. There may be slight resistance cased by the prostate gland, but resistance and bleeding may signify an underlying anatomic anomaly of the genitourinary tract or trauma. To ensure the catheter tip and the balloon are within the bladder and not in the posterior urethra. A non-balloon catheter may coil and knot within the bladder if inserted too far. For intermittent catheterization: a) Allow the urine to drain into the sterile collection cup while holding the catheter in place. b) Slowly remove the catheter, stopping if urine starts to flow again. To ensure that the bladder is empty. Muscle spasm may cause resistance to catheter removal. Wait 5-10 min & try again. c) Rinse and dry the end of the penis or

of 6 perineum. d) Measure urine returns and/or collect sterile specimen with appropriate specimen collection container. For continuous catheterization: a) Inflate the balloon with sterile water according to the manufacturer s specifications. Never inflate the balloon until urine is draining and you are sure the balloon is in the bladder and not in the urethra. Insert catheter after urine is obtained to ensure balloon is in bladder. In the diagram, urine is obtained, but the balloon remains in the urethra. Females Insert an additional 2 cm Males Insert an additional 5 cm Urine can be obtained when the catheter is in the urethra and inflating the balloon at this point will damage the urethra. Sterile water should be used to inflate balloon since saline may crystallize with time and prevent deflation. Bladder Balloon Urethra Urine Flow Prostate b) For girls, tape the catheter to the infant s thigh allowing slack on the catheter. For boys, tape the catheter to position the penis on the abdomen. Foley Allow slack when Allow taping slack when to allow taping for more to allow for movem movement. c) Attach the catheter to a sterile drainage system. d) Record output q 1 h and total q 24 hrs. e) Give catheter care every shift and as needed. Inspect urethral meatus and surrounding tissues for inflammation and discharge. Inspect for sediment by observation and pinching and rolling catheter between fingers. Clean meatus-catheter junction and external surface of catheter with soap and water or sterile saline. f) Empty urine drainage system every 24 hours using aseptic technique.

of 6 g) Observe urine for cloudiness, odour, increase or decrease in concentration, presence of fresh blood or clots, and presence of mucous. Notify physician or NNP if any of these appear. Related Documents References Adapted with permission from Stollery Children s Policy and Procedure Manual: http://www.intranet2.capitalhealth.ca/nicu/pages/policiesprocedures/policiesprocedures_new.htm Bladder Catheterization, Policy March 2008 Bladder Catheterization, Procedure March 2008 MacDonald, M.G., Ramasethu, J. & Rais-Bahrami, K. (2013) Bladder catheterization Chap. 20. Atlas of Procedures in Neonataology (5 th ed.)( pp.115-118). Philadelphia: Wolters Kluwer / Lippincott Williams & Wilkins. Revisions Urinary Catheterization, August 2003 May 2015

of 6 Signing Original Signed GAIL CAMERON SENIOR DIRECTOR OPERATIONS MATERNAL, NEONATAL & CHILD HEALTH PROGRAMS COVENANT HEALTH GREY NUNS & MISERCORDIA HOSPITALS 7 May 2015 DATE DR. SANTIAGO ENSENAT MEDICAL DIRECTOR NEONATAL PROGRAM COVENANT HEALTH GREY NUNS HOSPITAL DATE Original Signed 14 May 2015 DR. SHARIF SHAIK DATE MEDICAL DIRECTOR NEONATAL PROGRAM COVENANT HEALTH MISERCORDIA HOSPITAL