Care of the Catheterised Patient and Urinalysis
Male Pelvic Anatomy
Female Pelvic Anatomy
What does a urinary catheter do?
Urinary Catheters
Urinary Catheters
Urinary Catheters
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!
Emptying a catheter bag Equipment Disposable gloves Urine bottle or jug Alco wipes Measuring scales or jug
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
Urine collection devices Catheter bags Drainable Non drainable Urimeters Leg bags Sporrans / belly bags
Catheter Valves Assessment Mental ability Bladder sensation Manual dexterity Vision Recent bladder or prostate surgery?
Attachment Devices All catheters should be well supported Leg straps Urisleeve G Strap
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
Catheter Care Aims Minimise catheter associated complications Infection Tissue damage Pain Catheter blockage Promote dignity and comfort
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
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
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 24 48 hours Encourage high fluid intake Record urine output Inform nurse if fails to void or develops abdo pain
URINALYSIS
Urine 96% Water 2% Salts 2% Urea Metabolic waste produced in liver ph 4.6 8.0
Urine Colour Normal Pale yellow Almost clear if high intake Abnormal Dark amber bilirubin Red, brown or pink blood
Urine Colour Fresh beetroot Clorets Carrots Nitrofurantoin Methyldopa Rifampicin Red Green Amber Amber Black Red / Orange
Urine Volume Depends upon many factors Fluid intake Hydration Insensible losses Respiration Sweating Stools Kidney function
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
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
Haematuria Blood in the urine May be visible macroscopic Or invisible microscopic Common Causes Infection Urinary stones Trauma Cancer Catheter
Urine Specimens MSSU Mid stream specimen of urine CSU Catheter specimen of urine EMU Early morning urine 24 hour Urine Fasting urine
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
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
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
ANY QUESTIONS?