Urinary catheters are used to provide a therapeutic support in urinary elimination for patients who are unable to void (urinate) naturally. When dealing with patients that require or have a urinary catheter, it is essential to provide appropriate urinary catheter care in order to prevent complications and injury to the patient during the entire process.
The following are some reasons or indications for placing Urinary Catheters
- Relief of urinary retention caused by Urinary tract obstruction, paralysis or inability to void
- Bladder decompression pre-operatively and operatively for lower abdominal or pelvic surgery
- Facilitation of surgical repair of urethra and surrounding structures
- More common: If the client has a stage 3 or 4 pressure ulcers and the urine is affecting it’s healing process.
- Urinary incontinence.
- Terminal illness or severe impairment, which makes positioning or clothing changes uncomfortable/ painful.
- Unable to void 6 hours after surgery (usually an in and out catheter is used).
Diameter and Sizes for Urinary Catheter
Urinary Catheters comes in a variety of sizes. The sizes are as follows:
5Fr, 6fr, 8fr 10fr, 12fr, 14fr, 16fr, 18fr, 20fr, 22fr, 24fr, 26fr.
The catheter number and the diameter is directly proportional to the catheter size. This means that, the higher number for a catheter the larger diameter
For every 3Fr. The diameter is equals to 1mm.
Thus, a 24fr. catheter = 8mm in diameter
Types of Urinary Catheters
Simple urinary catheter
This type of catheter are for in and out procedures. They are straight-single use catheters have a single lumen with a small 1¼ cm opening.
Two-way Foley catheter (retention catheters)
Have an inflatable balloon that encircles the tip near the lumen or opening of the catheter.These catheters have an elbowed shaped tip and it is used for geriatric male clients in situations in which the client has a partially obstructed urethra as in the case of Benign Prostate Hypertrophy (BPH).
Three-way indwelling Catheter
The Three-way catheter are also known as retention catheters. The 3 way indwelling catheters usually have 3 lumens that encircle the body of the catheter. One lumen drains the urine coming from the catheter into a collection bag. The second contains sterile water which can inflate and deflate the balloon on the catheter. The third lumen is sometimes used to administer medications into the bladder or for continuous bladder irrigation in people who have had a prostate surgery.
Factors to Consider When Choosing a Urinary Catheter
- For the most part, urinary catheter should not be used for routine collection of urine specimen for laboratory analysis. There are few exceptions to this rule and one of the exceptions is when clients who normally have UTIs and need a sample, they may put in a catheter
- A catheter should never be put in just for the convenience of the nursing staff or the client’s family. If the patient is having difficulties urinating. There are other natural methods that nurses can try to help the patient void or promote urination.
Natural ways to Promote Urination
- Take the patient for a walk in the hall
- Ask the patient to stroke their inner thighs, as this can increase their urge to urinate
- Get the patient to put their hands inside a bowl of water
- Wet a wash cloth with cold water and apply it to the patient’s abdomen
- Get the patient to sit on the toilet and run the tap until they feel the urge to pee, you can also ask them to flush toilet a couple of times
Contraindication of Urinary Catheter Insertion
A huge contraindication for urinary catheter is the presence of urethral damage. Urethral damage is very common as this can happen if the client had a pelvic fracture) when this is suspected, a retrograde urethrogram should be performed to rule out this case.
How to Empty a Drainage Bag
With good urinary catheter care, it is best practice to empty the drainage bag every 8 hours, or at least when the drainage bag is 2/3 full. This is important to avoid traction from the weight of the drainage bag and prevent infection. When emptying a drainage bag, be careful not to contaminate the drainage port by touching the collection container or floor when emptying.
Additional Drainage Bags Tips
- When transporting patient, maintain position of drainage bag below the level of the patient’s bladder, to prevent reflux of contaminated urine from the bag to the bladder.
- Transport personnel should be instructed to wash their hands prior to transporting a patient with a Foley catheter.
· The catheter bag should be empty prior to transport to prevent reflux.
- If possible do not place more than one patient with a urinary catheter in the same room to prevent cross contamination.
- How often do you change the Foley catheter?
Major Urinary Catheter Complication
The biggest complication with regards to inappropriate urinary catheter care is infections. You can prevent infections by following strict sterile technique during the insertion of a urinary catheter and good hand hygiene practices. Listed below are some of the ways that you can promote good urinary catheter care and minimize the chances of infection.
How to Prevent Infections
- Wash hands or perform hand hygiene immediately before and after any manipulation of the catheter site or drainage bag.
- Clean the perineal area and catheter tubing proximal to distal, with foam body cleanser (4:1 body cleanser) or cleansing wipes daily and after every bowel movement. The meatal area should not be aggressively cleansed or cleansed with antiseptic solutions as this can lead to meatal aggravation and increase the likelihood of infection.
- If Foley catheter is to remain indwelling for 30 days, obtain an order for Foley catheter and bag change at 30 day intervals.
- If a Foley catheter has been in place for 3 days or longer, the nurse should provide daily reminders to the physician recommending the removal of the Foley catheter (unless the Foley catheter is still indicated).
- Provide patient and family education regarding the benefits of removing the Foley. Encourage use of the bedside commode or bathroom within 4-6 hours after the Foley is removed.
How to Obtain a Urine Specimen
To obtain a urine specimen, clean the sample port with alcohol and aspirate urine using a blunt needle (or leur lock syringe) and a 10 cc syringe.
Please note that to ensure good urinary catheter care, a sterile, continuously closed drainage system should be maintained. If the catheter must be disconnected from the tubing, disinfect the catheter-tubing junction before separating.
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