Insertion of a catheter into the bladder for temporary or permanent drainage of urine.
Objectives:
– Control urinary incontinence in incontinent and critical patients. – Evacuate the bladder in case of urinary retention. – Prevent alterations related to diuresis.
Equipment:
– Urinary Tray. – 2 sterile drapes. – See genital hygiene kit. – Clamp forceps.
Material:
– Hypoallergenic plaster. – Urine bag and support. – Diluted antiseptic. – 1 syringe of 10 c.c. sterile. – 1 10 ml ampoule of distilled water or saline solution. – Sterile gloves. – Non-sterile disposable gloves.
– Sterile anesthetic urological lubricant. – Mask, cap and gown. – Foley bladder catheter of the appropriate number. – 1 sterile cap. – See genital hygiene material.
Procedure:
– Perform hand washing. – Prepare material. – Preserve the patient’s privacy. – Explain the procedure to the patient. The insertion of the catheter may cause a sensation of urination, and possibly a burning sensation. – Ask the patient and family to cooperate. – Determine the most appropriate catheterization method given the objective and criteria specified in the prescription, such as the total amount of urine to be collected or the size of the catheter to be used. – Put on non-sterile gloves. – Place the patient in the appropriate position: Female supine position with knees flexed and rotated outward. Male supine position with legs slightly apart. – Perform genital hygiene. – Remove gloves. – Perform antiseptic hand washing Apply alcoholic hand disinfection solution. – Prepare the sterile field by placing the sterile material to be used on it. – Put on sterile gloves, gown, cap and mask. – Check the correct state of the balloon of the catheter by inflating it. – Lubricate the tip of the bladder catheter (2.5 to 5 cm in women and 15 to 17.5 cm in men). – Connect catheter to closed drainage circuit.
If the catheter has a curved tip, it is introduced with the tip facing upwards. MALE:
1. Remove foreskin and apply antiseptic solution to genitals. 2. Lubricate glans and internal part of the urethra by inserting a sterile lubricant container. 3. Grasp the penis with the non-dominant hand and hold it at 90º, retracting the foreskin and leaving the glans exposed. 4. Take the lubricated probe with the dominant hand and insert it through the meatus until a stop is felt. 5. Place the penis in a horizontal position and make slight forward traction indicating the patient to breathe deeply and continue introducing until the urine flows (approx. 20 cm in adults) advance the catheter about 2 cm more, thus ensuring the space to inflate the balloon into the bladder. 6. Inflate the balloon with the syringe loaded with saline or distilled water (amount indicated by the manufacturer about 10 ml approx.) and withdraw until you feel resistance. 7. Place foreskin in physiological position. 8. Place the bag on the support and place it under the patient’s bladder. 9. Fix the catheter with adhesive tape on the anterior aspect of the thigh.
WOMAN:
(same as man except) 1. Apply the antiseptic in a stream from top to bottom. Insert the bladder catheter by opening the patient’s vulva and placing the thumb and forefinger of the non-dominant hand between the labia minora. 3. Grasp the lubricated catheter with the dominant hand and gently insert it through the urinary meatus (progress the catheter during the patient’s inspiration as this relaxes the external sphincter muscle). 4. Do not insist if there is obstruction or difficulty. – Leave the patient in a comfortable position. – Collect the material and dispose it in the container according to waste segregation criteria. – Remove gloves. – Wash hands. – Record in the nursing documentation: reason for catheterization, day and time, type and size of catheter, incidents and patient response.
Observations:
– The most frequent complication is urinary tract infection. – When there is urinary retention (bladder balloon) do not allow emptying of more than 250 c.c. at once. – Avoid kinking or twisting of the catheter. – Notify the physician if 1 hour after catheterization there is no urine. – In voiding catheterization: remove the catheter once the urine has been voided.
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