Catheterization

Definition

Urinary catheterization is the insertion of a catheter into a patient's bladder. The catheter is used
as a conduit to drain urine from the bladder into an attached bag or container.

Purpose

Urinary catheterization is employed in hospital and nursing home settings to maintain urine
output in patients who are undergoing surgery, or who are confined to the bed and physically
unable to use a bedpan. Critically ill patients who require strict monitoring of urinary output are
also frequently catheterized.

Intermittent insertion of a urinary catheter is a treatment option for patients with certain types of
urinary incontinence. Patients who are unable to completely empty the bladder during urination
(urinary retention), or patients who have a bladder obstruction, may also require intermittent
urinary catheterization. Disabled individuals with neurological disorders that cause paralysis or a
loss of sensation in the perineal area may also use regular intermittent catheter insertion to void
their bladders.

Precautions

Because urinary catheterization carries a risk of causing urinary tract infection (UTI),
precautions should be used to keep the catheter clean and free of bacteria. Patients requiring
intermittent catheterization should be well trained in the technique by a qualified health care
professional.

Description

Intermittent catheterization is performed a minimum of four times a day by the patient or a care
giver. The genital area near the urethral opening is wiped with an antiseptic agent, such as
iodine. A lubricant may be used to facilitate the entry of the catheter into the urethra, and a
topical local anesthetic may be applied to numb the urethral opening during the procedure. One
end of the catheter is placed in a container, and the other end is inserted into and guided up the
urethra until urine flow begins. When urine flow stops, the catheter may be moved or rotated, or
the patient may change positions to ensure that all urine has emptied from the bladder. The
catheter is then withdrawn, cleaned, and sterilized for the next use. Recommended cleaning
practices vary, from the use of soap and water to submersion in boiling water or a disinfectant
solution. Some patients prefer to use a new catheter with each insertion.

Nonintermittent catheterization, which is initiated in a hospital or nursing home setting, uses the
same basic technique for insertion of the urinary tract catheter. The catheter is inserted by a nurse
or other health care professional, and remains in the patient until bladder function can be
maintained independently. When the catheter is removed, patients will experience a pulling
sensation and may feel some minor discomfort. If the catheter is required for an extended period
of time, a long-term, indwelling catheter, such as a Foley catheter, is used. To prevent infection,
it should be regularly exchanged for a new catheter every three to six weeks.

Use of indwelling catheters should be restricted to patients whose incontinence is caused by

urinary tract obstruction that can not be treated, and for which alternative therapy is not feasible.

Preparation

If a patient wishes to perform intermittent catheterization himself, training in the technique by a

qualified health care professional is required. Basic instruction in the anatomy, antiseptic
techniques, catheter insertion, and proper catheter care should be provided. Patients learning
chronic intermittent urinary catheterization may also benefit from an ultrasound examination to
verify that they are completely emptying their bladder during the procedure.

Materials:

1. Screen (if in the ward)

2. Flushing tray
3. Bedpan
4. Drape
5. Catheterization tray:

Catheter, Flashlight, Lubricant, kidney basin, specimen bottle

Female Catheterization

Bladder catheterization for girls; catheter is

introduced into urethral meatus; insert: lateral
traction of labia allows visualization of urethral
meatus

Procedure:

1. Bring all equipment to the bedside.

2. Prepare patient psychologically.
3. Have the patient in supine position
with knees flexed in a convenient
position.
4. Place kidney basin, flashlight and
specimen bottle in a convenient position.
 5. Open the tray and expose the sterile catheter. If you are alone, place or put a small
amount of lubricant in a sterile gauze inside the tray. If you have a companion, ask her to
apply lubricant aseptically.
6. Put on your gloves. Cleanse the urethral meatus with a povidine solution. Pick up the
sterile catheter and then lubricate.
7. With one hand hold the catheter, with the other hand open the labia minora using the
thumb and the index fitnger.
8. Keep the labia apart so that the urethral meatus is visualized, insert the cathter gently.
Introduce the cathter 5-7cm. (2-3inches) into urethral meatus using strict aseptic
technique. If the passage is obstructed by the urethral muscle contraction, withdraw the
catheter slightly and wait until the muscle have relaxed, then continue until the bladder is
reached.
9. Direct the open end of the catheter to the kidney basin or specimen bottle.
10. Hold the catheter steady during the outflow. When necessary, press the pubic area with
your forearm to let more urine come out.
11. In case of straight catheterization, where there is no more urine coming out, withdraw the
catheter gently, then place soiled catheter into the kidney basin. If urine is for
examination, label the bottle.
12. If catheter is to be kept indwelling, use foleybag catheter. Inflate balloo with 5-10cc of
sterile water, connect to a bedside drainage bottle. Anchor catheter in patient’s thigh with
the use of adhesive tapes.
13. If urine’s for examination, label and send to the laboratory.

Male Catheterization
Bladder catheterization for boys; (top) catheter is introduced with penis held perpendicularly to suprapubic
abdominal wall; (bottom) catheter is fully advanced into bladder prior to balloon infla

Procedure:

1. Bring all equipment to the bedside.

2. Prepare patient psychologically and physically. Drape the patient, place patient in a
supine position with legs extended.
3. Sterilize glans penis with disinfecting solution.
4. Open the tray and expose the urethral catheter.
5. Put on your gloves, pick up sterile catheter.
6. Wash off glans penis around urinary meatus with betadine. Lubricate it with the
lubricate available.
7. Keep the foreskin retracted and lubricate the penis up so as to have the urethra as
straight as possible.
8. With the thumb and index finger of the left hand, gently retract the prepuce to expose
the glands and meatus.
9. Insert catheter gently, advance catheter 15-25cm (6-10 inches) slowly to follow the
regular course of the urethra. If the onward movement is obstructed, as by the
contraction of the muscle, when a curve is reached, withdraw the catheter a little and
wait until the muscle have relaxed, or rotate it, then try again. Entry into the bladder
is generally indicated by the flow of urine. Direct the open oft eh catheter into a
kidney basin or specimen bottle.
10. When urine begins to flow, advance the catheter another 2.5cm (1 inches) to insure its
position in the bladder. Reduce or reposition the foreskin.
11. For straight catheterization; after removal of the catheter, cleanse with sterile water
the glands and meatus and then dry.
12. If catheter is to be kept indwelling, use a foley bag catheter. Inflate balloon with 5-10
cc of sterile water, connect to a bedside drainage bottle. Anchor catheter in patients
thigh with the use of adhesive tape.
13. Keep the patient in a comfortable position.
14. If urine is for examination, label and send to the laboratory.
Aftercare

Patients using intermittent catheterization as a treatment for incontinence will experience a

period of adjustment as they try to establish a catheterization schedule that is adequate for their
normal level of fluid intake.

Antibiotics may be prescribed as a preventative measure in long-term urinary catheterization

patients who are at risk for urinary tract infection.

A patient with an indwelling catheter must be reassessed periodically to determine whether

alternative treatment may be more effective in treating the problem.

Risks

Trauma to the urethra and/or bladder may result from incorrect insertion of the catheter.
Repeated irritation to the urethra during catheter insertion may cause scarring and/or stricture, or
narrowing, of the urethra. The catheter may introduce bacteria into the urethra and bladder,
resulting in urinary tract infection. UTI can cause fever and inflammation of the bladder and
urethra. Patients who practice intermittent catheterization can reduce their risks for UTI by using
antiseptic techniques for insertion and catheter care.

Normal results

When used correctly, catheterization facilitates complete voiding of the bladder.

CYSTOCLYSIS

Definition:

It is a continuous irrigation of the bladder with normal saline solution or other

solution prescribed by the surgeon.

Purposes:
 1. To wash the bladder continuously to remove blood clots after prostatic
surgery.

2. To determine the degree of hemorrhage from the drainage output.

3. To provide pressure (due to catheter ballon) on the operated area thus

minimize bleeding.

Special Consideration:

1. The rate of flow of the irrigation solution and the outflow should be the
same.

2. In case there is no output, it might be that the catheter is clogged or

there is malpositioning of the catheter. Try to determine the reason
before the resident is notified.

3. Notify the attending physician or the resident in charge for problem

like bleeding or clogged catheter etc.

Equipment:

3way Foleybag catheter Rubber connecting tubings

Venoset (to infuse solution) Irrigating solution (NSS, Sterile water)

Pail (for outflow solution)

Procedure:

Hang the irrigating solution in an IV pole after insertion of venoset. Connect

end of venoset to the inflow of the 3 way foley catheter. Connect the rubber
tubing to the outflow of the catheter and the other and connected to a urine
bag. Run the solution fast 100-150 drops per minute Irrigation usually last
from 48-72 hour or depending on the order of the attending physician.