URINARY CATHETERS

A Urinary Catheter is any tube system placed in the body to drain and collect urine from the bladder. A health care provider may recommend a catheter for short-term or long-term use because you have or had:
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Urinary incontinence (leakage of urine or the inability to control when you urinate) Urinary retention (being unable to empty the bladder when you need to) Surgery that made a catheter necessary, such as prostate or gynaecological surgery Other medical conditions such as multiple sclerosis, spinal cord injury, or dementia.

Three main types of catheters:

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Indwelling catheter Condom catheter Intermittent (short-term) catheter

INDWELLING URETHRAL CATHETERS An indwelling urinary catheter is one that is left in place in the bladder. Indwelling catheters may be needed for only a short time, or for a long time. These catheters attach to a drainage bag to collect urine. A newer type of catheter has a valve that can be opened to allow urine to flow out, when needed. An indwelling catheter may be inserted into the bladder in two ways:
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Most often, the catheter is inserted through the urethra, which is the tube that brings urine from the bladder to the outside of the body Sometimes, the doctor will insert a tube, called a suprapubic catheter, into your bladder from a small hole in your belly. This is done as an outpatient surgery or office procedure.

An indwelling catheter has a small balloon inflated on the end of it. This prevents the catheter from sliding out of the body. When it's necessary to remove the catheter, the balloon is deflated.

CONDOM CATHETERS Condom catheters are most frequently used in elderly men with dementia. There is no tube placed inside the penis. Instead, a condom-like device is placed over the penis. A tube leads from this device to a drainage bag. The condom catheter must be changed every day.

INTERMITTENT (SHORT-TERM) CATHETERS Some people only need to use a catheter on occasion. Short-term, or intermittent, catheters are removed after the flow of urine has stopped.

DRAINAGE BAGS A catheter is usually attached to a drainage bag. There are two types:
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A leg bag is a smaller drainage device that attaches by elastic bands to the leg. It is usually worn during the day, because it fits discreetly under pants or skirts. It is easily emptied into the toilet. A down drain is a larger drainage device. It may be used during the night. This device is hung on the bed or placed on the floor.

The drainage bag must always stay lower than the bladder to prevent urine from flowing back up into the bladder. Empty the drainage device at least every 8 hours, or when it is full. Cleanse and deodorize the drainage bag by filling the bag with two parts vinegar and three parts water. You can substitute chlorine bleach for the vinegar and water mixture. Let this solution soak for 20 minutes. Hang the bag with the outlet valve open to drain and dry the bag.

HOW TO CARE FOR A CATHETER  To care for an indwelling catheter, cleanse the urethral area (where the catheter exits the body) and the catheter itself with soap and water every day. Also thoroughly cleanse the area after all bowel movements to prevent infection.  If you have a suprapubic catheter, the opening in your belly and the tube must be cleansed daily with soap and water, then covered with dry gauze.  Drinking plenty of fluids can help prevent infections.

 Wash your hands before and after handling the drainage device. Do not allow the outlet valve to touch anything. If the outlet becomes obviously dirty, clean it with soap and water.  Some people have occasional leakage of urine around the catheter. This may be caused by a catheter that is too small, improper balloon size, constipation, urinary tract infections, or bladder spasms.  If bladder spasms occur or there is no urine in the drainage bag, the catheter may be blocked by blood or thick sediment. Or, there may be a kink in the catheter or drainage tubing. Sometimes spasms are caused by the catheter irritating the bladder.

POTENTIAL COMPLICATIONS Complications of catheter use include:

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Allergy or sensitivity to latex Bladder stones Blood infections (septicemia) Blood in the urine (hematuria) Kidney damage (usually only with long-term, indwelling catheter use) Urethral injury Urinary tract or kidney infections

Contact the Supervisor if the patient develops or notices:

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Bladder spasms that do not go away Bleeding into or around the catheter Catheter draining very little or no urine, despite drinking enough fluids Fever or chills Leakage of large amounts of urine around the catheter Skin breakdown around a suprapubic catheter Stones or sediment in the urinary catheter or drainage bag Swelling of the urethra around the catheter Urine with a strong smell, or that is thick or cloudy

URINARY CATHETER INSERTION

Universal precautions Gloves must be worn while starting the Foley, not only to protect the health care provider, but also to prevent infection in the patient. Trauma protocol calls for all team members to wear gloves, face and eye protection and gowns. Indications By inserting a Foley catheter, you are gaining access to the bladder and its contents. Thus enabling you to drain bladder contents, decompress the bladder, obtain a specimen, and introduce a passage into the GU tract. This will allow you to treat urinary retention, and bladder outlet obstruction. Urinary output is also a sensitive indicator of volume status and renal perfusion (and thus tissue perfusion also). In the emergency department, catheters can be used to aid in the diagnosis of GU bleeding. In some cases, as in urethral stricture or prostatic hypertrophy, insertion will be difficult and early consultation with urology is essential. Contraindications Foley catheters are contraindicated in the presence of urethral trauma or injuries. Equipment Sterile gloves Sterile drapes Cleansing solution Cotton swabs Forceps Sterile water (usually 10 cc) Foley catheter (usually 16-18 French) Syringe (usually 10 cc) Lubricant (water based jelly or xylocaine jelly) Collection bag and tubing

Procedure Gather equipment. Explain procedure to the patient Assist patient into supine position with legs spread and feet together Open catheterization kit and catheter Prepare sterile field, apply sterile gloves Check balloon for patency. Generously coat the distal portion (2-5 cm) of the catheter with lubricant Apply sterile drape. If female, separate labia using non-dominant hand. If male, hold the penis with the nondominant hand. Maintain hand position until preparing to inflate balloon. 10. Using dominant hand to handle forceps, cleanse peri-urethral mucosa with cleansing solution. Cleanse anterior to posterior, inner to outer, one swipe per swab, discard swab away from sterile field. 11. Pick up catheter with gloved (and still sterile) dominant hand. Hold end of catheter loosely coiled in palm of dominant hand. 12. In the male, lift the penis to a position perpendicular to patient's body and apply light upward traction (with non-dominant hand) 13. Identify the urinary meatus and gently insert until 1 to 2 inches beyond where urine is noted 14. Inflate balloon, using correct amount of sterile liquid (usually 10 cc but check actual balloon size) 15. Gently pull catheter until inflation balloon is snug against bladder neck 16. Connect catheter to drainage system 17. Secure catheter to abdomen or thigh, without tension on tubing 18. Place drainage bag below level of bladder 19. Evaluate catheter function and amount, color, odor, and quality of urine 20. Remove gloves, dispose of equipment appropriately, wash hands 21. Document size of catheter inserted, amount of water in balloon, patient's response to procedure, and assessment of urine. Complications The main complications are tissue trauma and infection. Catheters can also cause renal inflammation, nephro-cysto-lithiasis, and pyelonephritis if left in for prolonged periods. The most common short term complications are inability to insert catheter, and causation of tissue trauma during the insertion. The alternatives to urethral catheterization include suprapubic catheterization and external condom catheters for longer durations. 1. 2. 3. 4. 5. 6. 7. 8. 9.

Clean intermittent self-catheterization

INTERMITTENT CATHETERS: Some people may need a catheter for a short period of time or occasionally. Short-term (intermittent) catheterization may be necessary for:
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Anyone who is unable to properly empty the bladder People with nervous system (neurological) disorders Women who have had certain gynecological surgeries

The goal of intermittent catheterization is to:

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Completely empty the bladder Prevent further bladder or kidney damage Prevent urinary tract infections

 To perform clean intermittent self-catheterization (CISC), the person must learn the basic location of the important parts of the urinary system.  The person must also be physically able to reach the urethra, and to move the equipment as necessary. People who are unable to see the urethra may be taught how to feel for the proper location of the urethral opening.

HOW TO PERFORM CISC (MEN): 1. Assemble all equipment: catheter, lubricant, drainage receptacle (container). 2. Wash your hands thoroughly with soap and water and clean the penis and opening of the urethra. 3. Lubricate the catheter. 4. Hold the penis on the sides, perpendicular to the body. 5. Begin to gently insert and advance the catheter. 6. You will meet resistance when you reach the level of the prostate. Try to relax by deep breathing, and continue to advance the catheter. 7. Once the urine flow starts, continue to advance the catheter another 1 inch. Hold it in place until the urine flow stops and the bladder is empty. 8. Remove the catheter in small steps to make sure the entire bladder empties. 9. Wash the catheter with soap and water. If the catheter is disposable, discard it right away. If it is reusable, rinse the catheter completely and dry the outside. Store the catheter in a clean, dry, secure location. 10. Record the amount of urine obtained, as instructed by your health care provider.

HOW TO PERFORM CISC (WOMEN): 1. Assemble all equipment: catheter, lubricant, drainage receptacle. 2. Wash your hands thoroughly with soap and water and clean the vulva and opening of the urethra. 3. Lubricate the catheter. 4. Locate the urethral opening. The opening is located below the clitoris and above the vagina. 5. Spread the lips of the vagina (labia) with the second and fourth finger, while using the middle finger to feel for the opening. 6. Begin to gently insert the catheter into the opening. Guide it upward as if toward the belly button. 7. Once the catheter has been inserted about 2 - 3 inches past the opening, urine will begin to flow. 8. Once the urine flow starts, continue to advance the catheter another 1 inch and hold it in place until the urine flow stops and the bladder is empty. 9. Withdraw the catheter in small steps to make sure the entire bladder empties. 10. Wash the catheter with soap and water. If the catheter is disposable, discard it right away. If it is reusable, rinse the catheter completely and dry the outside. Store the catheter in a clean, dry, secure location. 11. Record the amount of urine obtained, as instructed by your health care provider.

Some women may perform CISC standing up with one foot on the toilet. This position is also recommended when there is a question about the cleanliness of the toilet, such as in public facilities. You may reuse a CISC catheter for 2 - 4 weeks. It may be helpful to soak the catheter in a white vinegar solution once a week to control odor and remove thick mucus deposits. A health care provider may recommend other cleaning or sterilization techniques if you often get infections.