ATI_Urinary Catheter Care_ Step by Step

Step-by-step viewing: removing an indwelling retention catheter

1. Hand hygiene 2.) check MAR 3.) Can I expose you now? 4.) position patient for privacy and ease performing the procedure.

Step-by-step viewing: perineal care - female

1.) Provide privacy 2.) Introduce yourself to the patient

3. Place a waterproof pad under the patient's buttocks and drape the patient with a bath blanket for privacy, exposing only the penis:

A waterproof pad protects bed linens from becoming soiled and draping helps to maintain patient dignity and ease anxiety.

3. Procedure: Insertion: Female Place a waterproof pad under the patient's buttocks and drape the patient with a bath blanket for privacy, exposing only the perineum.

A waterproof pad protects bed linens from becoming soiled and draping helps to maintain patient dignity and ease anxiety.

Urinary catheters are used to:

Accurately monitor urinary output • Assess bladder function • Obtain urine specimens • Relieve bladder distention and discomfort • Allow for healing after surgical procedures • Irrigate the bladder • Instill medications into the bladder • Manage urinary incontinence • Manage urinary retention

Prepare and test equipment (if required) to facilitate the procedure; many silicone catheters are pretested during manufacturing, and testing them a second time may result in stretching or damaging the balloon. Balloons without manufacturer pretesting may have faults or be damaged, so testing before insertion of the catheter prevents unnecessarily repeated procedures.

Damaged balloons may cause trauma to the tissues in the bladder or urinary tract.

16. Reposition the patient for comfort.

Dispose of catheterization equipment.

If you are left-handed, use your right hand to hold the labia open and expose the urethral meatus.

Do not release the labia. Keep the clean, nondominant hand in place throughout the remainder of the procedure.

secure catheter to patient's thigh

Document successful completion of the procedure

7. Follow steps 6 and 7 for "Insertion:

Female, placing the fenestrated drape over the penis."

Preprocedure III. Perform hand hygiene

Frequent hand hygiene prevents the spread of microorganisms.

5.) After removing your gloves, wash hands before proceeding.

Hand hygiene is essential before initiating a sterile procedure.

After removing your gloves, wash hands before proceeding.

Hand hygiene is essential before initiating a sterile procedure.

Using the appropriately designated hand maintains sterile procedure and reduces microorganism transmission.

Holding the labia open facilitates placement of the catheter; releasing the labia prematurely causes contamination of the urinary meatus and the catheter before insertion.

Preprocedure VII. Identify the patient, using two identifiers.

Identifying a patient involves scanning barcodes or comparing the patient's stated name and birthdate to information on the patient's wristband or health record. The correct person must receive the correct treatment.

13. If a urine specimen is needed, allow urine to flow into the sterile specimen container.

If an indwelling catheter is being placed and the collection bag is already attached, wait to obtain a sterile specimen from the collection port on the side of the drainage tubing until after completing the catheterization procedure.

8. Designate your nondominant hand as the clean hand:

If you are right-handed, use your left hand to hold the labia open.

Preprocedure V. Introduce yourself.

Initial communication establishes the role of the nurse and begins a professional relationship.

Preprocedure VI. Provide for patient privacy.

It is important to maintain patient dignity

Preprocedure I. Check PCP orders and the patient care plan.

Knowledge of patient-specific orders is critical for safe patient care.

Once an indwelling catheter is attached to the collection bag, it should not be detached.

Maintaining a closed system is recommended to prevent CAUTIs.

2. Position the patient in the supine position, with his thighs slightly apart.

Patient position provides for maximal patient comfort while facilitating insertion of the catheter and minimizing the risk of trauma with insertion.

Monitor the stoma for any changes.

Potential complications include skin breakdown, ulcerations, and even necrosis. • Routine assessment, together with consultation with a wound/ostomy care specialist, is an essential component of stoma care, with implementation of appropriate interventions to prevent infection.

Preprocedure II. Gather supplies and equipment.

Preparing for the patient encounter saves time and promotes patient trust.

4. Procedure: Insertion: Female Clean the perineal area and dry it thoroughly with a towel.

Proper cleaning should be used to prevent the spread of microorganisms into the urinary tract, where they may cause infection.

4. Provide perineal care.

Proper cleaning should be used to prevent the spread of microorganisms into the urinary tract, where they may cause infection.

Initial insertion length approximates the female urethral length (which usually is 1.5 to 2 inches).

The additional 1 to 2 inches of insertion ensures the catheter is firmly placed in the bladder.

Securing the catheter reduces risk of damage to urinary tissues and inadvertent removal.

The collection drainage bag should be consistently maintained below the level of the bladder to prevent backflow of urine and the potential introduction of bacteria into the bladder.

Preprocedure VIII. Explain the procedure to the patient.

The nurse has a responsibility to inform a patient before initiating care. Information may ease patient anxiety and facilitate cooperation

2. Procedure: Insertion: Female Place the patient in the dorsal recumbent position. Alternatively, use the Sims (or side-lying) position, with the patient's upper leg flexed at the hip

This position provides for maximum patient comfort while facilitating insertion of the catheter and minimizing the risk of trauma with insertion.

Delegation

UAP (Unlicensed Assistive Personnel) often empty the drainage bags, provide perineal care, and report abnormal findings to the nurse. If a client has had trauma or a surgical procedure that involved the perineal area, this care should not be delegated. Catheter irrigations are not delegated to UAP. • Bladder irrigation may not be delegated to unlicensed assistive personnel (UAP) without a nurse's assistance. UAP helping to care for the patient should report any of the following to the nurse: • Patient complaints of pain before or after the procedure • Clots noted in output • Change in color, odor, consistency, or amount (COCA) of output • Sores, wounds, irritations, or lesions noted • Fever or other changes in vital signs

Preprocedure IV. Maintain standard precautions.

Use of the correct personal protective equipment (PPE) is required whenever contact with bodily fluids is possible, to reduce the transfer of pathogens.

10. Use your dominant hand, designated as your sterile hand, to pick up the catheter, ensure that 5 to 8 inches of the tip are sufficiently covered with lubricant, and coil the distal end of the catheter in your hand.

Use the dominant hand to prevent unintentional contamination. Lubrication prevents trauma by facilitating insertion. Coiling the catheter in your sterile hand reduces risk of infection.

9. Designate the dominant hand as the sterile hand.

Use this hand to pick up antiseptic cleaning swab or the forceps; the forceps will be used to pick up cotton balls soaked in antiseptic solution.

Procedure: Inserting Female 1. If you are right handed, work from the side of the bed closer to the patient's right side if you are left-handed, work from the side of the bed closer to the patient's left side.

Using the appropriate hand promotes optimal placement of the catheter and decreases the likelihood of breaking sterile technique.

11. Using your sterile hand, pick up the catheter, ensure that the tip is sufficiently covered in lubricant, and coil the distal end of the catheter in your hand.

Using the sterile hand maintains sterile procedure. Lubrication prevents trauma by facilitating insertion. Coiling the catheter in your sterile hand reduces risk of contamination.

Lidocaine provides for greater patient comfort during the procedure.

Wiping the shaft of penis in downward direction helps to spread medication throughout the urinary tract. The peak analgesia effect of lidocaine gel is obtained at 2 to 5 minutes.

11. Insert the catheter:

a. Have the patient bear down. b. Insert the tip of the catheter into the urethral meatus while gently rotating the catheter; insertion should be for 7 to 9 inches or until urine appears. c. Insert the catheter to the bifurcation ports after urine appears. d. Lower the penis, but keep the catheter secure with your clean hand.

12.) Insert the catheter

a. Have the patient bear down. b. Insert the tip of the catheter into the urethral meatus; insertion should be for 2 to 3 inches or until urine appears. c. Insert the catheter an additional 1 to 2 inches after urine appears. d. Release the labia.

7. If the patient is to have an indwelling catheter:

a. Remove the cap from the prefilled syringe. b. Attach the syringe to the injection port. c. If the manufacturer instructions do not require a testing balloon, go to step 7d. If testing the balloon is required, inject the fluid amount indicated on the injection port or in the manufacturer instructions, and observe the balloon for inflation and leaks. Withdraw the fluid and, observe the balloon for complete deflation. d. Leave the syringe attached.

9. Wipe from the urethral meatus outward to the base of glans:

a. Use a new swab or cotton ball for each wipe. b. Discard cotton balls or swabs, as used, in the appropriate waste receptacle. c. Repeat the process for a total of three times.

10.) Cleanse the urinary/vaginal area:

a. Use one cotton ball or swab per wipe. b. Wipe from front to back (i.e., from anterior end of the labia toward the rectum), using a new cotton ball or swab for each wipe in the following sequence: right labial fold, left labial fold, then directly over the urinary meatus. c. Discard each cotton ball or swab in the waste receptacle immediately after use.

6.) Prepare a sterile field and organize supplies

a. Use the outer plastic wrapping/container from the kit as a waste disposal receptacle; place it on the bed in a location away from the sterile field (ideally, to the side of the sterile field). Alternatively, use a small bag or trash can at the side of the bed. b. Apply sterile gloves c. Place the sterile drape under the buttocks and the fenestrated drape over the perineum d. If using cotton balls in a kit with antiseptic solution, open the solution and pour it over the cotton balls. Place the forceps nearby. e. Lubricate 1 to 2 inches of the catheter tip. f. If a specimen is needed, open a new sterile specimen container; if it is not needed, remove the specimen container from the sterile field.

6. If your facility does not allow lidocaine gel injections, proceed to step 7 (below). If it is allowed, inject the lidocaine in accordance with the PCP order and facility policies and procedures:

a. Usually 10 to 15 mL of gel is used. b. Inject approximately 10 mL of the gel directly into the urethra. c. Wipe the shaft from the glans toward the testicles. d. Wait 2 minutes before insertion of the catheter.

Difference between catheters is that the ballon catheter needs

additional inflation

If a straight catheter was inserted,

allow complete drainage or drain 1000 mL clamp the tubing, and wait slightly before additional urine is allowed to drain. Remove the catheter after the bladder is emptied.

Hanging the bag from the bed frame

and not the side rail will help to keep the catheter stable and the bag consistently below the bladder.

Ati video

ask for religious preferences and allergies

Using the appropriate hand promotes optimal placement of the catheter and

decreases the likelihood of breaking sterile technique.

To reduce odor,

empty the collection device at least every 4 to 6 hours.

Bearing down relaxes the

external sphincter, which assists with insertion and reduces discomfort.

14.) If an indwelling catheter was inserted, inflate the balloon (or attach the sterile water syringe to the injection port and inflate the balloon, if not already in place);

gently tug on the catheter; connect the tubing, and secure the catheter with nonallergenic tape or leg securing device. Hang the collection drainage bag from the bed frame.

1. If you are right-handed, work from the side of the bed closer to the patient's right side;

if you are left-handed, work from the side of the bed closer to the patient's left side.

Advance the catheter until you see urine

inflate the ballon and then pull the catheter until it is accurately positioned.

Balloons are meant to be inflated with the amount of sterile water

marked on the side of the injection port. Tugging gently on the catheter ensures that the balloon rests at the bladder opening.

Use a sterile field to maintain sterile procedure

prepare and organize supplies to facilitate the procedure. Place the waste receptacle (for disposing of items during the procedure) at a location that will not contaminate the sterile field. Lubrication prevents trauma by facilitating insertion of the catheter.

Lift your knees and place them to the side

prepare your kit using surgical asepsis

Cleansing from the least-contaminated to the most-contaminated areas while using a fresh cotton ball or swab for each pass maintains sterile procedure,

reduces the number of microorganisms in the area where the procedure will take place, avoids introducing microorganisms from the more contaminated area to the cleaner area, and prevents infection.

Cleansing from the least-contaminated to the most-contaminated areas while using a fresh cotton ball or swab for each pass maintains

sterile procedure, reduces the number of microorganisms in the area where the procedure will take place, and prevents infection.

Uncircumcised males have extra skin covering the urethral meatus and glans;

this foreskin must be retracted for cleansing to reduce the number of microorganisms and prevent them from entering the urinary tract. The upright penis position straightens the urethra and facilitates insertion. Releasing the position and foreskin will cause contamination of the urethral meatus and the catheter before insertion.

REmove air or fluid from the retention ballon

towel is in non dominant hand; use the towel to collect any drainage.

Bearing down relaxes the external sphincter

which assists with insertion and reduces discomfort. Initial insertion length is approximately the male urethral length (which varies). Gentle rotation of the catheter may cause less discomfort for the patient. Inserting the additional length ensures that the catheter is firmly placed in the bladder. Lowering the penis assists the flow of urine via gravity.

8. Position the penis upright with your nondominant hand,

which is designated as your clean hand. (If you are right-handed, your left hand will be your clean hand; if you are left-handed, the right hand will be your clean hand.) If the patient is uncircumcised, use your clean hand to retract the foreskin and hold it in the retracted position. b. If the patient is circumcised, use the thumb and index finger of your clean hand to hold the penis below the glans. c. Do not release the positioning or the foreskin until after the catheter is inserted.

Collaboration and Delegation: Inserting a straight catheter may be delegated to unlicensed assistive personnel (UAP) with or without a nurse's assistance?

without!

Straight catheter insertion kit:

• All of the above except: the tubing and collection drainage bag and the leg securing device • Drainage collection container (tray from kit) • Extra sterile gloves (if desired) • Extra sterile catheter (correct size and type, if desired) • Clean gloves • Bath blanket (privacy draping) • Washcloth, towel, and/or perineal wipes • Specimen cup, if needed

UAP should report any of the following to the nurse:

• Patient reports of pain before, during, or after the procedure • Sores, wounds, irritations, or lesions noted • Difficulties encountered while performing the procedure

Foley catheter insertion kit

• Sterile fenestrated drape • Sterile field square drape • Sterile gloves • Lubricant • Antiseptic cleansing solution (povidone-iodine [Betadine] wipes, or swabs) • Cotton balls (if antiseptic solution is provided) • Forceps (if antiseptic solution is provided) • Prefilled sterile syringe with sterile water • Catheter (of the correct size) • Tubing and collection drainage bag • Leg securing device

UAP should be instructed in:

• Sterile technique • Appropriate procedure and timing • Required documentation