urinary catheterization


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Related to urinary catheterization: Foley catheter

Urinary 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 The catheter is then withdrawn, cleaned, and sterilized for the next use.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.

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.

Resources

Periodicals

Hunt, Gillian M., Pippa Oakeshott, and Robert Whitaker. "Intermittent Catheterization: Simple, Safe, and Effective but Underused." British Medical Journal 312, no. 7023 (Jan. 1996): 103-7.

Key terms

Bladder obstruction — A blockage of the bladder caused by the presence of calculi (e.g., mineral deposits) or an anatomic abnormality.
Catheter — A long, thin, flexible tube.
Foley catheter — A two-channel catheter with a balloon on the bladder end of one channel. Once inflated, the balloon keeps the catheter securely in the bladder. The other channel of the catheter facilitates the flow of urine out of the bladder.
Local anesthetic — Medication applied topically to the skin or administered through an injection that deadens a specific part of the body and inhibits the sensation of pain.
Perineal area — The genital area between the vulva and anus in a woman, and between the scrotum and anus in a man.
Ultrasound examination — A diagnostic test that uses sound waves to generate a picture of an organ or organ system.
Urinary incontinence — The inability to control one's urine flow.

catheterization

 [kath″ĕ-ter-ĭ-za´shun]
1. passage of a catheter into a body channel or cavity. See also cardiac catheterization and central venous catheterization.
2. introduction of a catheter via the urethra into the urinary bladder; called also urinary catheterization. This is often a nursing procedure, one that demands strict adherence to the principles of medical and surgical asepsis so that pathogenic microorganisms are not introduced into the urinary system. Since the urinary tract is normally sterile, any break in technique during the insertion of a catheter, or in the care of an indwelling catheter that is left in the bladder for a period of time, may result in a serious infection.
Patient Care. About 40 per cent of all nosocomial infections are urinary tract infections, and of these, about 75 per cent are related to urologic instrumentation, usually an indwelling bladder catheter. Prevention of these infections is a challenge to the nursing staff and others concerned with care of the patient.

The smallest gauge catheter that will drain the bladder should always be chosen. It should be inserted gently to avoid trauma, and under sterile conditions to avoid introducing microorganisms into the urinary system. Once an indwelling catheter has been inserted an absolutely closed drainage system must be maintained. Special care must be taken to guard against tension on the catheter and kinking of the tubing, which can obstruct the flow of urine. Catheters should never be pinned to the bedclothing as this can result in accidental removal of the catheter or unnecessary pulling when the patient moves about in bed. The catheter is taped securely to the patient's body. Male, bedridden patients can have the catheter taped to the abdomen to avoid pressure at the junction of the penis and scrotum.

The tubing and collection bag should be arranged so that there is continuous gravity flow of urine. The bag must always be kept below the level of the bladder to avoid backflow of urine into the bladder. It also should never be inverted, for the same reason. This is especially important when the patient is being positioned, helped out of bed, or transported on a stretcher. The catheter should not be clamped nor should it be routinely irrigated and changed. Most authorities agree that catheters need changing only if they are obstructed, if contamination is suspected, or if there is a malfunction of the apparatus. When the collecting bag is being emptied, care must be taken to avoid contamination of the spout.

Patient care must also include attention to the area surrounding the urinary meatus. At least twice daily, or more often if necessary, the genital area should be washed gently with soap and water and dried thoroughly. Crusts and secretions around the catheter may be removed by gentle wiping with a gauze or cotton square saturated with a mild antiseptic. These measures will reduce the possibility of infection and ensure the comfort of the patient by eliminating unpleasant odors and irritation.

Because of the ever-present danger of urinary tract infection, routine orders for catheterization to relieve bladder distention should be avoided and alternatives to an indwelling catheter should be considered. One-time catheterization following surgery may not be necessary if other measures to induce voiding are tried. Patients who require continuous care because of incontinence or an inability to void normally may respond favorably to measures other than indwelling catheterization, such as condom drainage, suprapubic catheter drainage, and, for some carefully selected patients, self-catheterization.
cardiac catheterization see cardiac catheterization.
central venous catheterization see central venous catheterization.
urinary catheterization
1. catheterization (def. 2).
2. in the nursing interventions classification, a nursing intervention defined as insertion of a catheter into the bladder for temporary or permanent drainage of urine.
urinary catheterization: intermittent in the nursing interventions classification, a nursing intervention defined as regular periodic use of a catheter to empty the bladder.

urinary catheterization

a nursing intervention from the Nursing Interventions Classification (NIC) defined as insertion of a catheter into the bladder for temporary or permanent drainage of urine. See also Nursing Interventions Classification.

urinary catheterization

The passage of a blunt-ended, rubber or plastic tube along the URETHRA into the bladder so as to release urine in cases of obstruction to outflow or inability to pass urine voluntarily for other reasons (URINARY RETENTION).
References in periodicals archive ?
Urinary catheterization in care homes for older people: self-reported questionnaire audit of catheter management by care home staff.
They walk with one assistive device or non, and no need urinary catheterization but remains with chronic pain in legs.
As already reported, genitourinary symptoms are mild or even absent in enterococcal urinary tract infections [15,21] and are frequently associated with urinary catheterization and/or instrumentation [22,23].
The TENA Safer Surveys program includes education on incontinence-related issues: how to determine whether an LTC facility is in compliance with CMS guidelines, components of the assessment of incontinence, environmental and physical barriers, appropriate implementation of toileting programs, use of alternative measures including absorbent products and skin care, indications of urinary catheterization and interventions to minimize complications, surveyor steps, facility responsibilities, and behavioral treatments.
Other procedures in hospitals and pediatricians' offices--such as heel sticks, urinary catheterization, lumbar punctures, and injection pain--remain relative pain treatment orphans.
The nurse is often the only person on campus who is trained in cardiopulmonary resuscitation, handling the safe distribution of medications, the performing of urinary catheterization, tube feedings, insulin injections, tracheotomy suctioning, and nebulizer treatments.
Urinary catheterization is recognized as the most accurate way to determine bladder volume but is uncomfortable and time consuming and may contribute to urinary tract infection (UTI).
She had a non-tender palpable mass in her right iliac fossa which persisted after urinary catheterization.
Medical tubing plays a major role in promoting cost efficiency because cardiac and urinary catheterization that involves the use of catheter tubing, greatly reduces the time taken for the concerned medical or surgical procedure," notes the analyst of this research service.
7% in patients with long-term urinary catheterization (Hadano, Shimizu, Takada, Inoue, & Sorano, 2012).