urinary catheterization: intermittent


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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.