by: janet botha h/n hhcs tabuk. encourage all health care workers to avoid urinary catheterization...
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URINARY CATHETER and GASTRO-INTESTINAL TUBE CARE
BY: JANET BOTHAH/NHHCS TABUK
URINARY CATHETER AND
GASTRO-INTESTINAL TUBE CARE
JANET BOTHA
OBJECTIVES
Encourage all health care workers to avoid urinary catheterization unless clinically indicated
Ensure the benefits outweigh the disadvantages and INFORMED consent is obtained
Encourage health education to avoid complications
TOPICS
- CONSIDERATIONS AND CLINICAL INDICATIONS
- RISK ASSESSMENT- EDUCATION AND CONSENT- CATHETER CARE AND PREVENTION
OF INFECTION- OBSERVATION- DOCUMENTATION
CONSIDERATIONS
Must benefit the patient NOT for the convenience of the caregiver
Complications Informed consent Patient cognitive status and agitated
patient Time frame of catheterization
CLINICAL INDICATIONS
Acute urinary retention Bladder irrigation or instillation of
medication Monitoring renal function during
critical illness For a variety of reasons pre-and post
operatively Pressure Ulcers – delayed healing
4 degreePressure ulcer
Healed Ulcer
RISK ASSESSMENT AND POSSIBLE COMPLICATIONS
Allergy Infection Trauma Recent UT surgery Medication Obstruction Pain, discomfort and emotional wellbeing Diabetes or Chemotherapy Patient with only one functional kidney or
CKD
POSSIBLE COMPLICATIONS
UTI Serious complications:- pyelonephrites, bacteremia,
bladder cancer Chronic obstruction due to urinary
calculi and in male patients, epididymites
Drug resistance due to chronic use of anti-biotics
Urethral necrosis or pressure ulcers
CONSENT
Verbal, written and demonstrative education on total care, regardless of type of catheterization
Informed consent Risks involved – advantages,
disadvantages, complications, and expected timeframe
EDUCTION
Total care Infection prevention Obtaining of materials Care and storage ID any possible problems –S&S Where and when to get help by
giving contact numbers
SUPRAPUBIC CATHETER
No risk of urethral trauma or
necrosis Greater comfort Patient can remain sexually active Micturition still possible
INSERTION OF SUPRA PUBIC CATHETER
-Insertion can be done under general or local anesthesia.
-A small incision or puncture is made above the pubis and the catheter is inserted.
-It could be temporarily or permanent – needs to be changed at 6-12 week intervals.
Supra-pubic
catheter
INTERMITTEND SELF-CATHETERIZATION
Reduced infection rate compare to indwelling catheters
Good cognitive ability Self motivated Less restriction to movement Socially more accepted No visible devices to carry
PROCEDURE
- Patient is educated :
- Verbal and by demonstration- Correct aseptic technique- Cleansing and storage if the catheter
is not disposable- to perform this procedure at 4 hourly
intervals- Where to obtain the supplies
Intermittent
Selfcatheteriza
tion
INDWELLING CATHETER
LONG AND SHORT TERM
Possibility of urethral trauma Increased risk of infection Patient needs to carry collection
bag Can impede on emotional wellbeing Can aid in pressure ulcer healing
PROCEDURE
Use STERILE materials for insertion - Sterile catheter – correct size- Sterile catheter tray- Sterile urine collection bag- Use aseptic technique for inserting
catheter Hand wash Gown and gloves Collection bag must be positioned
lower than the patient bladder
INFECTION PREVENTION GUIDELINES
o Hand washing before and aftero Aseptic technique with sterile
material when inserting a cathetero Change/removal of catheter at given
dateo Changing collection bag every 3
dayso Good personal hygieneo Adopting closed method of urinary
drainage
HANDWASHING
INFECTION PREVENTION GUIDELINES
Maintaining an aseptic technique when bladder irrigation, medication instillation or collecting of a urine sample is done
Ensuring unobstructed urine flow Emptying collection bag when it is 1/3 full Correct positioning of urine collection bag Traction free urinary catheter Meatal care Adequate fluid intake
ADEQUATE FLUID INTAKE
Specimen collection urine bag emptying when 1/3 filled
OBSERVATIONS
Patient health status Affectivity of antibiotics used Allergy and tolerance of urinary
catheter Renal status Ensure that urine flows from
catheter into collection bag
OBSERVATIONS
Urine bypassing the catheter Trauma Heamaturia, bleeding of the meatus Erosion, swelling, discharge Color, odor and volume of urine
Volume, Colour, odor
DOCUMENTATION
Physicians Order Indication, type, and brand of catheter Informed consent Cognitive state of patient Date inserted, removal/change Problems during insertion Procedures: specimen, irrigation,
medication Fixation Volume, color, and odor Education
Gastro-IntestinalTube Care
GASTRO-INTESTINAL TUBE CARE(naso-gastric tube for feeding)
INDICATION ADVANTAGES CONSIDERATIONS COMPLICATIONS RISK REDUCTION MEDICATION ADMINISTRATION EDUCATION AND MANAGEMENT DOCUMENTATION
GASTRO-INTESTINAL TUBE CARE(NASO-GASTRIC TUBE for feeding)
INDICATIONS
• Blockage in the esophagus• Problems swallowing
Tube feedings are given when oral intake is inadequate or not possible and the GI tract is functioning normally.
(This procedure is a short term solution to ensure complete nutrition and hydration)
Adult or Pediatric?
ADVANTAGES
To preserve GI integrity by delivery of nutrients, fluids and medications
To preserve the normal sequence of intestinal and hepatic metabolism
To maintain fat metabolism and lipoprotein synthesis
To maintain normal insulin/glucagon rations
To maintain normal hydration
CONSIDERATIONS
Patient nutritional and hydration status
Is the digestive tract and kidneys functioning
Patient dietary and fluid needs (30-40ml/kg body mass)
Metabolic disorders Medication in use
CONSIDERATIONS
Informed consent Responsible caregiver Cognitive status of patient – restraint Age and duration Patient environment
NUTRITIONAL REQUIREMENTS
NUTRIENTS INCLUDES:- Protein- Fat Carbohydrates- Vitamins- Minerals- Fiber
COMPLETE NURTRITION
COMPLICATIONS
Aspiration PneumoniaAccidental dislodging of feeding tubeDifficulty in inserting the tube –
epistaxisHerniation of esophageal varicesRegurgitation and aspirationnausea
COMPLICATIONS
Pressure ulcer formationConstipation or diarrheaDehydration or over-hydrationDifficulty in cleaning the nasal cavityPain and discomfortHyperglycemia
INSERTION
Use correct size tube Measure - tip of nose to earlobe and
from earlobe to xiphi sternum and mark the tube
Ensure the nasal cavity is clean Position the patient Lubricate the tube Insert and check position Fix to nose or convenient area
MEASURING A NGT
RISK REDUCTION
ASPIRATION PNEUMONIA- Checking NGT is in correct position before
any fluid is given- Correct placement of feed- Proper positioning of patient - (semi-fowlers with head elevated at least 30-45 degrees)
- Maintaining this position for at least one hour after the feed
- Monitor residual volumes before every feed- If aspiration is suspected, stop feed
immediately and suction patient in R lateral position
RISK REDUCTION
DEHYDRATION- Monitor hydration carefully ( patient can in most situation not verbalize thirst)
- Water should be given between feeds
- Checking of mucous membranes, decreased urine output
- Monitor intake and output
Prevent dehydration
RISK REDUCTION
BLOCKING OF TUBE- Tube must be flushed with warm
water after every feed- Medication must be crushed into
powder form and dissolved in warm water and tube flushed thereafter
- Water to be given between feeds- Change tube
MEDICATION ADMINISTRATION Use medication in liquid form where
possible Ensure whether medication should be
given before or after meals Simple compressed tablets – crush and
dissolve in water Buccal or sublingual tablets must be
given as prescribed Soft gelatin capsules filled with liquid –
cut opening and squeeze out contents
Crushing of Medication
MEDICATION ADMINISTRATION Enteric-coated tablets – do not crush,
change in form is required Timed-release tablets – do not crush,
check with pharmacist for alternative Timed-release capsules or sustained-
release capsules – some can be opened and contents added to water – but only after pharmacist was consulted
NEVER mix medication with feed
EDUCATION AND MANAGEMENT
All members of the clinical team is responsible to decide if a NGT is appropriate for the patient – Physician, Nurse, Dietician, Pharmacist, Speech Therapist.
Education given to the caregiver must be complete and be done verbally and by demonstration to ensure the caregiver is comfortable with the patient and the feeding regime, and know to check if NGT is intact.
CLINICAL TEAM DISCUSSION
MANAGEMENT
o Patient must be referred to dieticiano Feed formula will be calculated
according to blood works, weight, and nutritional needs
o Possible restrainto NGT placement and attachment to
be checked before any fluid is giveno Check pH from aspirate – pH5 or less
Correct formula
MANAGEMENT
o Medication should be checked with pharmacist to ensure it is appropriate for NGT patient
o If NGT should be re-inserted after third time, PEG-tube insertion should be considered and discussed with the family
o Before initial insertion, patient should be weighed and thereafter on a weekly basis
MANAGEMENT
o Swallowing assessments should be undertaken by qualified staff
o If the NGT is to be discontinued, wean the patient and the family must be educated accordingly
o Oral hygiene- at least 4x per dayo Good hygiene – environment,
handling and administering feed
MANAGEMENT
o Hygiene of nasal cavityo NGT should be placed in alternative
nostril when changedo If NGT is dislodged, no feed should be
given until correctedo Check for pressure ulcero If NGT is to be removed, patient must
be monitored and weighed weeklyo Accurate documentation
DOCUMENTATION
Physicians order Informed consent from family Patient’s initial weight and weekly weight Prescribed feeding formula, volume,
frequency and strength Date and time of insertion and date due
for change/removal Size of NGT and fixation method Education and demonstration Problems during insertion
THANKYOU
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