Urinary CatheterPart A: Catheterization**Successful completion of the “Sterile Technique” module is required prior to this module**

Urinary CatheterCatheters:Catheter-a tube that is inserted into the bladder to

drain urine Four main types:Indwelling/Foley/Retention Cath—remains in the

bladder for an extended length of timeIn and Out/Straight Cath—used for obtaining a

sterile urine specimen; is inserted, thebladder drained, then removed

Suprapubic Cath—surgically inserted through the abdominal wall directly into the bladder

Condom/Texas Cath—An external cath for the male patient only. Applied over the penis and attached to drainage tubing

Urinary CathetersCatherization—is the process of inserting a

rubber tube called a catheter into the bladder but may include placing a condom-type appliance over the outside of the penis.

Requires an MD orderIs a very personal procedureIs a Sterile ProcedureIncreases the risk of infection to the patient

Urinary CatheterIn-dwelling catheter (Foley)Inserted into the bladder to drain urine and

left in place for an extended period of timeUrine drains through a closed drainage

system to a collection bagCan be used during surgery for comfortNot a treatment for urinary incontinenceHigh risk for infection

Urinary CatheterIncontinent—unable to control the passage of

urine from the bladder, or stool from the bowel, or both

Void—to empty the bladder of urineUrinary Tract—this includes the urinary

meatus, urethra, and bladder but could include the ureters and kidneys as well.

Clean Catheters—someone who self-caths in the home setting will reuse the same catheter several times, just washing it out after use and allowing it to air dry.

Urinary CathetersAnatomical Structures:Meatus— Female urinary opening; located below the

clitoris but above the vaginal openingPenis—External male organ used for sex and

eliminationPerineum—the area between the anus and vagina in the

female; the area between the anus and scrotum in the male

Urethra—the hollow tube leading from the bladder to the outside of the body

Bladder-a hollow muscle in which urine is stored until it is eliminated from the body. This muscle will usually hold 240 cc’s of urine before indicating that it needs to void

Urinary CathetersPatient Preparation: Remember the beginning procedures of Knock on the door ID yourself and the patient by checking the

armband Assemble equipment Provide Privacy Wash hands Apply Gloves as needed Position the patient (Supine or Left Sims)

Urinary CatheterMeasuring Intake and Output:Most people eliminate about 15oocc’s of urine each dayI&O is monitored to ensure the body is functioning

correctly and the patient is taking in and putting out the correct fluid levels

When measuring urine output, each facility will have their own policies but Standard Precautions should be observed.

An in-dwelling catheter drains into a bedside drainage bag called a Foley bag. This bag will be emptied at the end of each shift and the total documented as output.

If the patient has had a Foley catheter removed recently, it will be very important to record the time and amount of each voiding for the rest of the shift and notify the RN if no void in 8 hours.

Urinary CatheterFoley Bag:This drainage bag must remain below bladder level at all

timesShould hang on the side of the bed on an immovable section

of the bed frame and NOT on the side railShould hang on the side of the bed that the resident is

facingThe Foley bag should NEVER be placed on the floor or

allowed to touch the floor from the bed frame.The tubing should not be kinked or crimped and should be

fastened to the leg with a strap to prevent pulling on the catheter, should always be placed OVER the leg not under, and should not hang below the drainage bag.

This is a closed drainage system which is sterile until opened.

Urinary CatheterEmptying the Foley Bag:Observe Standard Precautions and also wear

goggles and face mask (per facility policy)Use a Graduated Cylinder to measure the

urine in the drainage bag.Should be done at the end of each shift and

any time the amount of urine reaches 1000cc’s

Urinary Catheter- continuedA paper towel is placed on the floor under the

Graduate to catch any splashes or spillsThe spout should not touch the inside of the

GraduateThe spout should be cleaned with Alcohol

before replacing into the protective sleeve(per facility policy)

Graduate should sit on a level surface for reading, also noting the color, odor and clarity of the urine to be documented

Urinary CatheterMaintaining a Closed System with a Foley

Catheter:As long as the catheter and the drainage bag

tubing remain connected, the system is sterile and is referred to as a Closed System.

Opening the system should be avoided; each time the system is opened increases the risk for infection

Leg bags may be used for ambulatory patients with both in-dwelling and condom catheters.

Urinary Catheter-continuedThis appliance will require repeated opening

of the closed system. Special care must be used to clean the connectors before reattaching.

Leg bags should never be left on a patient while in the bed

Catheter plugs should be used to protect the drainage bag connection while the catheter is attached to the leg bag.

Urinary CatheterAmbulating a Patient with an In-dwelling

Catheter:Use care when moving and transferring the

patient to avoid accidentally dislodging the catheter

When ambulating, the tubing and drainage bag are carried below the level of the bladder

Most facilities use cloth catheter bags for privacy

Urinary CatheterUrinary Catheter Irrigation:Irrigation can be used to cleanse the bladderCommon after surgery and other conditions

in which blood clots are presentOver irrigating can lead to infectionSeveral methods are used: Open and Closed

and Continuous