Female Urinary Catheterization and Nursing Care Plan

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– Catheterization : introduction of a catheter through the urethra into the urinary bladder.

– Catheters: are tubes, It can be made up of rubber, plastic, metal or woven silk.

Purposes of Catheterization:

1. To relieve discomfort due to bladder distention and/or to provide gradual decompression of a distended bladder.

2. To assess the amount of residual urine if the bladder empties incompletely.

3. To obtain urine specimen

4. To empty the bladder completely to surgery.

5. Urinary incontinence.

6. For investigation (to introduce a dye)

Types of Catheters

– Non retention catheters:

A. Straight catheter/Robinson catheter: is single lumen tube with small opening about 1¼ cm from the insertion tip.

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B. Caude catheter: has a curved tip. Sometimes used for elderly men who have hypertrophied prostate, because its passage is often less traumatic to gland.

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Retention catheters:

Used for continuous bladder drainage and for bladder irrigations. Examples are

• 3 way Foley / 2 way Foley (Their tips have balloon to instill sterile water for retention purpose (5ml to 30 ml can be instilled).

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• De pezzer (mushroom)

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• Malecot

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Size of the catheter

– Diameter is graded according to the French scale. The larger the number, the bigger the lumen.

– # 8 and # 10 are for children.

– # 12, # 14 and # 16 for adult female

– # 14, # 16 and # 18 for adult male.

 

Assessment of Catheter

– When the client has last voided and amount

– Presence of urinary retention

– Symptoms of urinary infection

– Voiding pattern

– Ability to maintain position during catheterization

 

Equipment

– Disposable gloves.

– A mask gown and cap (according to policy)

– A bath blanket

– A receptacle for the urine.

– A specimen container if a specimen is to be obtained

– A paper bag or kidney tray for waste.

– A torch or lamp.

– Soap, a basin of water, a washcloth and a towel.

– An antiseptic solution

– A water soluble lubricant

 

A sterile catheterization kit containing

– Sterile gloves

– Drapes to protect the bed and to provide a sterile field.

– A fenestrated drape to place over the perineum.

– Cotton balls or gauze to apply the antiseptic.

– Forceps

– A catheter of appropriate size.

 

Procedure of Catheterization

Nursing Action

Rationale
Explain the procedure and purpose to the patient

Patient is more relaxed and better able to cooperate if they understand the procedure.

Prepare all equipment and take to bedside.

Screen the bed.

Maintain privacy and prevent embarrassment to patient. Embarrassment causes tension

Place patient in dorsal recumbent position.

The female urethra is best visualized when patient is in this position

Put mackintosh under hips.

Comfort – prevents wetting of bedclothes.

Place the light in a convenient position.

Light enables nurse to locate urethra without contamination of catheter.

Leave the patient comfortable, wash and dry hands thoroughly according to aseptic technique procedure.

Improper hand washing is a common source of infection.

Pour solution over cotton swabs.

Put on sterile gloves, if none are available use a sterile forceps.

The bladder and contents are sterile and aseptic technique is essential in prevention

Separate vulva with the left thumb and index finger, keeping right hand sterile.

Use your right hand to cleanse the genital area with antiseptic swabs, use one stroke from above downwards.

The bladder and its contents are sterile. The urinary meatus can not be sterilized, hence adequate cleansing is important to minimize the risk of contamination.

Pick up sterile catheter from tip. Lubricate the tip of catheter.

Lubrication reduces friction and chance of injury to tissue.

Visualize the meatus by pulling labia minora upward and out, using left hand that was used for cleansing.

Instruct patient to relax sphincter by breathing through mouth.

Insert the catheter 5 cm or until urine begins to flow.

The female urethra is appro­ximately 4 cm long. Do not force catheter resistance may be due to stricture or tumor. Forced insertion may cause damage.

If urine is to be sent to laboratory~ prepare and label specimen.

Prompt labeling avoids possible mix ups of specimen

Documentation for Catheterization

– Date and time of the procedure

– Amount and characteristics of urine.

– If specimen was sent to laboratory.

– Any complaints of patient.

– Signature of the nurse.

 

After the procedure

– Clean equipment according to hospital policy.

Note:
In labor time if you find resistance in introducing catheter this may be due to the pressure exerted by the head of the fetus on the urethra and you have to apply glove for your left hand and introduce two fingers as in P.V. examination in the vagina and lower the head of the fetus to relieve the pressure and introduce the catheter with your right hand.

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