RLE 107 MCF
CARE FOR MOTHER, CHILD AND ADOLESCENT
(WELL CLIENT)
RELATED LEARNING EXPERIENCE
STRAIGHT
CATHETERIZATION
CATHETERIZATION
Definition
Assisting in the introduction of a catheter into
the bladder through the urethra for the relief of
urinary retention or for emptying the bladder.
Catheter - is a thin, clean hollow tube which is
usually made of soft plastic or rubber.
TYPES OF CATHETER
1. Straight Catheter- has a single lumen with a small
opening about ½ inch from tip.
2. Foley Catheter- has a small inflatable balloon that
encircles the catheter just below the tip; has as many as
two or three separate lumens within the body of the
catheter.
3. Coude Catheter- has a curved tip; used on male
clients who may have enlarged prostate with
obstruction along the urethra.
URINARY CATHETER SIZES
The French scale (Fr.) is used to
denote the size of catheters. Each unit
is roughly equivalent to 0.33 mm in
diameter (that is, 18 Fr. Indicates a
diameter of 6mm). The smaller the
number, the smaller the catheter. A
larger sized catheter is used for a
male because it is stiffer, thus easier
to push the distance of the male
urethra.
Catheters come in several size:
TYPES OF CATHETERIZATION
[Link] catheter/indwelling urethral
catheter/retention catheter
- Used if the catheter is to remain in place
for continuous drainage.
It is designed so that it does not slip out
the bladder. A balloon is inflated to ensure
that the catheter remains in the bladder
once it is inserted.
the foley catheter has more than one
lumen or open tube within the catheter.
TYPES OF CATHETERIZATION
2. Intermittent catheterization/ straight catheter
- It has a single lumen; it is used to drain the
bladder for shorter periods (5-10 minutes).
INDICATIONS
1. Spinal cord injury & Pelvic nerve 7. Urinary retention with recurrent
damage episodes of Urinary Tract Infection
2. Neuromuscular degeneration 8. Clients with skin rashes, ulcer or
3. Incompetent bladder wounds irritated by contact with
4. Prostate enlargement urine
5. Clients undergoing surgical repair of 9. Pre-operative/post-operative client
the urethra and surrounding structures 10. Pre-partum/post-partum client
6. Critically ill or comatose client 11. Urinary incontinence
ASSESSMENT
1. Assess when client last voided, to indicate likelihood of bladder fullness
2. Assess level of awareness or developmental stage, to indicate client’s ability
to cooperate during procedure
3. Assess the mobility and physical limitations of client, or the ability to
cooperate during procedure
4. Assess client’s age to determine catheter size to be used
ASSESSMENT
5. Assess the patient’s bladder for distention
6. Assess presence pf pathological condition that may impair passage of catheter
from the urethra into the bladder.
7. Assess purpose of catheterization
• Use straight catheter if only a spot urine specimen is needed, if amount of
residual urine is being measured, or if temporary.
• Use an indwelling/ retention catheter if the bladder must remain empty or
continuous urine measurement/collection is needed.
ASSESSMENT
8. Check physician’s order for method of catheterization
to be done
9. Assess if client is allergic to antiseptic, tape or rubber
10. Assess need for perineal care before catheterization
OBJECTIVES
1. To relieve acute or chronic urinary retention
2. To promote urinary elimination
3. To obtain sterile specimen
4. To obtain accurate measurement of bladder function
5. To provide continual urinary bladder drainage
OBJECTIVES
6. For pre-operative and post-operative drainage
7. To measure the amount of residual urine after voiding
8. To monitor the output of critically ill patient
9. To facilitate duties of the urinary system
10. To prevent skin breakdown in incontinent bedridden patient
GENERAL CONSIDERATIONS
1. Follow good hand washing techniques
2. Do not allow the spigot on the drainage bag to touch a
contaminated surface
3. Do not open the drainage system at connection points to
obtain specimens or measure urine
4. If the drainage tubing becomes disconnected, do not
touch the ends of the catheter or tubing. Wipe the ends
of the tube with antiseptic solution before reconnecting
GENERAL CONSIDERATIONS
5. Prevent pooling of urine and reflux of urine into the
bladder.
6. Remove the catheter as soon as possible after
conferring with physician.
Straight Catheterization
1. Catheterization tray
➢straight catheter
E
➢sterile gauze (2)
Q ➢sterile bowl
U ➢sterile towel with hole (for male clients)
I ➢pair of sterile glove
P ➢antiseptic solution (Betadine)
M ➢ Sterile forceps
E • flashlight/lamp (optional)
N • water-soluble lubricant
• sterile specimen container
T
• flushing tray
S
• bedpan
• waste receptacle
STEPS RATIONALE
PREPARATION OF EQUIPMENT
1. Obtain treatment card from the nurseTo make sure that you will perform
and check with doctor’s order. correct procedure to the right patient.
2. Bring equipment to bedside table. Organization facilitates performance of
Perform hand hygiene the task & to save time, energy & effort.
Hand hygiene deters spread of
microorganisms.
3. Check lighting source Good lighting is necessary to see the
meatus clearly
STEPS RATIONALE
PREPARATION OF THE PATIENT
1. Identify the client and An explanation encourages
explain the procedure and its patient cooperation and
purpose reduces apprehension
2. Provide for privacy by closing The procedure may be
the curtains or door embarrassing for the client
STEPS RATIONALE
3. Assist client in the appropriate position. Good visualization of the meatus is
a. Female: Supine with the knees flexed important. Embarrassment, chilliness, and
and the feet about 2 feet apart and drape the feeling tense can interfere with introducing
client. Or if preferable, the client can be the catheter. The patient’s comfort will
placed in the side-lying position. promote relaxation.
b. Male – supine, thighs slightly abducted
or apart.
- Lower side rails on working side Promotes use of proper body mechanics
STEPS RATIONALE
4. Drape the client with top sheet. To avoid unnecessary exposure
a. Female
a.1. assist client to side near you
a.2 loosen foot part of the top sheet
a.3. use diagonal draping
b. Male
b.1 expose only the penis and a small surrounding
area
5. Provide perineal care if needed. Perform proper Clean technique decreases the possibility of
hand washing again. introducing organisms into the bladder
6. Place catheter tray between thighs To provide easy access to supplies
7. Place waste receptacle at an area near you
STEPS RATIONALE
8. Open sterile pack using sterile technique. Sterile technique protects the patient and
prevents the spread of microorganisms
9. Offer the pair of sterile gloves to the doctor
10. Place adequate amount of water-soluble Lubrication facilitates the insertion of the
lubricant over the non-dominant hand after catheter and reduces trauma to the tissues
the doctor cleanses the urinary meatus
11. Instruct client to breath through the mouth The sphincter relaxes, and the catheter can
while nurse inserts catheter to the urinary enter the bladder easily when the client relaxes.
meatus
STEPS RATIONALE
12. Place distal end of catheter in sterile bowl In general, no more than 750-1000 ml of urine
to measure urine volume. should be removed at one time. Pelvic floor
blood vessels may become engorged from the
sudden release of pressure leading to possible
hypotensive episode.
Collect urine specimen if needed. Fill sterile Allows sterile specimen to be obtained for
specimen container to the desired level by culture analysis or routine urinalysis
holding end of catheter over the specimen
bottle
After the collection of the specimen the doctor
removes the catheter smoothly and slowly
STEPS RATIONALE
12. Place distal end of catheter in sterile bowl In general, no more than 750-1000 ml of urine
to measure urine volume. should be removed at one time. Pelvic floor
blood vessels may become engorged from the
sudden release of pressure leading to possible
hypotensive episode.
Collect urine specimen if needed. Fill sterile Allows sterile specimen to be obtained for
specimen container to the desired level by culture analysis or routine urinalysis
holding end of catheter over the specimen
bottle
After the collection of the specimen the doctor
removes the catheter smoothly and slowly
STEPS RATIONALE
13. Remove the equipment and position the client Urine kept at room temperature may cause
comfortable in bed. Clean and dry the perineal organisms, if present, to grow and distort
area, if necessary. laboratory findings
Care for the equipment according to agency policy.
Send the urine specimen to the laboratory
promptly
14. Perform proper hand washing. Proper hand washing deters the spread of
microorganisms
15. Record the time of the catheterization, the A accurate recording is important for planning
amount of urine removed, a description of the the patient’s care.
urine, the patient’s reaction to the procedure,
and your name
If there is not an immediate flow of urine after the catheter
has been inserted, several measures may prove helpful:
1. Have the client take a deep breath, which helps to relax
the perineal and abdominal muscles.
2. Rotate the catheter slightly because a drainage hole may
be resting against the bladder wall.
3. Raise the head of the patient’s bed to increase pressure in
the bladder area
4. Place a gloved finger in the vagina to feel digitally for
the position of the catheter through the anterior vaginal
wall.
5.(Male) If resistance is met while inserting the catheter
and rotating the catheter does not help, do not use force.
Enlargement of the prostate gland is commonly seen in
men over 50 years. A special crook-tipped catheter called
a coude catheter may be required to maneuver past the
prostate gland.
EVALUATION
[Link] urine measured
[Link] urine specimen obtained
[Link] performed using sterile techniques
[Link] catheter inserted without difficulty
[Link] emptied when patient is unable to void
1. The following are assessments done prior to assisting the patient for catheterization,
EXCEPT:
A. Assess purpose for catheterization
B. Assess need for perineal care before catheterization
C. Proceed with the procedure without doctor’s order
D. Assess patient’s bladder for distention
2. A type of catheter that has a single lumen with a small opening about ½ inch from the
tip?
A. Foley catheter
B. Straight catheter
C. Coude catheter
D. All of the above
3. Has a small inflatable balloon that encircles the catheter just below the tip; has as many as
two or three lumens within the body of the catheter?
A. Foley catheter
B. Straight catheter
C. Coude catheter
D. All of the above
4. Has a curved tip; used on male clients who may have enlarged prostate with obstructions
along the urethra?
A. Foley catheter
B. Straight catheter
C. Coude catheter
D. All of the above
5. A patient is experiencing oliguria. Which action should the nurse perform first?
A. Increase the patient’s intravenous fluid rate
B. Encourage the patient to drink caffeinated beverages
C. Assess for bladder distention
D. Request an order for diuretics
6. A nurse is preparing to catheterize a female client. What will the nurse consider when
comparing the anatomy of the urethra with that of a male urethra?
A. Has a different innervation
B. No connection with bladder
C. Longer in length
D. Shorter in length
7. Which of the following describes the term micturition?
A. Catheterizing the bladder
B. Emptying the bladder
C. Collecting a urine specimen
D. Experiencing total incontinence
8. A client tells the nurse “Every time I sneeze, I wet my pants.” What is this type of
involuntary escape of urine called?
A. Urinary incontinence
B. Urinary incompetence
C. Normal micturition
D. Uncontrolled voiding
9. Due to the anatomical position of female urethra, women is more likely to develop which
medical condition compared to men?
A. Upper respiratory tract infection
B. Renal failure
C. Urinary tract infection
D. B and C
10. What is the relevance in performing straight catheterization to mothers during active
labor?
A. Reduces discomfort
B. Promotes fetal descent
C. Prevents uterine atony
D. All except C
11. What is the relevance of performing straight catheterization after delivery?
A. To prevent post-partum bleeding
B. To relieve bladder distention
C. Prevents post-partum voiding dysfunction
D. All of the above
12. The nurse is aware that general considerations must be observed when performing straight
catheterization. The following statements are correct, EXCEPT:
A. Follow good hand washing techniques
B. Do not allow the spigot on the drainage bag to touch a contaminated surface
C. Open the drainage system at connection points to obtain specimens or measure urine.
D. Prevent pooling of urine and reflux of urine into the bladder
13. A female patient is for straight catheterization procedure; the nurse should place the
patient in what position?
A. Dorsal recumbent position
B. Lithotomy position
C. Supine position
D. Knee- chest position
14. A male patient is for straight catheterization procedure; the nurse should place the
patient in what position?
A. Dorsal recumbent position
B. Lithotomy position
C. Supine position
D. Knee- chest position
15. The nurse is teaching an older female patient how to manage stress
incontinence at home. She instructs her to contract her pelvic floor muscles
for at least 10 seconds followed by a brief period of relaxation. What is this
intervention called?
A. Prompted voiding
B. Crede technique
C. Valsalva maneuver
D. Kegel exercise