الر ِح ِيم ِب ْس ِم اللَّـ ِه َّ
الر ْح َم ٰـ ِن َّ
نَ ْالََ ِلي ُم ْال َح ِِي ُم . س ْب َحان ََك ََل ِع ْل َم لَنَا ِإ ََّل َما َ
علَّ ْمتَنَا ۖ ِإنَّ َك َ َ َ قالُوا ُ
Skill lab II
By: Eslam Abd-Elsalam
Male catheterization
Equipment:
1- Gloves
2- Syringe 10ml of sterile water
3- Syringe 10ml lignocaine or KY gel
4- Catheter & catheter bag
5- Tape
Indications:
▪ Urine retention
▪ Before& during surgery
▪ Measuring urine output
▪ Neurological dysfunction (coma or paralysis)
Before:
1- Introduce & Explain & Consent
2- Position supine
2- Check expiry date of Catheter
3- Open the catheter aseptically
4- Wash hands & gloves
5- Non-dominant hand: hold the penis with sterile swab
6- Dominant hand: retract the skin and clean around the
urethra with sterile swab circular motion from in to out
During:
1- Gel: apply gel on the catheter and 10ml in urethra
2- Milking: spread gel by milking movement
3- Hold the penis vertically
4- insert the tube till bifurcation (male urethra is 20cm)
If resistant ? Get out and restart If no urine ?
Urine is obtained ? ✓ Inject 10cc air into the catheter, the gel may be
✓ Inject 10ml of sterile water(not air or saline) to obstructing the catheter
inflate the catheter ✓ Suprapubic compression
✓ Retract the catheter till resistance ✓ Inject 20cc of normal saline and reaspirate, if no
✓ Never inflate the catheter before urine is obtained resistance it is truly inserted
After:
1-Attach the catheter bag
2-Tape on the thigh
3- Check comfortability? Any question ? Thank you
Female catheterization
Equipment:
1- Gloves
2- Syringe 10ml of sterile water
3- Syringe 10ml lignocaine or KY gel
4- Catheter & catheter bag
5- Tape
Indications:
▪ Urine retention
▪ Before& during surgery
▪ Measuring urine output
▪ Neurological dysfunction (coma or paralysis)
Before:
1- Introduce & Explain & Consent
2- Position lithotomy position
2- Check expiry date of Catheter
3- Open the catheter aseptically
4- Wash hands & gloves
5- Non-dominant hand: separate 2 labia majora
6- Dominant hand: clean around the urethra with sterile swab one sweep
up to down
During:
1- Gel: apply gel on the catheter and some on clitoris
4- insert the tube 1 third or half (female urethra is 4cm & dimple shaped)
If resistant ? Get out and restart
Urine is obtained ? If no urine ?
✓ Inject 10ml of sterile water(not air or saline) ✓ Inject 10cc air into the catheter, the gel may be
to inflate the catheter obstructing the catheter
✓ Retract the catheter till resistance ✓ Suprapubic compression
✓ Never inflate the catheter before urine is obtained ✓ Inject 20cc of normal saline and reaspirate, if no
After: resistance it is truly inserted
1-Attach the catheter bag
2-Tape on the thigh
3- Check comfortability? Any question ? Thank you
Nasogastric tube
Equipment:
1- Gloves
2-K-Y jelly & Xylocaine spray
3- Glass water
4- Tape & Stethoscope
5- Syringe 20ml & PH paper
6- Catheter bag & Vomit bowel
7- Nasogastric tube
Indication: Feeding or drainage
Contraindications:
▪ Sever facial trauma (cribriform plate) so use
orogastric tube
Complications:
▪ Aspiration
▪ Tissue trauma
▪ Gagging or Coughing so withdraw the tube and give
him time to recover
Before:
1- Introduce & Explain & Consent
2- Upright:
✓ sit the patient upright for optimal neck and
stomach alignment
3- Nostril:
✓ Examine the nostril deformity, obstruction,
septal deviation, polyps to determine the
best one
4- Comfortable & Wash your hands:
✓ ensure patient is comfortable and wash your
hand and wear the gloves
5- length:
✓ measure the length of the tube: the tip on the
nostril and extend behind the ear then 2
finger breadth above the umbilicus
6- Lubricate the tube of the tube by K-Y jelly
7- Spray the nostril and back of throat by xylocaine
8- insert the tube and slide it on the floor of nose
and nasopharynx
During:
1- Swallow:
✓ Ask the patient to swallow some water through a
straw, each time he swallow introduce it forward
2- Flexion:
✓ Ask the patient to flex his neck
After:
1- Ensure that the tip of the tube is in the stomach:
❑ Air:
✓ insert 20ml of air and listen crepitation over the
epigastrium with stethoscope
❑ Aspirate the gastric content & test acidity on PH
paper (<6)
✓ If a fine bore tube the gastric content will not be
aspirated
❑ X-Ray
2- Tape the tube on the nose and to the side of the face
3- Attach the catheter bag
4- Check comfortability? Any question ? Thank you
Bag valve mask ventilation
Between each one 6sec
To prevent hyper or
hypoventilation
Airway management
CPR
Procedure:
1-Shaking shoulders or Shouting by his name
✓ If respond, leave him and ask him about any problem
✓ If no response: call for help, then turn him on his back
2- Check for Chest rise
3- Check for any obstruction
✓ If obstructed airway use:
▪ Jaw-thrust
▪ Head tilt chin lift
▪ Oropharyngeal airway insertion
4- Check for carotid pulse
If unconscious, no breathing, no pulse: start CPR
CPR:
1-Interlocked hand
2-Middle of the lower half of the sternum
3-Vertical position & Arm straight
4-Give 30 chest compression with 2 rescue breaths by bag-mask
✓ Not mouth to mouth or mouth to mask
5-Compression depress the chest by 5-6 cm
6-After each compression release the chest without losing contact
✓ Compression release ration 1:1
If 2 rescuers: change the compressors every 5cycles or 2minutes
Conscious choking
Thank you