Female Catheterization BSN: II-B

Mr. Archito L. Dela Cruz

What is a catheter? A catheter is a tube that can be inserted into a body cavity, duct, or vessel. Catheters thereby allow drainage, administration of fluids or gases, or access by surgical instruments. The process of inserting a catheter is catheterization. In most uses, a catheter is a thin, flexible tube ("soft) catheter, though in some uses, it is a larger, solid ("hard") catheter. A catheter is left inside the body; either temporarily or permanently, may be referred to as an indwelling catheter. A permanently inserted catheter may be referred to as a permcath (originally a trademark). What is urinary catheterization? Urinary catheterization is the insertion of a catheter through the urethra into the urinary bladder for withdrawal of urine. Straight catheters are used for intermittent withdrawals, while indwelling (Foley) catheters are inserted and retained in the bladder for continuous drainage of urine into a closed system. Kinds of Catheters Intermittent Catheter Intermittent catheters for females are generally 6 inches long and come in French sizes 8Fr-24Fr. Intermittent catheters (IC) are used in women with urinary retention (incomplete bladder emptying) and in women suffering from spinal cord injuries (paraplegics and quadriplegics). Intermittent catheters come in antibacterial and hydrophilic varieties. The antibacterial catheter features a site-specific controlled release of nitrofurazone that significantly reduces urinary tract infections associated with catheter use. Nitrofurazone has been found to be effective against common Gram-positive and Gram-negative urinary bacterial pathogens. This specialized coating is known to inhibit bacterial adherence and preserve the integrity of the urethral mucosa. Hydrophilic-coated catheters have a layer of polymer coating bound to the surface of the catheter. The polymer absorbs and binds water to the catheter, producing a thick, smooth and slippery surface that remains intact upon introduction into the woman's urethra and lubricates the urethra in its entire length. Use of hydrophilic catheters have led to increased patient satisfaction with this type of technique and is assumed to reduce the risk of urethral damage by decreasing the friction applied when the catheter is inserted and withdrawn. Indwelling Catheter An indwelling urethral catheter, also known as a Foley catheter, is a closed, sterile system inserted into the urethra that allows the bladder to drain. The female indwelling catheter is 6 inches long and comes in French sizes 12Fr-18Fr. Widely considered to be a unisex catheter, the indwelling urethral catheter is used by both women and men with urinary incontinence caused by obstruction (blockage in the urethra) or urinary retention (incomplete bladder emptying) unable to be treated through other methods like sterile intermittent catheterization, medication or surgery.

Moreover, indwelling catheters are used in sick people when the incontinence interferes with the monitoring of urinary output, in severely impaired or terminally ill women for whom moving is painful, and women with skin irritation or pressure ulcers caused by incontinence. Indwelling urethral catheters are also used when a woman is homebound, lives alone and a family member or a caregiver is not available to help. Indwelling catheters need to be replaced at least every four weeks.

Equipments: Sterile gloves Sterile drapes Cotton Swabs Forceps Sterile water Foley Catheter Syringe Lubricant (water based jelly or ky jelly) Collection bag and Tubing Indications By inserting a Foley catheter, you are gaining access to the bladder and its contents. Thus enabling you to drain bladder contents, decompress the bladder, obtain a specimen, and introduce a passage into the GU tract. This will allow you to treat urinary retention, and bladder outlet obstruction. Urinary output is also a sensitive indicator of volume status and renal perfusion (and thus tissue perfusion also). In the emergency department, catheters can be used to aid in the diagnosis of GU bleeding. In some cases, as in urethral stricture or prostatic hypertrophy, insertion will be difficult and early consultation with urology is essential. Contraindications Foley catheters are contraindicated in the presence of urethral trauma. Urethral injuries may occur in patients with multisystem injuries and pelvic factures, as well as straddle impacts. If this is suspected, one must perform a genital and rectal exam first. If one finds blood at the meatus of the urethra, a scrotal hematoma, a pelvic fracture, or a high riding prostate then a high suspicion of urethral tear is present. One must then perform retrograde urethrography (injecting 20 cc of contrast into the urethra). Diagnosis/Preparation Health-care practitioners performing the catheterization should have a good understanding of the anatomy and physiology of the urinary system, be trained in antiseptic techniques, and have proficiency in catheter insertion and catheter care.

After determining the primary purpose for the catheterization, practitioners should give the woman to be catheterized and her caregiver a detailed explanation. Women requiring self-catheterization should be instructed and trained in the technique by a qualified health professional. Sterile disposable catheterization sets are available in clinical settings and for home use. These sets contain most of the items needed for the procedure, such as antiseptic agent, perineal drapes, gloves, lubricant, specimen container, label, and tape. Anesthetic or antibacterial lubricant, catheter, and a drainage system may need to be added.

Steps Action 1. Gather equipment. 2. Provide for privacy and explain the procedure to the client. Assess for allergy to povidone-iodine. 3. Assist patient into supine position with legs spread and feet together or to a sidelying position. 4. Wash hands and apply disposable gloves. 5. Wash the perineal area. Remove gloves and wash hands. 6. Open catheterization kit and catheter. Prepare sterile field, use the wrapper to establish sterile field. Apply sterile gloves. Rationale Promotes accessibility of equipments. Promotes cooperation and client dignity.

Relaxes muscles and allows visualization of area to facilitate insertion of the catheter.

Reduces transfer of microorganisms. Reduces transfer of microorganisms.

Provides an area for the sterile equipment to be laid out and assembled.

7. Coat the distal portion of the catheter with Facilitate catheter insertion. water-soluble or sterile lubricant. 8. Place the drape over the clients perineal area with the labia visible through the opening. 9. Gently spread the labia minora with the fingers of your non-dominant hand and visualize the urinary meatus. 10. Use the forceps to pick up a cotton ball soaked in povidone-iodine and clean the Provides sterile field at the procedural site. Prevents accidental contamination from adjacent areas. Helps locate meatus, so the catheter can be placed in correct spot.

Cleans the area and minimize the risk of UTI by removing surface pathogens.

periurethral mucosa. Use one downward stroke for each cotton ball and dispose. 11. Holding the Catheter in the dominant hand, Steadily insert the catheter into the meatus until urine is noted in the drainage bag or tubing. Provides a visual confirmation that the catheter tip is in the bladder.

12. If the catheter will be indwelling with a Ensures adequate catheter insertion before retention balloon, continue inserting another retention balloon is inflated. 1 to 3 inches. 13. Reattach the water-filled syringe to the inflation port. 14. Inflate the retention balloon using the manufacturers recommendation, and according physicians order. 15. Instruct the client to immediately report discomfort or pressure during balloon inflation; if pain occurs, discontinue procedure, deflate the balloon and insert the catheter farther into the bladder. If the client continues to complain of pain, remove the catheter and notify the clients practitioner. 16. Once the balloon has inflated. Gently pull the catheter until the retention balloon is resting snug against the bladder neck. 17. Tape the catheter to the abdomen or thigh snugly, yet without enough slack so in will not pull on the bladder. Provides a sterile method of inflating retention balloon. Ensures retention of balloon.

Pain or pressure indicates inflation of the balloon in the urethra; further insertion will prevent misplacement and further pain or bleeding.

Maximizes continuous bladder drainage and prevents urine leakage around the catheter.

Prevents excessive traction from the balloon rubbing the bladder neck, inadvertent catheter removal or urethral erosion.

18. Place the drainage bag below the level of Maximize continuous drainage of urine from the bladder. Do not let it rest on the floor. the bladder (drainage is prevented when bag Make sure the tubing lies over, not under the is placed above abdomen. leg. 19. Remove gloves, dispose of equipment and wash hands. Prevents transfer of microorganisms.

20. Help client adjust position. Lower the bed. 21. Assess and document the amount, color, odor, and quality of urine. 22. Wash hands.

Promotes clients comfort and safety.

Monitors urinary tetanus.

Reduces transmission of microorganisms.

Aftercare Antibiotics should not be prescribed as a preventative measure for women at risk for urinary tract infection (UTI). Prophylactic use of antibacterial agents may lead to the development of drug-resistant bacteria. Women who practice intermittent selfcatheterization can reduce their risk for UTI by using antiseptic techniques for insertion and catheter care. The extended portion of the catheter should be washed with a mild soap and warm water to keep it free of accumulated debris.