Foleys Catheter Insertion Anish Final

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URINARY CATHER

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Urinary Catheterization:

Urinary Catheterization Dr. ANISH JOSHI MD, FNB CRITICAL CARE, INDIAN DIPLOMA IN CRITICAL CARE, FELLOW OF COLLEGE OF CHEST PHYSICIANS, FELLOW OF COLLEGE OF CRITICAL CARE MEDICINE Head, Critical Care Dept. Saviour Hospital, Ahmedabad, Gujarat

History:

History The name comes from the designer, Frederic Foley (April 5, 1891 - March 24, 1966), a american urologist working in Boston, Massachusetts in the 1930s. His original design was adopted by C R Bard, Inc. of Murray Hill, New Jersey, who manufactured the first prototypes and named them in honor of the surgeon.

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D one when a person is unable to urinate using a toilet, bedpan, urinal, bedside commode, or when accurate urinary output is required Indication

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Drain the bladder before or during a surgical procedure , during recovery from a serious illness or injury, or to collect urine for testing A urinary catheter may be used for a person who is incontinent of urine, if the person has wounds or pressure ulcers that would be made worse by contact with urine A urinary catheter is necessary when a person is unable to urinate because of an obstruction in the urethra Situations When a Urinary Catheter is Used

Types of catheters:

Types of catheters A condom catheter , consists of a soft plastic or rubber sheath, tubing, and a collection bag for the urine. The sheath is placed over the penis and the collection bag is attached to the leg. Collects urine when there is no need for catheter insertion. A straight catheter , is used when the catheter is to be inserted and removed immediately. An indwelling catheter , also known as Foley catheter , is left inside the bladder to provide continuous urine drainage. A suprapubic catheter is a type of indwelling catheter. The suprapubic catheter is inserted into the bladder through a surgical incision made in the abdominal wall, right above the pubic bone. A 3-way catheter for continuous bladder irrigation (CBI) is a type of indwelling catheter. Irrigate the bladder to prevent obstruction (i.e bleeding)

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Catheters Straight Suprapubic Indwelling Condom

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3-way CBI Irrigations performed on intermittent or continuous basis to maintain catheter patency. A closed system can provide continuous or intermittent irrigation without disrupting sterility

Classification as per material:

Classification as per material Red rubber Latex Silicon

Coated catheters:

Coated catheters coating consists of the noble metals gold, palladium and silver. Reduces adhesivenss of the bacteria

Sizes & Subtypes:

Sizes & Subtypes Most common sizes are 8 F to 28 F. 1 F is equivalent to 0.33 mm = .013" = 1/77" of diameter. Coudé" (French for elbowed) catheters have a 45° bend at the tip to allow easier passage through an enlarged prostate "Councill tip" catheters have a small hole at the tip which allows them to be passed over a wire

Caring for a Person with an Indwelling Urinary Catheter :

Caring for a Person with an Indwelling Urinary Catheter The catheter tubing is secured loosely to the person’s body near the insertion site using a catheter strap or adhesive tape Securing the tubing to the person’s body prevents the catheter from being accidentally pulled out during repositioning The drainage bag is then secured to the bed frame at a level lower than the person’s bladder .

Why Catheter Care ? :

Why Catheter Care ? Presence of the catheter in the urethra provides a pathway for bacteria to travel up from the perineum into the bladder Having a catheter eliminates the “flushing” action of normal urination, which helps to remove bacteria from the urinary tract naturally.

How are bacteria introduced? :

How are bacteria introduced? Both when a catheter is inserted and after it is in place , UTIs in catheterized people are one of the most common nosocomial infections .

Urinary Catheterization - Emptying Urine Drainage Bags :

Urinary Catheterization - Emptying Urine Drainage Bags Urine measured at the end of each shift or every 4 hourly in ward, every hourly in ICU . Urine drainage bags should also be emptied if they are full . Leg bags need to be emptied frequently because they are smaller, and hold less urine.

Quantity:

Quantity Be sure to monitor urine output Amount Characteristics (color, clarity, sediment, hematuria, odor) Less than 30 ml/hr of urine indicates a problem

Catheter Insertion :

Catheter Insertion Equipment: (check packages and expiry dates) Catheter tray (with drapes, fenestrated drape, cotton balls, swab holder, bowl) Catheter 14-16 Fr (for women) 12 Fr for young girls 16-18 Fr (for men) Sterile drainage tubing with collection bag Correct size syringe (check catheter balloon) Sterile water Cleansing solution: Chlorhexidine 4%, Povidone Iodine 10% Lubricant anaesthetic jelly Sterile gloves Specimen container Tape to anchor tubing

Assess:

Assess Review physician’s order and understand purpose of inserting catheter Assess client (last urination, level of awareness, understanding) Palpate bladder Identify meatus and assess skin integrity Identify potential difficulties (i.e enlarged prostate)

Implement:

Implement Arrange equipment Wash hands Provide privacy Raise bed, stand on left side of bed if right handed (right side if left handed) Water proof pad under client Position & drape client

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Female: dorsal recumbent (supine with knees flexed) or Sims position (side-lying with upper leg flexed at knee and hip) Male: supine position With disposable gloves, wash perineal areas Wash hands Apply sterile gloves Organize sterile field – add catheter, lubricant, syringe and sterile water, pour cleaning solution over cotton balls

Anatomy:

Anatomy

Procedure:

Procedure Anaesthetic Lubricant jelly Apply sterile drapes keep gloves sterile women: under buttocks and fenestrated over perineum men: over thighs and fenestrated over penis Place sterile tray and contents between legs Cleanse meatus:

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Women: with nondominant hand, expose meatus, maintain Position of hand, cleanse with forceps, wipe from front to back, new cotton ball each swipe, far labial fold, near, and directly over meatus Men: retract foreskin, hold penis below glans, maintain position of hand, with forceps clean in a circular motion from meatus down to base of glans, repeat three more times

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Hold end of catheter loosely coiled in dominant hand, place end of catheter in tray Insert catheter: Women: ask client to bear down as if to void, insert 5 to 7.5 cm or until urine flows, then advance another 2.5 to 5 cm Men: hold penis perpendicular, ask client to bear down, insert 17 to 22.5 cm or until urine flows, then advance to bifurcation

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Collect specimen if indicated Allow bladder to empty unless policy restricts (800 to 1000 ml) Pelvic floor blood vessels may become engorged from the sudden release of pressure, leading to possible hypotensive episode. This may also cause painful bladder spasms. Inflate balloon with amount indicated (10 ml) If client complains of pain, aspirate solution and advance catheter further and inflate Gently pull to feel resistance Attach catheter to collection bag and attach to bed frame below bladder Anchor catheter (thigh if appropriate and coil tubing on bed and attach to mattress)

Evaluate:

Evaluate Palpate bladder Assess comfort Characteristics and amount of urine

Document:

Document Report and record type and size of catheter Amount of fluid used to inflate balloon Characteristics of urine, amount, reason for catheter, specimens, client’s response

Procedure for removal:

Procedure for removal Deflate the bulb completely with syringe If bulb cannot be deflated then Cut the one way valve Puncture the channel with needle Go on puncturing from distal most end to most proximal end USG guided suprapubic needle puncturing of the bulb Inflate further till it gets bursted