Urinary catheterization Introduction

Urinary catheterization is a medical procedure commonly performed by healthcare professionals and nurses, to insert a catheter into a patient’s urinary bladder. The catheter is a flexible tube that allows urine to drain from the bladder into a collection bag. The urinary catheterization procedure is essential for patients who cannot urinate on their own due to various medical conditions or after certain surgeries. As nursing students, understanding the urinary catheterization procedure is crucial for providing effective patient care and maintaining urinary health.

Urinary catheterization Definition

Urinary catheterization involves the insertion of a catheter through the urethra into the urinary bladder to facilitate the drainage of urine.

Urinary catheterization Purpose

The primary purpose of urinary catheterization is to:

Relieve Urinary Retention: Patients with urinary retention, such as those with urinary obstruction or neurological issues, may be unable to empty their bladder voluntarily. Catheterization allows the removal of urine, preventing discomfort and potential complications.

Monitor Urine Output: In critically ill patients or those undergoing certain surgical procedures, it is essential to closely monitor urine output, which can be achieved through catheterization.

Facilitate Surgical Interventions: Many surgical procedures require the bladder to be empty, and catheterization ensures a clear surgical field.

Types of Urinary Catheters

There are different types of urinary catheters, including:

1. Intermittent Catheters: These catheters are used for short-term drainage and are inserted when needed. After emptying the bladder, they are removed, reducing the risk of infections.

2. Indwelling or Foley Catheters: These catheters remain in the bladder for an extended period and are held in place with an inflated balloon. They require a drainage bag to collect urine.

3. Suprapubic Catheters: These catheters are inserted through a surgical incision in the lower abdomen directly into the bladder, useful for long-term catheterization.

Indications for Urinary Catheterization

Urinary catheterization is indicated in the following situations:

Acute Urinary Retention
Chronic Urinary Retention
Postoperative Care
Accurate Measurement of Urine Output
Urinary Incontinence in Palliative Care
Patients with Severe Impairment or Immobility
Certain Medical Procedures and Tests

Contraindications for Urinary Catheterization

Urinary catheterization should be avoided in certain cases, such as:

Traumatic Urethral Injury
Urethral Stricture
Recent Pelvic Fractures
Genital Surgery or Trauma
Uncontrolled Bleeding in the Urethra or Bladder
Suspected Urinary Tract Infection

Step-by-Step Urinary Catheterization Procedure with Rationale

(Note: The following procedure is for the insertion of an intermittent urinary catheter.)

Preparation:
a. Explain the procedure to the patient, ensuring informed consent and answering any questions, reducing anxiety.
b. Gather the necessary equipment, including sterile gloves, a sterile catheter, antiseptic solution, sterile drapes, lubricant, and a collection container.
c. Wash hands thoroughly to maintain an aseptic technique.

The Rationale of Explanation and Consent: Informing the patient promotes trust and compliance with the procedure.

Positioning:
a. Assist the patient into a comfortable supine position with knees slightly bent and apart. This position provides better access to the urethra and reduces patient discomfort.

The Rationale of Positioning: Supine position aids accessibility and minimizes discomfort.

Sterile Field Setup:
a. Put on sterile gloves to maintain a sterile field during the procedure.
b. Prepare the antiseptic solution and sterile drapes to create a clean workspace.

The Rationale of Sterile Field: Reduces the risk of infection during catheter insertion.

Cleaning and Lubrication:
a. Cleanse the genital area with the antiseptic solution using gentle downward strokes from the urethra outward, maintaining cleanliness and preventing contamination.
b. Lubricate the tip of the catheter to ease insertion and minimize urethral trauma.

The Rationale of Cleaning and Lubrication: Prevents contamination and urethral trauma.

Catheter Insertion:
a. Using one hand, gently hold the patient’s genitals to expose the urethral meatus.
b. With the other hand, insert the catheter into the urethra, advancing slowly and steadily to avoid injury or discomfort.

Advance to the Bladder:
a. Once urine starts to flow, gently advance the catheter further into the bladder, securing proper placement and complete emptying.

The Rationale of Catheter Insertion and Bladder Advancement: Ensures successful catheterization and complete bladder emptying.

Urine Collection and Catheter Removal:
a. Allow urine to drain into the collection

container.
b. Once urine flow stops, carefully withdraw the catheter from the bladder.

The Rationale of Urine Collection and Catheter Removal: Proper handling prevents spillage and minimizes the risk of infections.

Aftercare:
a. Dispose of the used catheter and gloves properly.
b. Ensure the patient’s comfort and cleanliness.
c. Document the procedure, urine output, and any observations.

The Rationale of Aftercare: Ensures patient comfort and helps in monitoring post-procedure complications.

Urinary catheterization Complications

Urinary catheterization, like any medical procedure, carries potential complications, including:

Urinary Tract Infections (UTIs): Catheter-associated UTIs are common and can lead to further complications if not managed promptly.

Urethral Trauma: Incorrect insertion or manipulation can cause injury to the urethra.

Bladder Spasms: Irritation from the catheter can lead to uncomfortable spasms.

Hematuria: Blood in the urine may occur due to minor trauma.

Catheter Blockage: Blood clots or sediment can obstruct the catheter, leading to drainage issues.

Conclusion

Urinary catheterization is a valuable procedure in managing patients with urinary retention or monitoring urine output during critical care and certain medical procedures. As nursing students, understanding the proper technique, indications, contraindications, and potential complications is crucial for providing safe and effective patient care.

Related Questions (Exam Review)

What is the primary purpose of urinary catheterization?
List three types of urinary catheters and their respective uses.
Name three indications for performing urinary catheterization.
Identify two contraindications for urinary catheterization.
Describe the step-by-step procedure for inserting an intermittent urinary catheter with rationale.
What are the potential complications associated with urinary catheterization?
How would you provide aftercare to a patient following urinary catheterization?