Catheterization Procedures and Skills

by | Sep 10, 2024 | Nurse Article | 0 comments

Catheterization Procedures and Skills – Nursing Procedure

Catheterization Procedures and Skills – Nursing Procedure Updated

Catheterization is the process of inserting a tube (catheter) into the body to allow the drainage or injection of fluids. The most common type of catheterization is urinary catheterization, but it can also involve other systems such as the cardiovascular or gastrointestinal systems. Here, we will focus primarily on urinary catheterization, which is a common procedure performed by nurses and other healthcare providers.

Types of Urinary Catheterization

  1. Indwelling Catheter (Foley Catheter): A flexible tube inserted into the bladder via the urethra, left in place for a period to allow continuous drainage.
  2. Intermittent Catheter (In-and-Out Catheter): A catheter inserted temporarily to drain the bladder and then removed immediately after.
  3. Suprapubic Catheter: Inserted through a small incision in the abdominal wall directly into the bladder. This is often used for long-term catheterization.

Indications for Urinary Catheterization

  • Urinary retention (e.g., due to obstruction or postoperative conditions).
  • To monitor urine output in critically ill patients.
  • For sterile urine collection when needed for diagnostic purposes.
  • To relieve bladder distention in patients who cannot void.
  • Preoperative or intraoperative use during surgeries affecting the urinary system.

Preparation for Urinary Catheterization

  • Patient Assessment:
    • Explain the procedure to the patient and obtain informed consent.
    • Assess for any allergies, especially to latex or iodine (materials used in some catheters and cleaning solutions).
    • Position the patient: For females, the dorsal recumbent position (lying on the back with knees flexed) is often used, while males are positioned supine (lying flat on the back).
  • Gather Equipment:
    • Catheterization kit (includes sterile drapes, gloves, antiseptic solution, and lubricant).
    • Urinary catheter (size chosen based on patient age and need; commonly used sizes are 14–16 French for adults).
    • Sterile gloves.
    • Lubricating gel.
    • Collection bag (for indwelling catheters).
    • Syringe with sterile water to inflate the balloon (for Foley catheters).
    • Clean gloves (for handling non-sterile items).
    • Towels or absorbent pads to protect bedding.
  • Hand Hygiene and Sterile Technique:
    • Perform hand hygiene and apply clean gloves before handling equipment.
    • Use sterile gloves and maintain a sterile field throughout the procedure.

Urinary Catheterization Procedure

For Male Patients:

  1. Prepare the Patient:
    • Place a towel or pad under the patient to protect bedding.
    • Drape the patient to provide privacy and expose only the genital area.
  2. Clean the Area:
    • Clean the penis with an antiseptic solution, starting from the urethral meatus and working outward in a circular motion.
    • Retract the foreskin if the patient is uncircumcised and clean under the foreskin.
  3. Insert the Catheter:
    • Lubricate the first 5–7 inches of the catheter tip.
    • Hold the penis perpendicular to the body and gently insert the catheter into the urethra.
    • Advance the catheter slowly and steadily until urine flows into the catheter tube (usually around 7–9 inches).
    • Once urine flows, advance the catheter 1–2 more inches to ensure it is fully within the bladder.
  4. Inflate the Balloon (for indwelling catheters):
    • Inflate the balloon using the syringe filled with sterile water (usually 5–10 mL depending on the catheter size).
    • Gently pull the catheter until you feel resistance to ensure the balloon is seated in the bladder.
  5. Secure the Catheter:
    • Attach the catheter to a collection bag.
    • Secure the catheter to the patient’s thigh to prevent movement and reduce trauma to the urethra.
  6. Return Foreskin:
    • If the patient is uncircumcised, ensure the foreskin is returned to its natural position to prevent paraphimosis.

For Female Patients:

  1. Prepare the Patient:
    • Place a towel or absorbent pad under the patient to protect bedding.
    • Drape the patient for privacy, exposing only the perineal area.
  2. Clean the Area:
    • Clean the vulva and perineal area with an antiseptic solution, moving from front to back (from the clitoris towards the anus).
    • Clean each side of the labia majora and minora, then the urethral meatus.
  3. Insert the Catheter:
    • Lubricate the first 2–3 inches of the catheter.
    • Spread the labia minora with your non-dominant hand and locate the urethral meatus.
    • Insert the catheter gently into the urethra until urine begins to flow (typically 2–3 inches for females).
    • Once urine is visible, advance the catheter another 1–2 inches to ensure it is fully within the bladder.
  4. Inflate the Balloon (for indwelling catheters):
    • Inflate the balloon using the syringe filled with sterile water (usually 5–10 mL depending on the catheter size).
    • Gently pull the catheter until you feel resistance to confirm the balloon is in place.
  5. Secure the Catheter:
    • Attach the catheter to a collection bag and ensure the tubing is not kinked.
    • Secure the catheter to the patient’s thigh or abdomen with adhesive tape to prevent movement and discomfort.

Post-Catheterization Care

  • Monitor the Catheter:
    • Ensure the catheter is draining freely and there is no blockage or kinking of the tubing.
    • Monitor the color, clarity, and amount of urine. Record these observations regularly.
    • Check the patient for any signs of discomfort, bladder spasms, or leakage around the catheter.
  • Prevent Infection:
    • Ensure that the catheter and tubing are kept clean and dry.
    • Empty the drainage bag regularly to prevent backflow of urine, which can lead to infection.
    • Maintain strict hygiene by washing hands before and after handling the catheter.

Complications of Catheterization

  1. Infection (CAUTI – Catheter-Associated Urinary Tract Infection):
    • Use aseptic technique during insertion and ensure proper catheter care to prevent infection.
    • Avoid unnecessary catheterization and remove the catheter as soon as it is no longer needed.
  2. Urethral Injury:
    • This can occur if too much force is used during insertion. Always insert the catheter gently and never force it if resistance is felt.
  3. Bladder Spasms:
    • Patients may experience bladder spasms with indwelling catheters. This can sometimes be alleviated by ensuring the catheter is not blocked and the balloon is properly positioned.
  4. Hematuria:
    • Blood in the urine can occur due to trauma during catheter insertion. Monitor the urine color and report any significant changes.
  5. Dislodgement or Leakage:
    • Ensure the catheter is secured properly to avoid accidental dislodgement or leakage around the insertion site.

Skill Proficiency in Catheterization

  • Practice and Knowledge:
    • Regular practice and hands-on experience improve catheterization skills. Healthcare providers should be familiar with both male and female anatomy to perform the procedure confidently.
  • Patient Comfort:
    • Maintaining patient comfort and dignity is critical. Always explain the procedure clearly, provide reassurance, and maintain a gentle and respectful approach.
  • Stay Updated:
    • Follow updated guidelines and protocols regarding catheterization, especially concerning infection prevention (e.g., using closed-system catheter drainage, sterile technique).

By mastering these techniques and understanding the anatomy involved, healthcare professionals can ensure safe and efficient catheterization procedures while minimizing discomfort and complications for patients.