Catheterization (Urinary and Central Line)

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

Catheterization Procedure (Urinary and Central Line) (Steps for catheter insertion and removal, sterile techniques, care protocols to prevent infections, and troubleshooting catheter-related complications)

Catheterization Procedure: Urinary and Central Line

Catheterization is a common clinical procedure used for drainage, medication administration, and monitoring purposes. Proper sterile techniques, care protocols, and troubleshooting are critical to prevent infections and complications. This guide covers both urinary catheterization and central line catheterization, outlining steps for insertion, removal, infection prevention, and troubleshooting catheter-related complications.

Urinary Catheterization Procedure

Urinary catheterization involves the insertion of a catheter into the bladder to drain urine. It is typically used for patients with urinary retention, surgical procedures, or monitoring of urine output.

Steps for Urinary Catheter Insertion

  1. Gather Supplies:
    1. Sterile catheter kit (appropriate size for patient)
    1. Sterile gloves
    1. Sterile drape
    1. Catheter (typically Foley for indwelling)
    1. Sterile lubricant
    1. Sterile water-filled syringe (for balloon inflation)
    1. Antiseptic solution (chlorhexidine or iodine)
    1. Collection bag
    1. Adhesive tape or securement device
  2. Patient Preparation:
    1. Explain the Procedure: Inform the patient about the procedure, its purpose, and expected sensations.
    1. Position the Patient: Position the patient supine with legs apart (for males) or in a dorsal recumbent position (for females).
  3. Hand Hygiene and Sterile Gloves:
    1. Perform hand hygiene and put on sterile gloves.
  4. Prepare the Sterile Field:
    • Open the catheter kit and arrange all sterile supplies on a sterile drape.
    • Drape the patient’s perineal area with sterile drapes.
  5. Cleanse the Urethral Opening:
    1. For Females: Clean the labia and urethral opening from front to back using antiseptic swabs or solution.
    1. For Males: Retract the foreskin (if applicable) and clean the meatus in a circular motion, moving outward.
  6. Lubricate and Insert the Catheter:
    1. Lubricate the tip of the catheter.
    1. Gently insert the catheter into the urethra until urine begins to flow.
      1. For Females: Insert about 5-7 cm.
      1. For Males: Insert about 17-22 cm.
    1. Once urine flows, advance the catheter another 2-3 cm to ensure the balloon is fully inside the bladder.
  7. Inflate the Balloon:
    1. Attach the syringe filled with sterile water to the balloon port and inflate the balloon (usually 10 ml). Gently tug the catheter to ensure it’s secured in place.
  8. Connect the Drainage Bag:
    1. Connect the catheter to the urinary drainage bag and secure the tubing to the patient’s leg to prevent tension.

Steps for Urinary Catheter Removal

  1. Gather Supplies:
    • Syringe for balloon deflation
    • Gloves
    • Absorbent pad
  2. Hand Hygiene and Gloves:
    1. Perform hand hygiene and put on gloves.
  3. Deflate the Balloon:
    1. Attach an empty syringe to the balloon port and withdraw the sterile water from the balloon.
  4. Gently Remove the Catheter:
    1. Slowly and smoothly withdraw the catheter from the urethra.
    1. Dispose of the catheter and tubing appropriately in a biohazard container.
  5. Post-Removal Care:
    1. Clean the patient’s perineal area and monitor for any signs of urinary retention or discomfort.

Central Line Catheterization Procedure

Central line catheterization involves the insertion of a catheter into a large vein (e.g., subclavian, jugular, or femoral vein) to deliver medications, fluids, or for hemodynamic monitoring. The procedure is invasive and requires strict adherence to sterile technique to prevent infection.

Steps for Central Line Catheter Insertion

  1. Gather Supplies:
    1. Central line catheter kit
    1. Sterile gloves, gown, mask, and cap
    1. Chlorhexidine or iodine solution for skin prep
    1. Sterile drape
    1. Local anesthetic (lidocaine)
    1. Sterile saline
    1. Ultrasound machine (if used)
    1. Guidewire, dilator, and scalpel
  2. Patient Preparation:
    1. Explain the Procedure: Obtain informed consent from the patient.
    1. Position the Patient:
      1. Subclavian or Jugular Access: Place the patient in a supine position with head turned away from the insertion site.
      1. Femoral Access: Position the patient supine, with the leg slightly abducted.
  3. Hand Hygiene and Sterile Technique:
    1. Perform hand hygiene and don sterile gown, gloves, mask, and cap.
    1. Prepare a sterile field and drape the area around the insertion site.
  4. Prepare the Skin:
    1. Clean the insertion site thoroughly with chlorhexidine or iodine in a circular motion. Allow the antiseptic to dry.
  5. Local Anesthetic:
    1. Administer local anesthetic at the insertion site.
  6. Insert the Central Line:
    1. Insert the introducer needle at a 30-45 degree angle, aiming toward the target vein.
    1. Once venous return is observed, insert the guidewire through the needle and advance it.
    1. Remove the needle, leaving the guidewire in place.
    1. Make a small skin incision with a scalpel to facilitate catheter insertion.
    1. Advance the dilator over the guidewire to widen the tract, then remove the dilator.
    1. Thread the central line catheter over the guidewire, advance it to the appropriate depth, then remove the guidewire.
  7. Secure the Line and Confirm Placement:
    1. Secure the central line with sutures and sterile dressing.
    1. Flush the catheter ports with sterile saline.
    1. Confirm placement with chest X-ray or ultrasound to ensure the tip is in the correct location.

Steps for Central Line Removal

  1. Gather Supplies:
    1. Sterile dressing kit
    1. Suture removal kit
    1. Gloves
  2. Hand Hygiene and Gloves:
    1. Perform hand hygiene and don gloves.
  3. Remove Sutures and Catheter:
    1. Remove any sutures securing the catheter.
    1. Instruct the patient to perform the Valsalva maneuver (bearing down) to prevent air embolism.
    1. Gently withdraw the catheter.
  4. Apply Pressure:
    1. Immediately apply pressure to the insertion site for 5-10 minutes to prevent bleeding.
    1. Apply a sterile dressing to the site.
  5. Post-Removal Monitoring:
    1. Monitor the patient for signs of bleeding, air embolism, or infection.

Infection Prevention in Catheter Care

  1. Hand Hygiene:
    1. Always wash hands before and after handling a catheter.
  2. Use of Sterile Techniques:
    1. Sterile techniques should be used during insertion, dressing changes, and any time the catheter or tubing is manipulated.
  3. Proper Dressing Changes:
    1. For central lines, change dressings regularly using sterile technique, and inspect the insertion site for signs of infection (e.g., redness, swelling, or discharge).
  4. Catheter Securement:
    1. Secure both urinary and central line catheters to prevent movement and reduce the risk of trauma and infection.
  5. Routine Care and Flushing:
    1. For urinary catheters, ensure the drainage bag is positioned below bladder level to prevent backflow.
    1. For central lines, flush ports regularly with saline or heparinized solution as per protocol to maintain patency and reduce clot formation.
  6. Avoid Prolonged Use:
    1. Remove catheters as soon as they are no longer necessary to reduce the risk of infections, especially urinary tract infections (UTIs) and central line-associated bloodstream infections (CLABSI).

Troubleshooting Catheter-Related Complications

  1. Urinary Catheter:
    1. Blockage or No Urine Flow:
      1. Check for kinks or bends in the catheter tubing.
      1. Irrigate the catheter if obstruction is suspected.
    1. Urinary Tract Infection (UTI):
      1. Monitor for signs such as fever, cloudy urine, or burning sensation.
      1. Remove or replace the catheter if infection is confirmed.
    1. Leakage Around the Catheter:
      1. Ensure the catheter is the appropriate size, and the balloon is inflated correctly.
      1. Consider replacing the catheter if it is malfunctioning.
  2. Central Line Catheter:
    1. Air Embolism:
      1. Ensure the patient performs the Valsalva maneuver during insertion and removal to prevent air entry.
      1. Position the patient in Trendelenburg during insertion for subclavian or jugular lines.
    1. Infection:
      1. Monitor for fever, chills, or drainage from the site.
      1. Remove and replace the central line if infection occurs.
    1. Catheter Occlusion:
      1. Attempt to flush the catheter with saline. If occlusion persists, use thrombolytic agents (as per protocol) to dissolve clots.
    1. Phlebitis or Thrombosis:
      1. Look for swelling, redness, or warmth near the insertion site. Remove the catheter and treat as needed.

Conclusion

Urinary and central line catheterization requires precise technique, adherence to sterile protocols, and careful post-insertion care to minimize infection risk and complications. Early recognition of issues and appropriate interventions are essential in preventing adverse outcomes related to catheter use.