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G-10: Catheterization of the Urinary Bladder Reviewed: 4/89 Revised: 9/84; 1/86; 10/87; 3/88; 5/90; 3/91; 7/92;

5/93; 7/95; 7/97, 8/99; 7/01; 7/04; 11/06; 9/09; 6/12

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Nursing Policy: G-10


LSUHSC-Shreveport, LA

______________________________________________________________________________
CATHETERIZATION OF THE URINARY BLADDER PURPOSE: To empty contents of bladder. To obtain a sterile urine specimen. To determine amount of residual urine in bladder after voiding. POLICY: 1. A physician's order shall be written for the insertion of and discontinuation of a urinary catheter. 2. Catheterizations shall be performed by competent medical/nursing personnel. If the patient is alert and objects to being catheterized by a member of the opposite sex, a member of the same sex shall perform the procedure. Chlorhexidine solution can be substituted for those patients with an iodophor (Betadine) allergy. Patients with an indwelling catheter shall have documentation of character of urine and urine outputs recorded every eight (8) hours unless otherwise ordered by the physician. Abnormal findings shall be reported to the physician. Indwelling catheters shall not have the closed urinary system broken unless ordered by a physician. However, it is recommended that the system be changed out when the system is contaminated for whatever reason. Urine specimens ordered for laboratory analysis (i.e., urinalysis, cultures, etc.) shall be collected from the indwelling catheter port using aseptic technique. This task may be delegated to a Certified Nursing Assistant (CNA)/Medical Assistant. Catheters and drainage collection systems shall be changed per physicians order. Routine catheter care shall consist of cleansing the genital area with soap and water at least daily, avoiding excessive manipulation of the catheter and document Foley care Q 24 hours in the Daily Cares flow sheet under hygiene. Patients with an indwelling catheter shall have individual urine collection containers for the emptying of the drainage bag. If the patient is in a double occupancy room, collection containers shall be labeled with the patients name. Catheters shall be assessed daily for necessity and discontinued as soon as possible. A catheter securing device shall be used to prevent piston movement of the catheter, unless contraindicated. Securement method/device will be documented Q shift in the Intake/Output flow sheet EQUIPMENT: Disposable Urinary Catheter Tray Appropriate sized catheter Light Source Urine Collection Containers Clean Gloves Sterile Gloves

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G-10: Catheterization of the Urinary Bladder

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RESPONSIBLE PARTY I. Insertion of the Catheter MD MD, RN, RN Applicant, LPN, Student Nurse 1. 2.

ACTION

RATIONALE

Writes order to catheterize patient. Obtains equipment. 2. The smallest catheter size helps avoid trauma to the urethral and bladder mucosa.

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Explains procedure to patient. Provides for the patients privacy. Washes hands with antimicrobial soap and dons clean gloves. Assists patient to appropriate position. a. Female - supine with knees flexed and separated and with feet flat on bed. b. Male - supine with legs extended and flat on bed. Cleanses the patient's genital area with soap and water if necessary. Opens equipment maintaining sterility of contents, establishing and maintaining a sterile field. Removes moisture proof pad and places under the buttocks (female) or across the thighs (male). Removes gloves and washes hands. Dons sterile gloves. Pours iodophor solution over cotton balls, saturating well. Lubricates catheter tip with water soluble lubricant, and checks balloon inflation (if applicable). Places drape over perineum (female) or penis (male).

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MD, RN,

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Cleanses urinary meatus with cotton balls keeping

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To

help

prevent

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RESPONSIBLE PARTY RN Applicant, LPN, Student Nurse ACTION labia or foreskin retracted until catheter is inserted. Female a. Using non-dominant hand, separates labia to expose meatus. b. Uses "front to back" motions to cleanse. c. Wipes one side of the urinary meatus with a sterile cotton ball, with a single downward stroke. Wipes the other side with another sterile cotton ball in the same way. Wipes directly over the meatus with still another sterile ball. d. Discards cotton balls after each stroke. Male a. Using non-dominant hand, grasps penis and holds perpendicular to body. b. Retracts foreskin, if indicated. c. Cleanses penis in a circular motion starting at meatus and working outward. d. Discards cotton balls after each use. 16. Inserts lubricated catheter into meatus until urine flows. (To facilitate catheter insertion have the patient breathe slowly and deeply.) Female - urethra is 2 to 3 inches in length. Male - urethra is 6 to 8 inches in length. After urine begins to flow, advances catheter another inch to seat the catheter in the bladder. 17. Inflates balloon according to manufacturer's directions. If resistance is met during insertion or inflation of balloon, terminates the procedure, notifies the physician, and documents. 18. Collects sterile specimen for laboratory analysis, if ordered. Attaches catheter to collection system. Removes drapes; assists patient to comfortable position. Secures collection bag below bladder level at all times off the floor and without dependent loops in the tubing to prevent reflux urine into the bladder and to facilitate gravity drainage of the bladder.

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RATIONALE contamination.

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RESPONSIBLE PARTY MD, RN, RN Applicant, LPN, Student Nurse ACTION 22. Secures tubing to inner thigh or abdomen. 22.

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RATIONALE To prevent Traction on the bladder and alteration in the direction of urine flow. Prolonged traction causes the bladder neck to weaken, which can lead to incontinence.

23. 24. RN, RN Applicant, LPN, Student Nurse 25.

Disposes of soiled equipment in trash containers. Removes gloves and washes hands. Documents on patients record: a. b. c. d. e. f. Date/time of procedure Size of urinary catheter inserted. Amount, color, odor and other characteristics of urine. Securement device used. Patients tolerance to procedure. Whether urine specimen was sent for analysis.

RN, RN Applicant

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Notifies the physician immediately: a. If traumatic insertion is suspected (i.e., bleeding from the meatus, penis bloody urine, signs/symptoms of shock, or excessive pain occurs). b. If adverse reactions occur related to removal of excessive volumes of residual urine (700-1000 ml) for adults; pediatrics volume-based on weight and intake.

II. Care of the Patient RN, RN Applicant LPN, Student Nurse NA 1. Empties collection system every 8 hours avoiding contact with side of collection cup and records amount of urine output along with character of urine. 1. Urine collection cups should be labeled for each individual patients use to prevent nosocomial infections.

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RESPONSIBLE PARTY 2. ACTION Performs catheter care at least daily with soap and water, avoiding excessive manipulation of the catheter and documents Foley care in the Daily Cares flow sheet. Documents Securement method/device Q shift in the Intake/Output flowsheet.

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RATIONALE

III. Collection of a Urine Specimen RN, RN Applicant LPN, Student Nurse, CNA/Medical Assistant 1. Washes hands and dons clean gloves.

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Swabs catheter port with Iodophor/Chlorhexidine solution and allows to dry. Punctures port with sterile/needle syringe withdrawing desired amount of urine. Places urine in appropriate specimen container, maintaining sterility of container and specimen. Disposes of contaminated equipment in appropriate containers.

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IV. Discontinuation of Catheter RN, RN Applicant LPN, Student Nurse 1. 2. Washes hands and dons clean gloves. Discontinues indwelling catheter by: a. Deflating balloon and gently aspirating injected number of cc's with syringe. (NOTE: If unable to deflate the balloon, notify the M.D.) b. Gently removing catheter. Measures amount of urine in collection system. Washes hands. Documents on patient's record: a. Date/time of catheter removal. b. Amount, color, odor and other characteristics of urine. Monitors patient's urine output until adequate voiding has been established. NOTE: Within 24 hours the patient should be voiding normally (300 - 400 ml at a time for an adult; for a child may vary with weight), depending on fluid intake. If voiding small amounts (30 100ml every 30 minutes to an hour), the patient is not emptying the bladder completely. Report these

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RESPONSIBLE PARTY ACTION findings to the doctor immediately. 6. Notifies MD if patient has not voided within 8 hours of catheter removal.

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RATIONALE

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References:
Newman, D.K., & Willson, M.M. (2011). Review of intermittent catheterization and current best practices. Urologic Nursing, 31 (1), 12-28, 48; quiz 29. Accessed 6/22/12 http://search.proquest.com/docview/851623737?accountid=26197

Louisiana State Board Website: www.lsbn.state.la.us.

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______________________________________ Renee Lamb, RN Administrative Nursing Director for Medicine Services

________________ Date

____________________________________ Jean DiGrazia, MBA, RN Assistant Hospital Administrator and CNO Patient Care Services

_______________ Date

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