Nursing Practical Guideline Procedure : Catheterisation of Female and Male patient

Catheterisation:

This is the removal of urine by means of a catheter.

Purpose:

a)     To relieve  distension of the bladder due to retention of urine.

b)    To obtain a sterile specimen of urine for laboratory testing.

c)     To make sure the bladder is empty for certain pelvic operation.

Catheterisation of a female patient. 

Articles required:

A sterile tray containing

a)     Two rubber catheters , number 6 or 7

b)    antiseptic solution in a small bowl ( saline only if a laboratory specimen is required).

c)     Cotton swabs

d)    Two dressing forceps

e)     Towel

f)      Pair of gloves if necessary

g) Kidney tray

h)two specimen bottles or test tubes to collect the sterile urine. Clean tray containing

i)       Rubber sheet or plastic sheet and towel

j)       Kidney tray or paper bag

k)    Transfer forceps in lotion

l)       Bedpan to empty urine from the kidney tray.

Nursing measures before catheterisation:

a)     Reassure the patient

b)    Apply hot water bag to the pubic area.

c)     Give a bedpan and pour warm water over the genitals

d)    Let the patient hear running water.

e)     Give a hot drink

f) Help the patient to sit in as natural a position as possible.

g)     A sitz bath or hot enema may be effective.

Procedure:

1.     Explain the patient and get her co-operation.

2.     Screen the bed and bring the articles to the bedside.

3.     Place the patient in modified dorsal position. Protect the bed under her buttocks and drape to expose only.

4.     Wash your hands thoroughly and if possible wear gloves.

5.     Place the sterile towel carefully in position under buttocks.

6.     Cleanse the vulva using a dressing forceps to hold a swab moistened in lotion. Use one swab only for one stroke, first the labia majora, right side then left side , then the labia minora. Lastly separate the labia with thumb and first finger of the left hand and clean directly over the urethral opening down to the anus. Discard the forceps.

7.     Place a swab lightly in the vaginal opening to prevent contamination by any discharge.

8.     Place the sterile kidney on the sterile towel between the thighs.

9. With the right hand take a catheter holding it 5 cm from the tip with the other end in the sterile kidney tray.

10.                        Separate the labia again with your left hand. Instruct the patient to breathe through the mouth and insert the catheter gently and carefully into the urethral opening. Direct it downwards and backwards for about 5 cm. Urine should begin to flow into the kidney tray. If gloves are not used use the sterile forceps to pick up and insert the catheter. If the catheter becomes unsterile before it is inserted, discard it and take the second one.

11.                        If a specimen of urine is required collect it directly into the test tube or bottle in the middle of the stream.

12.                        Slightly pressure above the pubis will make sure the bladder is emptied.

13.                        When the bladder is empty withdraw the catheter gently and leave the patient comfortable.

14.                        Specimen is obtained, labeled and send it immediately to the testing laboratory.

15.                        The remaining urine is measured and charted. Record the time and procedure.

Precautions:

1.     Remember that urinary system is considered to be sterile and strict asepsis is to be observed in this procedure.

2.     Avoid causing injury by too large catheter or using force.

Catheterisation of a male patient.

This is preferably done by a doctor or the nurse.

Articles required:

The materials required are similar to those required for female catheterisation but a longer catheter may be require and there must be a sterile lubricants.

Sterile gloves should be worn.

Procedure:

1.     This also is similar to female catheterisation for most steps.

2.     Place the rubber sheet across the thighs under the penis.

a.     After scrubbing the hands and wearing gloves, place the sterile towel over the rubber sheet.

3.     Using the forceps clean the penis thoroughly with moistened swabs.

4.     With the left hand retract the foreskin, exposing the urethral meatus and using forceps in the right hand gently clean the area.

5.     Lubricate the catheter and insert it gently while holding the penis upwards and stretching it to straighten the urethra as mush as possible.

6.     Never use force and if there is difficulty, refer the patient to a doctor.

7.     If there is no obstruction , insert the catheter up to 20 cm or until urine begins to flow.

8.     The remaining urine is measured and charted. Record the time and procedure.