Deinition
A sterile catheter is inserted aseptically into the bladder in order to drain it of urine. The most common catheteriza-tion is urethral (via the urethra), for which the catheter may be secured in the bladder (indwelling) or inserted and immediately removed (intermittent).
Figure 14.1 Different types of bedpan. A, Non-disposable slipper; B, Bedpan with disposable lining.
A B
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Principles of elimination management: micturition and catheterization
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Comprehensive catheter care, including maintaining a sterile closed drainage system that does not allow entry to bacteria (Fig. 14.2). Clean non-sterile gloves should be worn over decontaminated hands for every aspect of catheter care. Specimens should be obtained aseptically using the sampling port and care should be taken when emptying the drainage system to avoid contamination between the tap and the container.•
The drainage bag should be supported at a level lower than the bladder (max. 30 cm) to allow free drainage and prevent backlow of the urine. A catheter stand is used to both keep the bag away from the loor and to reduce trauma to the urethra. Drainage bags should be changed after the manufacturers’ agreed number of days.•
The bag should be emptied when two-thirds full.Occluding or kinking the catheter (e.g. in the knicker leg) can cause stasis of urine in the bladder and subsequent UTI. Ongoing catheter care includes observing the amount, colour, clarity and smell of the urine, in conjunction with the woman’s vital signs and clinical signs of illness or UTI. Advice regarding all aspects of catheter care must be given to the woman.
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Attendance to daily personal hygiene, Leaver (2007) suggests that showering is preferable to bathing.•
Choice of equipment (discussed below).•
General health of the woman. While largelyunresearched, a daily oral luid intake of 2L per day is considered to lush the urinary tract and limit the chances of UTI (Getliffe & Fader 2007).
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Trained and competent staff.Prevention of infection
The infection risk increases according to the susceptibility of the woman, type and length of time the catheter is in situ, and the quality of catheter care. The risk is higher for women than for men, due to the close proximity of the urethra to the anus, and the shorter length of the female urethra. Catheterization is often a short term measure in maternity (<28 days); this reduces the risk of infection.
Infection reducing measures (largely adapted from Loveday et al 2014):
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Document the indication (as well as other details, see below), review (and document) daily, removing the catheter as soon as possible.•
Strict hand decontamination before and after any aspect of catheter care and the correct use of personal protective equipment.•
An Aseptic Non Touch Technique (ANTT, Chapter 10) for insertion using sterile equipment. Loveday et al (2014) advocate the cleansing of the meatus with sterile 0.9% sodium chloride. NICE (2014b) suggest that the perineum is cleansed with tap water prior to vaginal examination. Where the two procedures are likely to take place at a similar time, the local protocol regarding meatal cleansing should be followed.•
The use of a sterile lubricant reduces trauma, discomfort, and infection. Baston (2011) suggests that anaesthetic gel provides both pain relief andlubrication; care should be taken if there is any break in the mucous membranes or if contact with the fetus/neonate is likely, bradycardia may ensue.
Figure 14.2 Closed drainage system – no breaks or open entry points from bladder to drainage tap.
(Adapted with kind permission from Jamieson et al 2002) Urinary bladder
Urine collection bag
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any problems encountered with the insertion•
plan of care including duration/expected removal time•
specimen taken and sent (if needed)•
drainage system used•
name and signature of midwife.PROCEDURE: female urethral catheterization using an indwelling catheter
This is based on the ANTT guidelines (Chapter 10), working from a suitable height and using a dressings trolley. The procedure is adapted according to the working environ-ment. It is helpful to have an assistant while setting up for catheterization. If one is not available, the procedure is adapted using additional hand hygiene episodes.
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Conirm identiication, gain informed consent, and ensure privacy.•
Wash and dry hands, obtain dressings trolley, put on non-sterile gloves, and clean the trolley with the locally approved wipes.•
Gather equipment onto lower shelf:■ sterile Foley catheter (likely size 10–12 Ch) (a second one may be helpful)
■ sterile drainage bag and stand
■ 2 pairs of sterile gloves and a plastic apron
■ sterile catheter pack (sterile receiver will also be needed if not contained in this pack)
■ sterile anaesthetic gel
■ sterile sachet sodium chloride 0.9% or other approved skin cleanser
■ disposable sheet
■ good light source
■ 10 mL sterile water and sterile 10 mL syringe and sterile drawing up needle (not needed if catheter has a self-inlating balloon).
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Take trolley to the woman. Position the woman (removing sanitary towels and underwear) on a disposable sheet, in a semi-recumbent position, ankles together, knees apart. Keep the woman covered while the remainder of the preparations are made.•
Apply apron and decontaminate hands, open the outer layer of the catheter pack, sliding the inner part onto the trolley. Open the inner wrapper handling only the corners (Fig. 10.1 p. 90)•
Open the gloves, catheter (syringe and needle if needed), drainage bag, and anaesthetic gel onto the sterile ield. Ask the assistant to pour in the sodium chloride and to hold the vial while drawing up the sterile water. Protect all Key-Parts.•
Decontaminate hands and put on sterile gloves. Ask the assistant to lift the covers off the woman.Choice of equipment
Catheter choice should consider reducing:
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tissue inlammation and trauma to the urethra (also improves comfort)•
mineral deposits that may cause the catheter to block•
bacterial growth.Sterile polytetraluroethylene (PTFE) latex catheters have a lifespan of 7–21 days and so are often the catheters of choice for maternity use. Caution must be taken to ensure that there is no latex allergy on the part of the recipient. A standard length catheter (40–45 cm) is used for larger women, otherwise a female catheter (23–26 cm) is accept-able. The lumen should be large enough to drain ade-quately without overdistending the urethra, a size 12 Ch is suitable for most women.
Indwelling catheters are retained in the bladder by a balloon inlated with a maximum (in adults) of 10 mL of water (Foley catheter) (Loveday et al 2014). Catheters vary;
some have a self-inlating balloon or a preilled sterile syringe. The sterile water is squeezed from the external balloon or syringe to the internal balloon (and clamped) when the catheter is in the bladder. Catheters for intermit-tent use are generally made from PVC plastic with holes at the tip (no balloon). All catheters are singly wrapped, sterile, and with an expiry date. Correct storage – out of sunlight, heat, and humidity; in original cardboard; and without elastic bands (Winder 1999) – protects the quality of the catheter. Valves, drainage bags, and catheter packs (containing swabs, gallipot, and receivers) are also sterile and for single-use only.
Analgesia
It’s noted that it’s dificult to anesthetize the length of the female urethra, but nevertheless efforts should be made to reduce the pain and the discomfort/trauma of catheter insertion. Usually preprepared 6 mL lidocaine (lignocaine) 2% gel is used but with caution (as above). It takes effect after 3–5 minutes.
Documentation
As well as the clinical indication for the catheterization, these details also need to be recorded in the woman’s record:
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date of insertion•
the catheter – type, length, size, manufacturer, batch number, expiry date and number of millilitres in balloon (sometimes a label is supplied with the catheter for sticking into the woman’s records)•
cleansing solution and lubricant used, complete medicine administration chart also|
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Principles of elimination management: micturition and catheterization
the syringe. If there is great discomfort, the balloon may be in the urethra, and the catheter would need to be advanced further into the bladder before the balloon is inlated.