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catheter assessment
| Question | Answer |
|---|---|
| pre-procedure steps in catheter insertion | provider order, indications, gather supplies/bring to bedside, identify pt, provide pt education, assess for sensitivity, place waste basket, raise bed, ensure privacy, assist client to proper position |
| indications for an indwelling catheter include | urinary retention/bladder obstruction, improve comfort for end of life care, critically ill, specific surgical procedures, assistance in healing, prolonged immobilization |
| what size foley do you use for children | 8-10 french |
| what size foley do you use for women | 14-16 french |
| what size foley do you use for men | 16-18 french |
| examples of patient identifiers | name, DOB |
| patient education for a foley (why its being placed, what to expect during the procedure) | I'll be inserting a catheter to drain your urine and as I go along with the process I'll explain the steps each step of the way |
| what sensitivity do you need to assess for before inserting a foley catheter | betadine |
| what do you use in place of betadine if there is a sensitivity | chlorhexadine |
| proper position for women | supine with knees flexed |
| proper position for men | supine with legs open |
| what are the cleansing steps before placing a urinary catheter | perform hand hygiene, place unopened kit b/w the pt's legs, take the catheter tray out of the packaging, open up cleansing wipes, apply clean exam gloves, cleanse peri rectal area, remove gloves and perform hand hygiene |
| what type of catheter is recommended for men | caude = curved tip |
| how do you cleanse the peri-rectal area of a vagina | use one wipe to clease furthest labia from you in a single downward motion, use the second wipe to cleanse the labia nearest, and use the thir to cleanse the middle area |
| how do you cleanse the peri-rectal area of a penis | gently grasp the penis use one wipe to cleanse around the urinary meatus, the second to cleanse the glans of the penis (if pt uncircumcised, pull the foreskin back, cleanse, and the reposition the foreskin), third to cleanse shaft to scrotum |
| steps to setting up the catheter tray | open catheter kit - flap away, left, right, towards you, apply sterile gloves on clean bedside, place sterile drape beneath pt, place fenestrated drape over perineal area, prepare tray |
| how do you place the sterile drape on a client with a vagina | place under buttocks |
| how do you place the sterile drape on a client with a penis | place just below penis |
| how do you prepare the tray | separate the two trays on sterile field, open swab sticks, attach syringe to inflation port, deposit lubricant on tray, take catheter out and place in the lubricant |
| how do you cleanse the perineum of a vagina | separate labia majora and with thumb and index finger of non dom hand, cleanse labia furthest in single downward motion, cleanse majora closest, cleanse middle area, (do not allow the labia to close over once done |
| how do you cleanse the perineum of a penis | hold the penis upright, retract foreskin use a swab to cleanse the penis in a circular motion starting at the urinary meatus and working outward and then discard, do same for second and third |
| how do you proceed to insert the catheter after cleansing the perineum | use sterile dominant hand to move catheter tray closer and remove the lubricated cath from the tray, instruct client to bear down and then to take deep breaths and exhale, advance catheter, inject all 10 ml of the syringe, detach syringe, pull cath, hang |
| how far do you insert a cath for a pt with a vagina | until urine flows then 1-2 inches further |
| how far do you insert a cath for a pt with a penis | until urine flows then all the way to the bifurcation |
| what do you do after inserting the cath for pts who are uncircumcised | return foreskin to normal position |
| why do you pull on the catheter once injecting the syringe | to make sure the balloon is in place |
| coiling of tubing of the cath on the bed is permitted when | a sheeting clip is used |
| steps in post insertion of a catheter | discard equipment, drapes, gloves, perform hand hygiene and apply clean gloves, perform urinary catheter care using wipes, dispose of the gloves and perform hand hygiene, secure the foley cath to the client - statlock, reposition client, educate patient |
| what should you educate your pt on after placing a foley catheter | don't disconnect/ pull on/or twist catheter and drainage tube, let me know if you notice any leaks or kinks in the system, drainage bag always needs to be below your bladder |
| steps to removing an indwelling urinary catheter | assess provider orders, perform hand hygiene and put on gloves, explain procedure, ensure privacy, lift gown and expose, place towel under client, deflate catheter balloon, slowly remove catheter while the pt exhales, cleanse/dry perineal area, educate pt |
| how do you deflate the catheter balloon | pull back syringe to 0.5 ml and insert into the inflation port, allow water to naturally flow back, remove all 10 ml, if no deflation noticed reseat the syringe |
| what do you educate a pt on after removing an indwelling catheter | might have a burning sensation a few times after voiding which is completely normal (let nurse know if it continues to be painful) symptoms can occur 3-4 days after |
| what should the nurse do after removing a cath | monitor pt and if unable to void within 6-8 hrs or experience abdominal pain notify the provider |
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