hi i'm barbara pettit and today i'm
going to talk to you about how to place
a urinary bladder catheter this video
will cover the indications
contraindications supplies you'll need
to place the catheter how to prepare the
patient how to place the catheter while
maintaining sterile technique securing
the catheter as well as some
troubleshooting and complications that
can arise you should already be aware of
the relevant anatomy and have a basic
understanding of the indications and
contraindications
speaking of which indications for
indwelling catheters include the need to
precisely monitor urinary output relief
of urinary retention a neurogenic
bladder patients who are immobilized or
incontinent including patients that are
not conscious and inter obvious patients
and after urethral surgery non and
Welling or straight catheters can be
used for retrograde bladder irrigation
obtaining sterile urine samples such as
in children who are too young to produce
a clean catch sample or to administer
contrast for certain radiologic studies
of course there are other indications
but these are many of the most common
reasons contraindications for placement
of a urinary catheter include a history
of urethral stricture a urethral trauma
which you should suspect in patients
with a high-riding prostate on rectal
exam blood at the urethral meatus or
pernil or scrotal hematoma or ecchymosis
relative contraindications include
patients with acute urinary tract
infections and anticoagulated patients
catheter associated urinary tract
infections or CAUTIs are a huge source
of nosocomial infection and medical
spending so always think carefully if
you're patient truly needs an indwelling
bladder catheter I've talked about both
indwelling and non end well in catheters
so it's probably a good time to talk
about that a little more in dwelling
catheters such as this one are placed
under sterile conditions and have a
balloon at the end to ensure that they
stay inside the bladder they're used
when the patient will need
catheterization for several days the
most common type of indwelling catheter
is a Foley catheter like this one it
comes in various sizes measured using
the French system on the internal end it
has a balloon to ensure that it stays in
place on the external end it has two
branches one drains the urine into the
collection system it's connected to some
tubing and then to usually a bag while
the other is used to fill the balloon
with sterile water we would put it in
here like this
and blow up the balloon be sure to check
the number on the ring at the end of the
catheter because that will tell you how
much volume to use when filling the
balloon other forms of indwelling
catheters also exist the coudé catheter
is a catheter with a bulbous tip and a
curved end and it's used for patients
who have urethral obstructions such as
from benign prostatic hypertrophy it's
placed using a bit of pressure but the
principle of placing it is the same it
has a balloon and it's indwelling the
other type of catheter is a non
indwelling or straight catheter these
are used when the patient only has to be
catheterized once they are still placed
under sterile technique but they don't
stay in the body after the bladder is
drained they are not connected to a
collection system but instead drain
directly into a basin many people
self-catheterize at home using a
straight catheter when you determine
that your patient needs a bladder
catheter talk to the patient explaining
why they need it what will happen during
the placement and talk about risks
alternatives and answer any questions
that they may have inquire about
allergies to latex or iodine as many
kits come with parts that contain these
chemicals ask the patient if they have
ever had a previous catheter inserted
and if there was any difficulty with the
insertion let's briefly talk about the
supplies you'll need for placement
most institutions use
commercially-available catheter
insertion kits that contain all the
necessary items you'll need for catheter
insertion in that case all you'll need
to do is look on the outside of the box
and choose the appropriate size catheter
for your patient 16 or 18 French is
typical in an adult let's look at a kit
that contains everything you'll need
sometimes the catheter is packaged
separately as with this kit so make sure
you're choosing the right kit in
addition to the catheter you'll need
cleaning towelettes or soapy water non
sterile gloves
absorbable pads sterile gloves a
fenestrated drape betadine or iodine
with applicators for preparing the
patient lubricant of sterile syringe
with water or saline and a collection
system in this video we will be focusing
on placement in a patient with a penis
positioning is key for this procedure
place the patient in the supine position
with their legs extended place a
waterproof or absorbent pad under their
buttocks and upper legs ensure privacy
for the patient pull the curtain and
expose only the necessary parts of the
body sanitize your hands and put on non
sterile gloves this first part is not
sterile cleanse the penis with
towelettes or with soap and water making
sure to retract the foreskin if present
note to self if you do this at the end
of the procedure you must return the
foreskin to normal position in order to
avoid eye at regenexx paraphimosis which
is a urologic emergency now that the
penis is washed it's time to move to the
sterile portion of the procedure open
the kit to set up your sterile field
near the patient make sure to place the
sterile field in an easy-to-reach
location that organ Amelie works for you
you will be doing most of the work with
your dominant hand so that should be the
side closer to the field an easy place
to put it is on the patient just next to
the sterile field
place the large
square drape across the thighs and under
the penis now Don your sterile gloves
like so making sure you have nothing
below your elbows such as a watch or
ring
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open the fenestrated drape and place it
on the patient tear open the iodine and
pour it into the well in the tray
lift the top tray out and place it in
the sterile field in front of the rest
of the box containing the actual
catheter and tubing while it used to be
commonplace to check the balloon by
instilling it with the provided saline
the manufacturer and most institutions
no longer recommend this step so check
with your institution to determine their
policy next open the syringe with the
sterile water as well as the syringe
with lubricant hold the shaft of the
penis in your non-dominant hand
retracting the foreskin if it is there
if you are using your left hand to place
the catheter stand on the patient's left
side your non-dominant hand is now
contaminated and cannot assist in
placement until the catheter is in place
and the balloon is inflated pull up on
the penis if your grip is not tight
enough placement will be difficult and
can leave to unsterile placement using
three cotton balls prepare the glans
from the meatus towards the shaft in a
circular motion 2% lidocaine jelly can
be injected directly into the lumen of
their urethra via syringe and squirt the
rest of the lubricant onto the sterile
field place the tip of the catheter into
the lubricant and attach the syringe to
the appropriate port holding the penis
at a ninety degree angle to the abdomen
grasp the pre lubricated catheter and
insert the tip into the meatus make sure
you hold the catheter far enough away
from the tip to not contaminate your
dominant hand on the penis but not so
far away that you cannot control the tip
of the catheter when placing bladder
catheters in patients with a penis
advance the catheter all the way to the
hub regardless of urine is spilling the
tubing or not once at the hub instill
the correct volume of saline into the
balloon and gently pull back on the
catheter until resistance is met once
you meet resistance re advance the
catheter so the balloon is not putting
pressure on the bladder neck if the
patient has a foreskin retracted back
over the glans at this point remove the
drain
now it's time to secure the catheter
many kits come with a stabilization
device usually this device has a
mechanism to lock the catheter in a
single orientation an adhesive on the
other side to secure it to the patient
so like this if there's no stabilization
device provided use two pieces of tape
to secure the tubing to the patient the
first piece of tape goes directly on the
patient's leg under the tubing the
second piece of tape goes over the first
around and is taped to itself before
it's taped down this provides a
mesentery that it provides a lot of
stability for the tube whether using
tape or a commercial stabilization
device leave enough slack in the
catheter and tubing so there's no
tension on the bladder neck technically
the correct orientation is to secure the
tubing so that the penis is cephalad and
the tubing is taped to the abdomen
however many people choose instead to
secure the device to the patient's leg
if the patient is immobilized or unable
to move this can lead to ulcers but as
it is acceptable in an otherwise healthy
patient who will not need the catheter
for more than 72 hours or so regardless
of how you secure the tubing is crucial
to ensure that there is no tension on
the tubing the tubing can then be
clipped to the sheets or the patient's
gown the bag should be placed in a
dependent position and may be hung by
the string or the hanger above the bag
let's talk about errors and
complications by far the most common
error is a break in sterile technique
once your non-dominant hand touches the
skin it's contaminated and cannot touch
any of the tubing or the catheter
likewise your dominant hand must stay
sterile and not touch the penis or vulva
or outside the sterile field
another common complication is urethral
trauma secondary to insufficient
lubrication leading to pain on insertion
urine leaks around the catheter gently
tug it to see if the balloon is inflated
if it is you may need to replace the
catheter with a larger French size if no
urine drains ensure the catheter is
fully inserted deflate and re-inflate
the balloon when you are sure you're in
the bladder and gently press on the
bladder if you place the catheter and
get return of franc blood
it is likely either miss placement of
the catheter traumatic placement or
attempted removal before the balloon is
deflated it can also be from infection
post urinary tract surgery stones trauma
to the urethra or pelvis or cancer in
the GU tract in this case ensure correct
placement order a CBC and urinalysis and
make sure that an IV is in place and
consider making sure that blood is
available in the setting of trauma to
the pelvis bladder or urethra consider a
retrograde cystogram if your
pre-rounding on your patients and find a
previously functioning catheter is no
longer working check the catheter
placement by pulling back gently until
resistance is met make sure none of the
catheter tubing is kinked plant or
dislodged
seriously this is the most common cause
of loss of function and the easiest to
fix if it's not a problem with the
tubing consider blood clots urinary
sediment and stones if the catheter is
no longer draining palpate the abdomen
to check for bladder distension check
with your resident or attending to see
if they want you to irrigate the
catheter using sterile technique if all
else fails it may be necessary to
replace the catheter however check with
your resident or attending before doing
so so there you have it the indications
contraindications and some
troubleshooting of urinary catheters we
talked about the supplies you'll need
and how to maintain sterile technique
while placing the catheter some advice
asks someone if you can open a kit
before you have to place one that way
you can familiarize yourself with the
kits at your institution and be ready to
place a Foley without confusion when the
time comes
ask nurses to let you place a Foley
catheter whenever you can there's only
one way to get good at do
and that is with practice most nurses
will be happy to help and will stay with
you to make sure you don't run into
trouble hopefully this video was helpful
thanks and be sure to watch the video on
bladder catheterization in patients with
a vulva as well have a good day
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