The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [184]
14 Place sterile towels across the patient’s thighs. To create a sterile field. E
15 Using low-linting swabs, separate the labia minora so that the urethral meatus is seen. One hand should be used to maintain labial separation until catheterization is completed. This manoeuvre provides better access to the urethral orifice and helps to prevent labial contamination of the catheter. E
16 Clean around the urethral orifice with 0.9% sodium chloride or an antiseptic solution, using single downward strokes. Inadequate preparation of the urethral orifice is a major cause of infection following catheterization. To reduce the risk of cross-infection (Fraise and Bradley 2009, E).
17 Insert the nozzle of the lubricating jelly into the urethra. Squeeze the gel into the urethra, remove the nozzle and discard the tube. Allow 5 minutes for the gel’s antiseptic and anaesthetic effects to occur. Adequate lubrication helps to prevent urethral trauma. Use of a local anaesthetic minimizes the patient’s discomfort (Woodward 2005, P).
18 Place the catheter, in the receiver, between the patient’s legs. To provide a temporary container for urine as it drains. E
19 Introduce the tip of the catheter into the urethral orifice in an upward and backward direction. Advance the catheter until 5–6 cm has been inserted. The direction of insertion and the length of catheter inserted should relate to the anatomical structure of the area. E
20 Either remove the catheter gently when urinary flow ceases or advance the catheter 6–8 cm. This prevents the balloon from becoming trapped in the urethra. E
21 Inflate the balloon according to the manufacturer’s directions, having ensured that the catheter is draining adequately. Inadvertent inflation of the balloon within the urethra is painful and causes urethral trauma (Getliffe and Dolman 2003, P).
22 Withdraw the catheter slightly and connect it to the drainage system. To ensure that the balloon is inflated and the catheter is secure. E
23 Support the catheter, if the patient desires, either by using a specially designed support, for example Simpla G-Strap, or by taping the catheter to the patient’s leg. Ensure that the catheter does not become taut when patient is mobilizing. Ensure that the catheter lumen is not occluded by the fixation device or tape. To maintain patient comfort and to reduce the risk of urethral and bladder neck trauma. Care must be taken in using adhesive tapes as they may interact with the catheter material (Pomfret 1996, P).
Postprocedure
24 Make the patient comfortable and ensure that the area is dry. If the area is left wet or moist, secondary infection and skin irritation may occur. E
25 Measure the amount of urine. To be aware of bladder capacity for patients who have presented with urinary retention. To monitor renal function and fluid balance. It is not necessary to measure the amount of urine if the patient is having the urinary catheter routinely changed (Fillingham and Douglas 2004, E).
26 Take a urine specimen for laboratory examination if required (See Chapter 11). For further information, see Procedure guideline 11.5.
27 Dispose of equipment in an orange plastic clinical waste bag and seal the bag before moving the trolley. To prevent environmental contamination. Orange is the recognized colour for clinical waste (DH 2005a, C).
28 Draw back the curtains.
29 Record information in relevant documents; this should include:
reasons for catheterization
date and time of catheterization
catheter type, length and size
amount of water instilled into the balloon
batch number and manufacturer
any problems negotiated during the procedure
a review date to assess the need for continued catheterization or date of change of catheter.
To provide a point of reference or comparison in the event of later queries (NMC 2009, C).
Postprocedural considerations
Documentation
To ensure adequate documentation of the process of urinary catheterization, the following information should be recorded in the patient’s notes.
Note patient’s consent and understanding