Urinary catheter care by Dr.T.V.Rao MD

Urinary Catheter Care
Skills & A sepsis
Dr.T.V.Rao MD

1. Urinary Catheter Care
Skills & Asepsis
Dr.T.V.Rao MD
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2. Urinary Catheter
Dr. Frederick Foley
•Developed in the 1920s
by Dr. Frederick Foley
•The urinary catheter was
originally an open system
with the urethral tube
draining into an open
container.
•In the 1950s, a closed
system was developed in
which the urine flowed
through a catheter into a
closed bag.

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3. What is a Foley's catheter

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4. What is a urinary catheter
•Urinary catheter
is any tube
placed in the
body to drain
and collect
urine from the
bladder

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5. Catheter type
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6. Structure of Foley Catheter

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7. Urinary Catheter Utilization
•About 15-25% of patients
during their hospitalization
will have an urinary
catheter placed
•Many are placed either in
the intensive care or
Emergency Department
•40% - 50% of these patients
do not have a valid
indication for urinary
catheter placement

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8. Purpose of Catheterization
Catheterization is carried out for a number of
reasons and can either be a temporary or
permanent solution to a number of problems.
Problems include physical disease and damage,
psychological issues and a way to help to
improve the quality of life to someone who is
bed ridden. Good regular catheter care involves
good hygiene, observation, monitoring well-
being and prevention of problems associated
with catheterization.
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9. Foley Catheter

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10. Documentation
•Details regarding the
catheterisation
should be recorded
in the patient’s
notes. For further
information please
refer to your
hospitals policy and
procedure manual.

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11. Matters to consider for
Catheterization
•Indication for catheterisation
•• Time and date of catheterisation
•• Type of catheter
•• Amount of water in balloon
•• Size of catheter
•• Expiry date of product
•• Any problems on insertion
•• Description of urine, colour and volume drained
•• Specimen collected
•• Review date
•(Marsden Manual 2001)
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12. What you Need for Catheterization
•1 Dressing trolley
•2. Catheterisation pack
•3. Sterile gloves
•4. Appropriate size catheter
•5. Xylocaine jelly syringe
•6. Sterile water for the balloon
•7. Syringe
•8. Specimen jar
•9. Antiseptic solution
•10. Waterproof Sheet
•11. Extra Jug
•12. Light source
•13. Tape to secure the catheter to the leg
•14. Drainage bag
•15 Urine bag holder
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13. Choose the Right Catheter
•Choose the smallest
catheter size that
will drain adequately
for its intended use
•Catheters range in
size from 5 – 24 Fg.
•(Joanna Briggs
Institute 2003)

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14. Guidelines on Size
•Women 12 – 14 Fg
•Men 16 – 18Fg
•Suprapubic 16 –20Fg
•Haematuria 20 -24 Fg
•If a haematuria catheter is required a 3 –way
should be used to allow for the option of
continuous bladder irrigation without requiring a
further catheter change. When not in use, the
irrigating port should be spigotted.
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15. Length of Catheters
•Catheters are available in 3 lengths: Paediatric,
Regular length and Female length.
•Female length is a shorter length catheter (20-
25cm). A shorter length catheter may be more
convenient for ambulant women with a long
term catheter. A shorter length catheter is not
appropriate for all women particularly those
who are bedridden or obese.
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16. Catheters in Obese Women
•In obese women, the
inflation valve of the
shorter catheter may
cause soreness by
rubbing against the
inside of the thighs, and
the catheter is more
likely to pull on the
bladder neck (Britton &
Wright 1990; Pomfret 1996)


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17. Catheterization is a skill in Medicine
•The ability to insert a
urinary catheter is an
essential skill in
medicine.
•Catheters are sized in
units called French,
where one French
equals 1/3 of 1 mm.
Catheters vary from 12
(small) FR to 48 (large)
FR (3-16mm) in size.


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18. Catheters are available in different
varieties
•They also come in
different varieties
including ones without
a bladder balloon, and
ones with different
sized balloons - you
should check how much
the balloon is made to
hold when inflating the
balloon with water!


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19. What is indwelling Catheter
•In indwelling urinary catheter is one that is left in
place in the bladder. Indwelling catheters may be
needed for only a short time, or for a long time.
These catheters attach to a drainage bag to collect
urine. A newer type of catheter has a valve that
can be opened to allow urine to flow out, when
needed. An indwelling catheter may be inserted
into the bladder in two ways:
•Sometimes, one may insert a tube, called a
suprapubic catheter, into your bladder from a small
hole in your belly. This is done as an outpatient
surgery or office procedure.

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20. Caution on catheterization

•The potential for contact with a
patient's blood/body fluids while
starting a catheter is present and
increases with the inexperience
of the operator. Gloves must be
worn while starting the Foley,
not only to protect the user, but
also to prevent infection in the
patient. Trauma protocol calls for
all team members to wear
gloves, face and eye protection
and gowns.
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21. Explain the patient before doing the
catheritization
•Before you start tell the person what you are going
to do and why. This is important for everyone, but
especially if the person is confused, has memory
problems as in Alzheimer's disease or dementia. If
you can, assist the catheterized person with their
hygiene, rather than doing it yourself. It is
important to try to help the person / patient keep
their skills rather than just take over for them.
There are so many advantages but it can just take
that bit longer.
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22. Which Disinfectant Should be Used for
Catheter Site Care?
•Povidone-iodine (PI) is
currently the most widely
used agent for site
disinfection
•Chlorhexidine gluconate
(CHG) has been compared
to PI with mixed results
•We performed a formal
meta-analysis of published
and unpublished studies to
clarify relative efficacy

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23. Skills in catheterization to be
Perfected

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24. CONDOM CATHETERS
•Condom catheters are most
frequently used in elderly
men with dementia. There
is no tube placed inside the
penis. Instead, a condom-
like device is placed over
the penis. A tube leads from
this device to a drainage
bag. The condom catheter
must be changed every day.

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25. When Men suffer with Incontinence
•When a man is unable to control
his urine for long periods of time
he is said to be incontinent. To
avoid soiling his clothes and bed a
condom-style sheath can be used
to connect the penis to a closed
drainage system in which the
urine is collected.
•This avoids having a catheter
inserted into the man's urinary
bladder and greatly decreases the
risk of bladder infections.

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26. INTERMITTENT (SHORT-TERM) CATHETERS
•Some people only need
to use a catheter on
occasion. Short-term, or
intermittent, catheters
are removed after the
flow of urine has
stopped. For more
information on this type
of catheter, see: Clean
intermittent self-
catheterization.
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27. Hand washing the most important
preparation before catheterization
•Wash your hands
before and after
handling the drainage
device. Do not allow the
outlet valve to touch
anything. If the outlet
becomes obviously
dirty, clean it with soap
and water.
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28. Antiseptic Hand Rinses many
using alcohols
•60-70% alcohol
solutions
•Effective against most
bacteria, viruses, fungi
•Protective against
hand drying
•Faster, increased
compliance
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29. Caring before the insertion of Catheter
•Wash around the
catheter entry site with
soap and water twice
each day. Clean the top
several inches of the
catheter too.
Always wash the site
after a bowel
movement.
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30. Health care workers should develop skills
in introduction of Catheter
•Introduction Female
urethral catheterization, the
insertion of a catheter
through the urethra into the
urinary bladder to permit
drainage of urine, is a
fundamental skill Insert the
catheter completely into
the urethra, and do not
inflate the balloon until
there is return of urine, to
avoid trauma …

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31. Principles of placement of catheter and
collecting bag

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32. The Urine collecting bag should be at a
lower level to the patient
to prevent retrograde flow


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33. •Criteria for insertion and
continuation of a F/C includes:
a.Retention
b.Critical I&O
c.Comatose
d.Paralyzed
e.Neurogenic Bladder
f.Pre-op placement
g.Wound with incontinence
h.Bladder Irrigation
i.Physical trauma/pain with bedpan/incontinence brief
j.Terminal illness/comfort measures
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34. Care of Inserted Catheters
• Every day , wash around the catheter and
perineum with soap and water; rinse and dry
these areas well. you may shower while
wearing the catheter
• Sitting in the tub, however , is not
recommended. Good personal hygiene pre
vents the accumulation of bacteria, reduces
the risk of infection, and prevents odor
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35. POSSIBLE COMPLICATIONS
•Inability to catheterise
•• Urethral Injury – by inflating balloon before insuring correct
catheter placement in the
•bladder
•• Infection
•• Psychological Trauma
•• Haemorrhage – trauma sustained during insertion or balloon
inflation
•• False Passage – by injury to the urethral wall during insertion
•• Urethral Strictures – following damage to the urethra – long term
problem
•• Paraphimosis due to failure to return foreskin to normal position
following catheter insertion.
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36. Complications of catheterization
•The main complications are tissue trauma and infection. After
48 hours of catheterization, most catheters are colonized with
bacteria, thus leading to possible Bacteriuria and its
complications. Catheters can also cause renal inflammation,
nephro-cysto-lithiasis, and pyelonephritis if left in for
prolonged periods.
•The most common short term complications are inability to
insert catheter, and causation of tissue trauma during the
insertion.
•The alternatives to urethral catheterization include
suprapubic catheterization and external condom catheters for
longer durations.

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37. Urinary Catheter-related Infection:
Background
•Urinary tract infection (UTI) causes over 40%
of hospital-acquired infections
•Most infections due to urinary catheters
•25% of inpatients are catheterized
•Leads to increased morbidity and costs


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38. Risks / Consequences of
Catheterization
•UTI
•PYELONEPHRITIS
•DEATH R/T BACTEREMIA
•DAMAGE TO URETHRA (SCARRING AND
STRICTURES)
•Prostatitis and epididymitis
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39. •Indwelling Foley catheters are a major
source of UTI’S.
•Direct relationship between duration a f/c is in the
patient and incidence of infection.
•Risk factors:
Female
Advanced age
Duration
Diabetes
Renal insufficiency

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40. Biofilm: Extracellular Polymers
(Donlan, CID 2001; 33:1387–92, Liedl, Curr Opinion Urol 2001;11: 75-9)
•Organisms attach to and
grow on a surface and
produce extracellular
polymers
•Intraluminal ascent
(48hours) of bacteria
faster than extraluminal
(72-168 hours)
•Most catheters used >1
week have biofilms
•Extraluminal more
important in women
40

Staphylococcus aureus biofilm on
an indwelling catheter.
CDC Public Health Image Library
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41. What we are doing now, is it right things to do.
Foley Catheter Bundle
What is the Foley Catheter Bundle?
Insert using sterile technique
Hand hygiene before and after any contact with the F/C
system
Secure catheter to thigh at ALL times
Keep catheter bag below the level of the bladder at
ALL times
Maintain a sterile, continuously closed system
Specified criteria for insertion and continuation of a Foley
catheter
Peri care daily and after all incontinent stool
What is “Peri Care” for a patient with a f/c? Daily wash with
warm soap & water then dry.
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42. Gravity will help the Draining of
Bladder
•Gravity is important for drainage and the
prevention of urine backflow. Ensure that
catheter bags are always draining
downwards, do not become kinked and
are secured and below thigh level. Metal
or plastic hangers should be attached to
the side of the bed. Cloth bags tied to the
bed to support the bags are also
available
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43. Collection of urine from catheterised
patients
•The process of obtaining a sample of urine
from a patient with an indwelling urinary
catheter must be obtained from a sampling
port. The sample must be obtained using an
aseptic technique.
•This port is usually situated in the drainage
tubing, proximal to the collection bag which
ensures the freshest sample possible. The use
of drainage systems without a sampling port
should be avoided (Gilbert, 2006).

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44. COLLECTION OF CATHETER SPECIMENS
In Urinary Tract Infections
•Clean entry port with alcohol swab using firm
friction and allow to air dry
•• Insert syringe into direct entry point of bag
and aspirate urine. The port will self-seal
when the syringe is withdrawn.
•• If direct syringe entry port is not available,
insert needle into entry port and aspirate
urine. The port will self-seal when the needle
is withdrawn
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45. Specimens for Culturing Should not
be Cultured from Urine bags
•Specimens should not
be collected from the
tap from the main
collecting chamber of
the catheter bag as
colonisation and
multiplication of
bacteria within the
stagnant urine or
around the drainage tap
may have occurred.


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46. Aspirating the urine with syringe and
Needle
•Aspirating urine from a
sampling port has
traditionally been
performed using a
syringe and needle.
However, needle-free
systems are
commercially available,
which may reduce the
risk of inoculation
injury.
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47. Contraindications for catheterization
•Foley catheters are contraindicated in the
presence of urethral trauma. Urethral injuries
may occur in patients with multisystem
injuries and pelvic factures, as well as straddle
impacts. If this is suspected, one must
perform a genital and rectal exam first. If one
finds blood at the meatus of the urethra, a
scrotal hematoma, a pelvic fracture, or a high
riding prostate then a high suspicion of
urethral tear is present.
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48. Epidemiology of urinary
catheterization
•Up to 25% of hospitalized patients
–urinary catheterization
•Catheter associated nosocomial UTI
–5% per day !
•Nosocomial UTI
–40% of nosocomial infection
•Bacteria ascend intraluminally into the bladder
– within 24 to 72 hours (from Harrison’s 16th)
•> 1 month of catheterization
–Nearly all will be bacteriuic
•Long-term (>30 days) and short-term (<30 days)
catheterization
•80% of patients with nosocomial UTI
–have an indwelling urinary catheter

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49. Women in labour Need
Catheterization

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50. Reminder for Appropriate Urinary
Catheter Use
•Avoid urinary catheter use if
not indicated
•Try to discontinue the
catheter promptly when not
needed
•The longer the catheter is
present, the higher the risk
of infection!
•The urinary drainage system
should always remain a
closed system

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51. Rapid draining leads to Complications
•Rapid drainage of large
volumes of urine from
the bladder may result
in hypotension and/or
haemorrhage.(Upson
1995) Clamp catheter if
the volume drained is
1000mls or greater.
After 20minutes release
the clamp and allow
urine to drain

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52. Repeat the Clamping when
volume is higher

• If the amount of
urine is 1000mls
or greater
repeat the
clamping
procedure.

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53. PROCEDURE FOR EMPTYING CATHETER
BAGS
•Use a clean jug large enough to avoid spillage
eg 2-3 litres.
•• After emptying the bag, wipe the end of the
catheter outlet with an alcohol swab.
•• Note the amount and colour of drainage –
record .
•• Empty jug carefully down the sluice to avoid
splashing
•• Place jug straight into sanitizer and store dry
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54. Constant evaluation to continue to use catheter
…….
•Both nurses and physicians
should evaluate the
indications for urinary
catheter utilization.
•Physicians should promptly
discontinue catheters that
are no longer needed.
•Nurses evaluating catheters
and finding no indication
should contact physician to
promptly discontinue
catheter.

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55. Important question when to remove
•Should we need to remove the urinary
catheter in 48~72 hours of smoothly post op
patients to reduce the rate of catheter
associated UTI? What’s the rate of catheter
associated UTI in 48~ 72 hours?
–Remove urinary catheter as soon as
possible!
–Rate of Bacteriuria in indwelling catheter
patient in 48 hours post-OP: average 24%
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56. Mannequins Recruited To Teach
Medicine

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57. Clean and Washed Hands Saves many Lives
from Complications of Catheterization

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58. For More Articles of Interest on
Infectious Diseases Visit Me …

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59. •Programme Created by Dr.T.V.Rao MD
for Medical Professionals Under the
Human Safety in Medical Care
•Email
•[email protected]
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