Male Urinary Catheterization

Introductory group work

group 1. list the possible indications for catheterization in men

group 2. what equipment is required for the procedure

group 3. list some management principles/ interventions

group 4. list possible complications

aim

safe competent appropriate male catheterization

objectives

discuss the scope of professional practice document

list the indications for male catheterization

discuss the relative merits of using a particular type of catheter

discuss factors involved in choosing a particular catheter diameter

discuss the aims of management

list the stages of the procedure as carried out in the clinical setting

list possible complications of the procedure and how they may be prevented/minimised

Indications

to allow the nurse or patient artificial control over urination

to ensure urine drainage

facilitate accurate recording of urine production, eg. in shock

introduction of drugs

relieve retention

management of urinary incontinence, as a last resort

Equipment

plastic catheters, short term eg. post op, should only be passed by surgeons

coated latex, 2 - 12 weeks indwelling, depending on the coating

pure silicon and silicon coated, long term use over 2 months

catheter size, start off as small as possible, Ch 12 or 14, use larger diameters later as indicated

Ch 18 and Ch 20, just for haematuria

larger catheters, are associated with greater incidence of complications, even obstruction, than smaller ones.

size of balloon, 5 - 10 mls of water, 30 mls just for prostatectomy

Aims of management

maintenance of an unimpaired flow of urine

minimise/prevent any complications of the procedure

Management

prevent concentrated urine by a minimum of 2 000 mls of fluid per day.

minimise length of catheters and drainage tubes, prevent kinking

keep collection bag low

only wash out for specific indications

ensure closed drainage system

Procedure

* explanation to patient

* ensure privacy

* use apron

* wash hands

* prepare equipment

* position patient

* open pack and other sterile equipment

* wash hands

* put on two pairs of sterile gloves

* retract foreskin and clean the glans penis with soapy solution

* remove outer gloves

* extend sterile field using dressing towels

* wrap sterile towel round shaft of penis

* insert local anaesthetic gel

* wait for several minutes

* hold the base of the penis at an angle of approx 90`

* place catheter container between patients legs

* feed in catheter directly from its storage bag

* only touch catheter with sterile glove or forceps

* pass until urine flows out

* connect up drainage bag

* pass the catheter further in

* fill balloon with sterile water

* take CSU if required

* retract catheter gently until balloon rests at the top of the urethra

* return foreskin to normal position

* secure catheter and drainage tube to prevent tugging

* leave area dry

* dispose of all equipment minimising cross infection

* record urine type and volume

* record procedure in nursing records

Complications

urinary tract infection - keep system closed

bacterial ways in;

* via urethra during procedure

* via catheter lumen

* contamination during circuit breaking

* via the catheter/urethra junction

by-passing

* oversize catheter

* balloon size too big

* blockage

* bladder spasm

* UTI

pain, urgency, pressure sore, abscess, fistula

Safe Practice

Essential principles

* Asepsis

* Do not force the catheter if obstruction is felt, enlist medical help

* Ensure balloon is in the bladder cavity before inflating

* Return foreskin to normal position to prevent paraphimosis