Skill 29[1]..urinary Catheterization

71

SKILL 29

Urinary Catheterization

EQUIPMENT Catheter, straight or indwelling Urethral catheterization tray: Gloves, sterile Cotton balls and povidone-iodine or Betadine swab sticks or cleansing solution specified by agency policy Sterile, water-soluble lubricant 10 cc syringe, sterile Sterile water Light source Blanket Closed drainage system (for indwelling catheter) Catheter plug (for children going to X ray) Tape or other tube securing device RECOMMENDED SIZE AND TYPE OF CATHETER < 3 Kg 5 French feeding tube or straight catheter 3–8 Kg 5–8 French straight or indwelling catheter 8–11 Kg 8–10 French straight or indwelling catheter 11–14 Kg 10 French straight or indwelling catheter 14–24 Kg 10–12 French straight or indwelling catheter 24–32 Kg 12 French straight or indwelling catheter PROCEDURE 1. Check chart for order. 2. Gather equipment. Promotes organization and efficiency. 3. Wash hands. Reduces transmission of microorganisms. 4. Provide for privacy. 5. Explain procedure to child and family. Enhances cooperation and participation and reduces anxiety and fear. a. Explanation should include that povidone-iodine or cleansing solution may feel cold, as catheter is passed may feel urge to urinate, and deep breathing or “panting” will help to pass catheter. 6. Place child on back in a recumbent position. Place a chux or other protection under the child’s buttocks. 7. Adjust light source to provide maximum lighting. 8. If needed, put on nonsterile gloves and cleanse perineum of stool. Protects from contact with body fluids. Reduces risk of introducing fecal material into genitourinary tract. 9. Remove gloves. Wash hands. Reduces transmission of microorganisms. 10. Prepare sterile field maintaining strict aseptic technique. Open catheterization tray or sterile gloves, and drop sterile catheter and syringe onto sterile field.

11. Put on sterile gloves. Reduces transmission of microorganisms. 12. If using catheterization tray, unfold waterproof underpad and place under child’s buttocks. DO NOT contaminate gloves while doing this. 13. Prepare povidone-iodine or agency-prescribed cleansing solution and cotton balls or have asssistant open povidone-iodine swabs. 14. Open sterile lubricant. If lubricant not part of catheterization tray have assistant open and squeeze lubricant onto sterile field. 15. Maintaining sterile technique fill syringe with sterile water. NOTE: Some catheterization trays come with prefilled syringe. 16. Check catheter balloon prior to insertion by inflating and deflating it with sterile water. Ensures functioning of catheter. 17. Cleanse area and insert catheter. a. Male 1. Grasp shaft of penis gently but firmly with nondominant hand. This hand is now contaminated and stays in place throughout the procedure. A firm pressure rather than a light pressure helps avoid an erection. NOTE: Never catheterize a child with an erection. 2. Clean the meatus and then clean outward in a circular motion. Use each swab or cotton ball (generally held with forceps) only once. Be careful not to touch the penis with the sterile glove. NOTE: If child is uncircumcised retract the foreskin. Do not leave the foreskin retracted following the procedure. 3. Pick up the catheter with free (sterile) hand and lubricate the tip. 4. Hold the penis shaft perpendicular to the body and insert the catheter slowly and gently. 5. Insert the catheter to the hub. Ensures balloon will inflate in bladder, not in urethra. 6. Inflate the balloon with the recommended amount of water. b. Female 1. Separate labia using thumb and forefinger of nondominant hand. This hand is now contaminated and stays in place during the procedure.

continued Copyright © 2007 by Thomson Delmar Learning, a division of Thomson Learning, Inc. All rights reserved.

72

SKILL 29

Urinary Catheterization

2. Clean the labia and meatus from front to back using each swab or cotton ball (generally held with forceps) only once. Cleanse each side and then directly over the meatus. Be careful not to touch area with sterile glove. 3. Pick up the catheter with the free (sterile) hand and lubricate the tip. 4. Align catheter opposite the meatus and insert gently downward. 5. Insert to the hub. Ensures balloon will inflate in the bladder, not in urethra. 6. Inflate balloon with the recommended amount of water.

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DOCUMENTATION 1. Procedure and time done. 2. Size of catheter. 3. Amount of urine output. 4. Color and character of urine. 5. Child’s response and how tolerated.

18. Connect catheter to closed drainage system. 19. Attach drainage bag to bed below level of bladder and position catheter tubing in a loop on the bed. Promotes drainage of urine. 20. Secure catheter with tape or tube holder. a. Male: On abdomen or outer thigh. b. Female: Inner thigh. 21. Clean the perineum to remove all Betadine. 22. Make child comfortable. NOTE: The procedure for a straight catheterization (not indwelling) is the same as described above. However, the catheter is inserted only long enough to obtain a urine specimen or to completely drain the bladder.

Copyright © 2007 by Thomson Delmar Learning, a division of Thomson Learning, Inc. All rights reserved.