Scope of application Catheterization is to insert a catheter into the bladder under aseptic operation, which should be operated by medical personnel.
There are two kinds of catheterization in clinical application, one is not indwelling catheterization, and the other is indwelling catheterization. Which one to adopt depends on the purpose of catheterization. Non-indwelling catheterization is often used for temporary treatment or collection of urine samples, and the catheter is removed immediately after catheterization. Indwelling catheterization is often used to continuously drain urine or observe renal function, and the catheter needs to be fixed after being inserted into the bladder.
Comprehensive classification and characteristics The specific operation methods of urethral catheterization vary according to the physiological characteristics of men and women:
1? Non-indwelling catheterization:
① Preparation of articles before catheterization, sterile catheterization package -T set (one thick catheter, one thin catheter, two curved discs, two tweezers, two hole towels, two gauze pieces and a little cotton balls), one rubber blanket, one treatment towel and disinfectant (0? 1% bromogeramine or mercuric chloride), sterile lubricant, bedpan, etc. Do a good job in patients' ideological work before operation, relieve worries and get cooperation. Let the patient wash the vulva with soapy water. If the patient can't look after himself, the nurse can help him. Nurses should ask patients about urethral injury and urethral catheterization history.
② Specific operation methods for male patients with urethral catheterization:
I. The operator stands on the right side of the patient and the patient lies on his back. Take off his trousers to one third of his knees, cover his upper body to avoid unnecessary exposure, lay his legs flat and slightly separate, and put a blanket and a therapeutic towel under his hips.
Ⅱ Disinfect vulva. Hold the penis wrapped with gauze in your left hand and push the foreskin backward to expose the glans penis. Hold tweezers with bromogeramine cotton ball in your right hand, and wipe the glans penis, coronary sulcus, penis, pubic mound and scrotum skin from the urethral orifice for 2 ~ 3 times in a rotating motion.
ⅲ wear sterile gloves, spread a hole towel, lift the penis from below the coronary sulcus with the thumb, middle finger and ring finger of the left hand, and make an angle of 60 with the abdomen. Separate the urethral orifice with the index finger, and clamp the head end of the lubricating catheter with a vascular clamp or tweezers in the right hand for 5 cm. With the help of the fingers of the left hand, gently insert it from the urethral orifice for about 18 ~ 20 cm, and continue to insert it for 2 cm after the urine flows out.
Ⅳ After catheterization, pull out the catheter and let the patient rest.
③ Specific operation methods of female patients with urethral catheterization:
I prepare before catheterization.
Ⅱ. The performer stands on the right side of the patient and will be folded to the end of the bed. He will take off his right trouser leg and cover it on his left leg. A small blanket can be covered on his right leg, and then a blanket and a therapeutic towel can be placed under his hip.
ⅲ patients lie on their backs, bend their knees, fully expose vulva, and bend between their legs.
Ⅳ Disinfect vulva, clamp a new cotton ball with tweezers, and scrub it from urethral orifice, labia minora and labia majora in turn, and use cotton ball from top to bottom.
V Put on the sterile gloves, spread the hole towel, put the dressing bowl under the hole towel, open the gauze and fold it into a long strip, wrap it around the thumb and forefinger of the left hand in a figure of eight, and then fix the labia majora and labia minora separately. Hold tweezers with mercuric chloride cotton ball in your right hand, wipe both sides of urethral orifice from top to bottom, and then scrub with mercuric chloride cotton ball twice. When finished, remove the bent plate. Hold tweezers in your right hand, clamp the head end of the catheter lubricated with cotton ball 5 cm (put the tail end into the urine bottle) and aim at the urethral orifice, and slowly insert it about 4 ~ 6 cm. After seeing the urine flowing out, insert a little more to avoid the catheter coming out due to the patient's nervous breathing.
After catheterization, pull out the catheter, and then wipe the vulva with gauze to help the patient get dressed and rest.
1? Indwelling catheterization. When indwelling urethral catheterization, in addition to urethral catheterization, sterile glass nozzle, rubber drainage tube (about 65 cm long), urine storage bottle, therapeutic bowl, 200 ~ 300 ml physiological saline, irrigator, pin, adhesive tape and thin thread rope (for men) should be provided. The specific operation method is as follows:
(1) Shave off pubic hair, so that the catheter can be fixed with glue.
(2) According to the routine catheterization method. After the urine runs out, 60 ~ 80 ml of normal saline is sucked by the irrigator and injected into the bladder from the catheter. If the recovery is successful, the amount of liquid is basically equal to the injection amount, which shows that the catheter is in the right position in the bladder and can be fixed with adhesive tape.
③ Fixation method of male indwelling catheter: Fix the catheter on both sides of penis with butterfly-shaped adhesive tape, then gently wrap the adhesive tape to fix it, and tie the distal folded part of the catheter with a string. The fixing methods of female urinary catheter include: ligating the urinary catheter with string, fixing the distal end with adhesive tape or fixing it with adhesive tape in three directions.
(4) After the catheter is fixed, connect the catheter and drainage tube with a glass nozzle, and put the distal end into a urine storage bottle and hang it beside the bed.
⑤ Fix the drainage tube on the bed sheet with a pin, but keep a certain length to prevent the drainage tube from being pulled out of the urine storage bottle when the patient turns over.
⑥ When intermittent urination occurs, open the catheter regularly.
Matters needing attention in the process of catheterization:
I want to master the anatomical characteristics of male and female urethra. Male urethra is long and partly curved and narrow, especially when bladder neck muscles contract, which will make intubation difficult. Therefore, the intubation should be gentle, so that the patient can relax as much as possible, take a deep breath or pause for a moment before intubation, and don't forcibly insert it rudely or blindly, so as not to damage the urethral mucosa. The female urethra is short, so it is necessary to prevent the catheter from coming out. The urethral orifice is sagittal and above the vagina. Be sure to identify clearly when intubation, and don't insert the vagina by mistake. Once the catheter is inserted incorrectly or comes out, it should be replaced in time to prevent bacterial infection.
Ⅱ Strictly abide by the principle of aseptic operation and carefully disinfect to prevent secondary infection of urinary tract.
ⅲ. Patients with urinary retention should urinate in stages, and the first urination volume should not exceed 65,438 000 ml, so as to avoid sudden drop of intravesical pressure, leading to collapse, shock or other discomfort.
Ⅳ Before catheterization, we should pay attention to choosing a good catheter and check whether it is unobstructed and the thickness is appropriate. For patients with urethral stricture or urinary retention caused by prostatic hypertrophy, better quality catheter should be selected. When it is difficult to intubate, the pressure dilation intubation method can be used (that is, sterile paraffin oil 15 ~ 20 ml is injected into the urethra under pressure, and intubation is performed with urethral dilation).
If this method fails, a metal catheter can be considered.