A. Purpose
1. For patients with urinary retention to drain out the urine to relieve pain. Such as after anesthesia surgery (bladder smooth muscle paralysis).
2. To assist in clinical diagnosis. Such as retaining uncontaminated urine specimens for bacterial culture (such as pyelonephritis); measuring bladder capacity, pressure and checking residual urine; urethra or cystography.
3. Before pelvic organs surgery, for the patient to export urine, empty the bladder, to avoid accidental injury during surgery.
4. Therapeutic role. Such as intravesical chemotherapy for bladder tumor patients.
Supplies and equipment
(A) Supplies
Treatment cart ----------------------------------------------------------- 1
Treatment tray -------------------------- --------------------------------- 1
Sterile catheterization kit ------------------------------------------------------ 1
Built-in: No. 10 catheter 1, No. 12 catheter 1, small medicine cup 1 (built-in cotton balls 4),
Treatment bowl 1 (for urine), curved tray 1, vascular forceps 2, liquid paraffin cotton ball bottle 1, hole towel 1, gauze 2, culture test tube 1
Sterilization kit (for vulvar cleansing) -------------------------------------------- 1
Built-in: treatment bowl (built-in cotton balls more than 10) 1, vascular forceps (or forceps) 1
5. Other --------------------------------------------------------- 1
Including: clean gloves (or disposable gloves) 1, sterile gloves 1, sterile holding Clamps and containers 1, pvp-iodine (containing 0.5% effective iodine) appropriate amount, curved disk 1, small rubber sheet and treatment towel 1 or disposable pads and towels 1, bath towels 1, commode and toilet towel 1, screen 1
(B) the type of catheter
1. single-lumen catheter for disposable catheterization.
2. double-lumen catheter for indwelling catheterization.
3. Triple-lumen catheter Used for bladder irrigation or to the bladder drug drops.
Three, the operating procedures
(a) preparation
1. Nurses prepare
(1) dress neatly, wash hands, wear masks.
(2) Understand the patient's condition, clinical diagnosis, and the purpose of catheterization; understand the patient's consciousness, vital signs, and psychological state. To determine the patient's degree of cooperation and understanding.
2. Preparation of materials
(1) The materials must be strictly sterile, carefully check whether the sterile catheterization kit is out of date, broken, wet, to ensure that the sterile items, to prevent urinary tract infections.
(2) Disposable catheterization is generally chosen as a single-lumen catheter. It is generally appropriate to use No. 10 or No. 12 catheter for adults, and No. 8 or No. 10 catheter for children.
(3) according to the need to prepare a complete set of supplies, placed in the upper level of the treatment car, the potty in the lower level of the treatment car, brought to the patient's bedside.
3. Patient preparation
(1) Check the patient's bed number, name and identify the patient.
(2) The nurse should explain to the patient and his family the purpose, significance, process and precautions of urinary catheterization, to eliminate the patient's nervousness and embarrassment of the psychology, in order to obtain cooperation.
(3) If the patient's vulvar secretion is more to wash the vulva, can take care of the patient will be asked to clean themselves, such as the patient can not take care of, the operator to assist the patient to wash the vulva. Keep the vulva clean, reduce the chance of retrograde infection of the urinary tract.
4. Environmental preparation
(1) The environment in the hospital room should be clean and quiet.
(2) Accompanying staff to leave the sick area.
(3) Close the doors and windows and regulate the room temperature to prevent the patient from catching cold.
(4) Cover the patient with a screen to maintain the patient's privacy.
(2) Clean the vulva
1. The operator stands on the patient's right side, helps the patient to take off the opposite side of the trouser leg, cover the near side of the leg with a bath towel, and cover the opposite side of the leg with a coverlet. Expose the patient as little as possible to reduce the patient's sense of embarrassment, and prevent the patient from getting cold.
2. The patient takes the supine bent-knee position, with both legs slightly outstretched, exposing the vulva. If the patient can not cooperate because of the condition of the patient, you can help the patient to maintain the appropriate position.
3. Put a small rubber sheet and therapeutic towels or disposable pads under the patient's buttocks to protect the sheets from moisture.
4. Place the curved tray next to the patient's vulva; open the vulvar disinfection kit on the treatment trolley, take out the small medicine cup and cotton balls, pour in pvp-iodine, soak the cotton balls, and place the treatment bowl behind the curved tray.
5. The left hand wearing gloves, the right hand holding vascular forceps to clip the cotton ball from the outside to the inside, from top to bottom, disinfection of the pubic mound, labia majora, followed by the left hand to separate the lips of the labia majora, in the same order to disinfect the labia minora and urethral orifice; stained cotton balls placed in the curved tray. When clamping the cotton ball, the center of the cotton ball should be clamped so that the cotton ball is wrapped around the tip of the clamp to avoid tissue damage during disinfection. Each cotton ball is limited to one time, to prevent contamination of the sterilized parts.
6. Disinfection is complete, take off the gloves and place them in the treatment bowl, move the bowl and the curved tray to the lower level of the treatment trolley, or move the curved tray to the end of the bed.
(C) disinfection of the vulva
1. Open the catheterization kit Between the legs of the patient, open the catheterization kit, with sterile holding forceps to unfold the catheterization kit inner layer of the therapeutic towel, in accordance with the order of operation of the treatment bowl containing a cotton ball placed in the sterile area near the side; pour pvp - iodine in the bowl, soaked with a cotton ball, to prevent the pouring of disinfectant across the sterile area.
2. Wear sterile gloves.
3. Lay out the tunic so that the tunic and the inner layer of the sterile catheterization wrap form a sterile zone.
4. Select a suitable catheter and a hemostatic forceps into the treatment bowl or curved tray, and lubricate the front end of the catheter with liquid paraffin cotton balls to facilitate insertion into the urethra and reduce irritation and injury.
5. The left hand to separate and fix the labia minora, the right hand clip pvp-iodine cotton balls from the urethral opening from the inside out, top to bottom sequentially disinfect the urethral opening and bilateral labia minora, and finally in the urethral opening to strengthen the disinfection of a time; the dirty cotton balls placed in the end of the bed in the curved tray. Each cotton ball is used only once to ensure that the disinfected area is not contaminated.
(D) insert the catheter (Figure 8-1)
1. The left hand continues to fix the labia minora not to release, not only to avoid contamination of the urethral orifice, but also fully expose the urethral orifice, to facilitate the insertion of the catheter.
2. The right hand places the sterile treatment bowl next to the opening of the cavernous towel.
3. Ask the patient to open his mouth and take deep breaths to relax the abdomen and perineum.
4. Use another vascular forceps to hold the catheter against the urethral opening and gently insert the urethra 4-6 cm, see the urine outflow and then inserted 1 cm or so, let go of the left hand, move down to fix the catheter.
Figure 8-1 Catheterization of female patient
(E) Exporting urine
1. Introduce urine into the treatment bowl or curved tray. After the bowl is full of urine, the end of the catheter can be clamped with vascular forceps and the urine can be poured into the potty, and then the catheter can be opened to continue to release urine. Pay attention to ask the patient's feeling and observe the patient's reaction.
2. If you need to do urine culture, use a sterile test tube to receive 5ml of urine, cover the bottle, and put it in a suitable place.
(F) pull out the catheter
1. After the catheterization, gently pull out the catheter, remove the hole towel, wipe the vulva.
2. Take off the gloves, set the catheterization bag, wrapped.
3. Remove the small rubber sheet under the patient's buttocks and the therapeutic towel, and place it on the lower level of the therapeutic trolley.
4. Assist the patient to put on pants.
(VII) finishing
1. Organize the bed unit to prevent the patient from catching a cold and keep the room tidy.
2. Cleaning up the supplies.
3. Measure the amount of urine.
4. Urine specimen labeled with a single test number and sent to the test.
5. Wash your hands.
6. Record the catheterization time, urine volume, urine color and nature, patient response.
Fourth, the precautions
1. Things must be strictly disinfected and sterilized, and in accordance with the principles of aseptic technology, to prevent retrograde infection of the urinary tract.
2. The female urethra is thin, and the urethra retracts due to the relaxation of perineal muscles in women and elderly women, which changes the position of the urethral opening, and the first-time operator can often insert the catheter into the vagina by mistake due to the lack of recognition of the urethral opening, so the operator should carefully identify the position of the urethral opening. Once the catheter is mistakenly inserted into the vagina, it is not allowed to insert the original catheter into the urethra immediately after pulling it out of the vagina, so as to avoid contamination of the urethra, so the catheter must be replaced and then re-inserted.
3. Choose a smooth and appropriate thickness of the catheter.
4. The catheter should be inserted gently, steadily and accurately, do not be rough to avoid damage to the urethral mucosa.
5. Urine culture specimens should be sent for examination in a timely manner.
6. When intubating, ask the patient to breathe with the mouth open, so that the abdominal muscles and urethral sphincter relaxation, which helps intubation.
7. If the urine drainage is not smooth, the patient's bladder area can be gently pressed with the hand to help the bladder to empty.
8. During the catheterization process, the patient is asked not to move the limbs, to maintain the original position, so as not to contaminate the sterile area.
9. If the bladder is highly distended, and the patient is extremely weak, the first release of urine should not be more than 1000ml, because a large amount of urine bladder pressure suddenly reduced, can lead to a sudden drop in intra-abdominal pressure, a large amount of blood stagnation in the abdominal cavity blood vessels lead to a drop in blood pressure caused by the collapse, and the other due to the sudden decompression of the bladder, bladder mucosa can be caused by rapid congestion, hematuria.