Introduction Show
Aim Definition of Terms Indications Preparation Catheter size Procedure for insertion of urinary catheter Special precautions Documentation Ongoing nursing management Troubleshooting Removal of urinary catheter Complications Discharge information Companion documents References IntroductionInsertion of an indwelling urethral catheter (IDC) is an invasive procedure that should only be carried out using aseptic technique, Insertion of an indwelling urethral catheter (IDC) is an invasive procedure that should only be carried using aseptic technique, either by a nurse, or doctor if complications or difficulties with insertion are anticipated. Catheterisation of the urinary tract should only be done when there is a specific and adequate clinical indication, as it carries a risk of infection. AimTo ensure the insertion and care of the urinary catheter is carried out in a safe manner that minimises trauma and infection risks. Definition of terms
Indications
PreparationPreparation of the child and family
Preparation of Environment and EquipmentEnsure the patient’s privacy is maintained throughout the procedure and that they are kept warm. Ensure there is adequate light to perform the procedure. Prepare the following equipment:
Catheter sizeUse an appropriate size catheter
depending on the age of the child. Catheters that are too big or small are at risk of urethral trauma or leakage. The rational for IDC insertion should also be considered when selecting catheter, for example a patient requiring an IDC post kidney trauma may require a larger size to provide adequate drainage of potential blood clots. Consider silicone catheter if for long term use.
Procedure for insertion of urinary catheterThe need for an IDC should be discussed with the patients’ medical team prior to insertion. Medical approval for IDC insertion should be ordered and/or documented. The following should be completed in line with the RCH Aseptic Technique Procedure. Female child
Male child
If unable to pass the catheter seek assistance from treating medical team or Urology registrar. DO NOT use force as you may damage the urethra.
Special precautionsRapid drainage of large volumes of urine from the bladder may result in hypotension and/or haemorrhage. If concerned clamp catheter if the volume seems excessive. Release clamp after 20 minutes to allow more urine to drain. A medical review of the child should be requested. For post obstructive diuresis IV replacement of fluid and electrolytes may be required. This should be discussed with the treating medical team. DocumentationInsertion of the IDC should be documented in the LDA activity.
Ongoing nursing management
Drainage systemAdherence to a sterile continuously closed method of urinary drainage has been shown to markedly reduce the risk of acquiring a catheter associated infection. Therefore breaches to the closed system should be avoided. Consider changing the catheter tube and/or bag based on clinical indicators including infection,
contamination, obstruction or if system disconnects. If the equipment is damaged or leaks, replace system and/or catheter using aseptic technique and sterile equipment. Hygiene
Infection surveillance
Specimen collection
Troubleshooting
The following
techniques to check for patency and/or flush a catheter should be completed following the Aseptic Technique Procedure.
Catheter leaking
Removal of urinary catheterEquipment required for removal:
Procedure:
Complications
Discharge information
Companion documentsOther RCH IDC resources available:
References
Evidence tableIndwelling urinary catheter insertion and management evidence table Please remember to read the disclaimer. The development of this nursing guideline was coordinated by Liam Cunningham, RN, Day Medical Unit, and approved by the Nursing Clinical Effectiveness Committee. Updated September 2020.
What is the most common problem associated with indwelling catheter use?A urinary tract infection is the most common problem for people with an indwelling urinary catheter. Call your provider if you have signs of an infection, such as: Pain around your sides or lower back.
How can you prevent risk of infection in a patient with indwelling catheter?If you have an indwelling catheter, you must do these things to help prevent infection:. Clean around the catheter opening every day.. Clean the catheter with soap and water every day.. Clean your rectal area thoroughly after every bowel movement.. Keep your drainage bag lower than your bladder.. What are 3 interventions that could be implemented to reduce catheter related infection?ANA Initiative to Prevent CAUTI
There are three areas to improve evidence-based clinical care to reduce the rate of CAUTI: (1) prevention of inappropriate short-term catheter use, (2) nurse-driven timely removal of urinary catheters, and (3) urinary catheter care during placement.
What nursing interventions would you perform to prevent catheter associated urinary tract infections?Essential elements of a CAUTI prevention program include staff education, ongoing monitoring of CAUTI incidence, monitoring catheter insertion and ensuring prompt removal, and careful attention to techniques for catheterization and catheter care.
|