Surgical Technology Lecture
Series 2000©
Power-Point®
Content Outline
•
•
•
•
•
•
Laboratory Values of Urine
Indications for Catheterization
Catheterization Considerations
Necessary Supplies
Insertion Procedure
Output Monitoring
Quantity
• Normal urine output per day
– 1000 to 1500 ml
– Approximately 95% is H2O
– Output can vary greatly according to
•
•
•
•
Intake of fluid
Type and amount of food
Exercise
Kidney function
Quantity (continued)
• Abnormalities and indications
– Polyuria: diabetes (mellitus or insipidus),
nephritis, intake of diuretics such as caffeine
– Oliguria: nephritis, heart disease, fever,
diarrhea, vomiting, low fluid intake
– Anuria: uremia, acute nephritis, complete
obstruction of ureters or urethral opening from
bladder
Color
• Normal: yellow to
amber
– Depends on
concentration of the
pigment urochrome
• Abnormalities and
indications
– Milky or cloudy: pus
or fat globules
indicating a GU
infection, bacterial
sediment due to GU
infection
Color (continued)
– Red:
• Hematuria: urinary
obstruction, renal
calculi, tumor, renal
failure
• drugs or dyes used for
x-ray purposes
• food dyes
– Pale: diabetes insipidus
– Greenish-brown: bile
pigment due to
jaundice
– Black: poisoning,
hemorrhage
Odor
• Normal
– Faintly sweet, but not too strong
• Abnormalities and indications
– Strong sweet smell: acetone present associated
with diabetes mellitus
– Unpleasant smell: ingestion of a drug or certain
types of food
Composition
Proteinuria
• Albumin and globulin
– Normal: 10-100 mg excreted in the urine in
each 24 hour period
• Abnormalities and indications
– Albumin: renal disease, diabetes mellitus
– Globulin: renal disease, pyelonephritis
Sugar
• Normal
–0
• Abnormalities and indications
– Glycosuria: diabetes mellitus, high intake of
sugar
Ketones
• Normal
–0
• Abnormalities and indications
– Ketonuria: diabetic ketoacidosis, starvation,
eating disorders
Red Blood Cells
• Normal
– 0-4
• Abnormalities and
indications
– Hematuria due to
injury to kidney
White Blood Cells
• Normal
– 0-5
• Abnormalities and
indications
– UTI
Specific Gravity
• Definition
– Abbreviation sp gr
– Weight of a substance as compared to the equal
volume of water
– Water is the standard and has a sp gr of 1
• Normal
– 1.010 - 1.025
Specific Gravity (continued)
• Abnormalities and indications
– Low: dilution of urine, renal disease such as
nephritis, pituitary disease is suspected due to
decreased ADH
– High: acute nephritis, diabetes mellitus if urine
is light yellow in color
pH
• Review of pH scale
–
–
–
–
Neutral: 7
Less than 7: acid
More than 7: alkaline
Maximum acidity
(acidosis): 0
– Maximum alkalinity:
14
pH (continued)
• Normal
– 4.6 - 8.0
– average is 6.0
• Abnormalities and indications
– High acidity: acidosis, diabetes mellitus, fever,
starvation
– Alkaline: vegetarian diet, infection, ingestion of
alkaline compounds/products
Indications for Catheterization
• Specimen (typically done through clean
catch)
– A sterile specimen is needed for laboratory
analysis
• Decompression of bladder
– Decompress bladder to avoid injury to the
bladder during abdominal or pelvic surgery
• Monitor output
– Measure urine output pre-, intra-, and
postoperatively
Indications (continued)
• Incontinence
– Placed in surgical patient who has incontinence
prior to surgical procedure
– Placed in surgical patient who will possibly
have temporary incontinence after surgical
procedure
– Placed in surgical patient who will possibly
have permanent incontinence due to trauma
Indications (continued)
• Facilitate hemostasis
– Large balloon on indwelling catheter
compresses against bladder wall
– Aids in hemostasis after a TURP or other
surgery on GU tract structures
• Facilitate output and healing
– Facilitates output of urine after surgery on GU
tract structures
– Allows structures time to heal and regain
strength
Physician’s Order
• Know the physician’s
order
• straight catheter
vs. indwelling
catheter
• how long should
catheter be left in
place
• size of catheter
• type of catheter
Know the Anatomy
• Male anatomy
– Due to length of
urethra, it may curve
on its path from the
bladder to the urethral
meatus
• Curves may make
catheter insertion
difficult
– Lift penis vertically
and hold taught to
straighten any curves
when inserting catheter
Know the Anatomy (continued)
• Female anatomy
– Urethra much shorter
than male
– Urethral meatus
difficult to locate
– Must retract labia to
locate the urethra
– Due to shorter urethra,
females are more prone
to contracting a UTI
than a male
Positioning
• Male
– Supine
• Female
– Frog-leg(modified recumbent) position
– Place pillows under knees for support
Note: Catheterization is accomplished
before the patient is placed in the
surgical position
– Exception - lithotomy position
Lighting
• Recommended to have surgical lights
turned on and in position before placement
of catheter
– Aids in visualization of urethra, especially the
female
Sterile Technique
• Urinary catheterization is
a sterile procedure
• Strict sterile technique
must be followed to
prevent the patient from
experiencing a UTI
• Sterile gloves are worn
• Sterile, disposable
catheterization tray is used
Size of Catheter
• Review of French scale
– Abbreviation Fr
– System of measurement used to indicate the
outer diameter of catheters, dilators, and sounds
– Each unit of the Fr scale is equal to
approximately 1/3 mm
– Example: 21 Fr = 7 mm
Size of Catheter (continued)
• Adult
– Female
• Usually 14 Fr or 16 Fr
– Male
• Usually 16 Fr or 18 Fr
• Pediatric
– According to size of infant/child
– Smallest size available is 8 Fr
Types of Catheters
• Robinson catheter
– Also called red
Robinson, red rob, or
straight cath
– Non-retaining
– 1 or 2 holes at tip
– May be lubricated (KY Jelly®)
Types of Catheters (continued)
• Foley catheter
– Indwelling catheter
• 5 ml or 30 ml balloon
used to retain catheter
in bladder
– 5 ml used most
frequently; 10 ml
of sterile H20
required to inflate 5
ml balloon
– 30 ml used
postoperatively to
aid in achieving
bladder hemostasis
Types of Catheters (continued)
• Foley catheter (continued)
– 2-way Foley
• Lumen for filling and emptying the balloon
• Lumen for drainage (outflow)
– 3-way Foley
• Lumen for filling and emptying the balloon
• Lumen for drainage (outflow)
• Lumen for irrigation (inflow)
Foley Catheter Tray
• Sterile Foley catheter kit may contain
– Drapes
– Gloves
– Lubricant (K-Y Jelly®) may be in a small
packet or syringe
– Cotton balls or gauze
– Forceps
– Antiseptic solution (Betadine®)
Foley Catheter Tray (continued)
• Kit contents (continued)
– Foley catheter
– Drainage bag (may be pre-connected to
catheter)
– Sterile specimen cup with label
– 10 cc syringe prefilled with water
– Tape
Coude Catheter
• Non-retaining or
ballooned style
• Firm curved tip
– Used when urethra is
distorted (eg BPH)
Insertion Procedure
The following are the procedural steps for the
placement of an indwelling catheter in a
female
• Wash hands
• Position and expose patient
• Provide illumination
• Open catheter tray in a sterile manner
– Tray may be placed between the patient’s legs
Insertion Procedure (continued)
• Don sterile gloves using the open glove
technique
• Organize supplies within sterile field
– Attach syringe and inflate balloon with water to
check the integrity of the balloon
– Lubricate tip of catheter
– Prepare antiseptic solution and applicators
– Prepare specimen container (if needed)
– Connect catheter to drainage bag (if needed)
Insertion Procedure (continued)
• Use nondominant hand to retract the labia
• Cleanse meatus
– Antiseptic soaked applicator is grasped with
forceps in dominant hand
– Meatus is cleaned in an anterior to posterior
motion - applicator is discarded after use
– Repeat x 2
Insertion Procedure (continued)
• Insert catheter
– Grasp lubricated catheter near tip
– Insert catheter appropriate distance
– Observe urine flow
• May require application of external pressure
Insertion Procedure (continued)
• Inflate balloon
– DO NOT INFLATE BALLOON UNTIL
URINE FLOW IS CONFIRMED!!!
• If balloon is inflated before urine flow is confirmed,
it is possible that the catheter has not entered the
bladder and the balloon may damage the urethra
Insertion Procedure (continued)
• Position catheter
– Position catheter within bladder by gently
retracting any redundant tubing
– Position and secure the external tubing
• Tape to inner aspect of patient’s thigh
• Position drainage bag below the level of the bladder
to facilitate drainage
Insertion Procedure (continued)
• Care for patient and supplies as needed
–
–
–
–
–
Dry patient
Remove and discard unnecessary items
Remove soiled gloves
Reposition patient (if necessary)
Care for specimen (if necessary)
• Wash hands
• Document procedure
Insertion Procedure (continued)
CAUTION
• DO NOT raise the drainage bag above the
level of the bladder
– If drainage bag must be raised be sure to kink
or clamp tubing to prevent retrograde flow of
urine and prevent a UTI
– Care must be taken when moving the patient to
protect the catheter and drainage bag to avoid
injury to the urethra and avoid retrograde flow
Drainage Bag
• Graduated in ml’s to
estimate output
– Empty urine from bag
into graduated pitcher
for more accurate
measurement
– Make sure all urine has
passed from drainage
tube into the bag prior
to measurement
Urometer®
• Plastic container
attached to bag
– Graduated in ml’s
– Allows for more
accurate measurement
than bag
– Back of container has
opening to allow
excess urine to flow
into the bag
General Information
• Urine collection unit is emptied as needed
or just prior to transport to PACU
• Amount of urine excreted during surgery is
recorded prior to patient transported to
PACU
• Bag is again emptied and the amount
recorded prior to transport from PACU