Download Surgical Asepsis Urinary Care and Catheterization

Using Surgical Asepsis
Urinary Care and
Catheterization
Lesa McArdle, RN
Week 8 day 2
Asepsis
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Microorganisms
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These are tiny, usually microscopic, entities
capable of carrying on living processes.
They are naturally present on and in the
human body, as well as in the environment.
Many are harmless (nonpathogenic) and do
not produce disease in most individuals.
If an individual is highly susceptible to
infection, the nonpathogenic
microorganisms could be dangerous.
There are also known microorganisms
(pathogens) that do cause specific diseases
or infections.
Asepsis
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Infection Control
This consists of the policies and
procedures of a health care facility to
minimize the risk of the spread of
nosocomial or community-acquired
infections to patients and other staff
members.
 Control of infection is an important part
of every action the nurse performs.
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Asepsis
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Asepsis
Free of Pathogenic Microorganisms
 Medical Asepsis
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 Inhibits
growth and spread of pathogenic
microorganisms
 Clean technique
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Surgical Asepsis
 Destroys
all microorganisms and their spores
 Sterile technique
Infection Process
The chain of infection.
Nosocomial Infections
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Exogenous Infection
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Endogenous Infection
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Infection caused by microorganisms from
another person
Infection caused by the patient’s own
normal microorganisms becoming altered
and overgrowing or being transferred from
one body site to another
Nosocomial infections are most
commonly transmitted by direct contact
between health personnel and patients
or from patient to patient.
Handwashing
Performing a 2-minute handwashing.
This is the most important and basic
preventive technique for interrupting the
infectious process.
Handwashing
Performing a 2-minute handwashing.
Wash hands before patient care; after touching
blood, body fluids, secretions, excretions, and
contaminated items; immediately after gloves are
removed; between patient contacts; and when
otherwise indicated.
Surgical Asepsis
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This requires the absence of all
microorganisms, pathogens, and spores from
an object.
The nurse working with a sterile field or with
sterile equipment must understand that the
slightest break in technique results in
contamination.
This is practiced in the operating room, labor
and delivery area, and major diagnostic
areas, as well as at the patient’s bedside,
when inserting IV lines or urinary catheters,
or when reapplying sterile dressings.
Surgical Asepsis
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Explain what the patient can do to
avoid contaminating sterile items.
Avoid sudden movements of body parts
covered by sterile drapes.
 Refrain from touching sterile supplies,
drapes, or the nurse’s gloves and gown.
 Avoid coughing, sneezing, or talking
over a sterile area.
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Surgical Asepsis
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Principles of Sterile Technique
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A sterile object remains sterile only when touched by
another sterile object.
Only sterile objects may be placed on a sterile field.
A sterile object or field out of vision or an object held
below the waist is contaminated.
A sterile object or field becomes contaminated by
prolonged exposure to air.
When a sterile surface comes in contact with a wet,
contaminated surface, the sterile object or field
becomes contaminated.
Fluids flow in the direction of gravity.
The edge of the sterile field or container is considered
contaminated.
Surgical Asepsis
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Opening Sterile Packages
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Sterile items are placed in plastic or paper
containers that are impervious to
microorganisms as long as they are dry and
intact.
Reusable supplies may be wrapped in a
double thickness or in linen or muslin.
Sterile supplies have dated labels or
chemical tapes that indicate the date when
the sterilization expires.
If the integrity of the sterile package is
questionable, the item should not be used.
Surgical Asepsis
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Opening Sterile Packages
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Nurse performs a thorough handwashing.
The supplies are assembled at the work
area.
Commercially packaged items are usually
designed so that the nurse only has to tear
away or separate the paper or plastic cover.
The item is held in one hand while the
wrapper is pulled away with the other.
Care is taken to keep the inner contents
sterile before use.
Surgical Asepsis
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Preparing a Sterile Field
When performing sterile procedures, the
nurse needs a sterile work area that
provides room for handling and placing
of sterile items.
 A sterile field is an area that is free of
microorganisms and is prepared to
receive sterile items.
 The field may be prepared by using the
inner surface of a sterile wrapper or by
using a sterile drape.
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Creating a sterile field
Placing items on a sterile field
(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)
Surgical Asepsis
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Pouring Sterile Solutions
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A bottle containing a sterile solution is sterile on
the inside and contaminated on the outside;
the bottle’s neck is also contaminated, but the
inside of the bottle cap is considered sterile.
Before pouring the solution into the container,
the nurse pours a small amount (1 to 2 ml) into
a disposable cap or waste receptacle. This
cleans the lip of the bottle and is referred to as
“lipping.”
Pour the solution slowly to avoid splashing.
The bottle should be held outside the edge of
the sterile field.
Pouring Sterile Solutions
A, Nurse stands well back from
solution being poured into sterile
receptacle.
B, Receptacle receiving fluids is
placed near edge of sterile table.
Surgical Asepsis
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Donning Sterile Gloves
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Two Methods
 Open
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Used on general nursing divisions before
procedures such as dressing changes or urinary
catheter insertions
 Closed
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Performed when the nurses wear sterile gowns
and is practiced in operating rooms and special
treatment areas
Surgical Handwashing
Surgical Handwashing
Closed gloving
(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)
A, Grasp back of glove
cuff with non-dominant
hand, pull on with
dominant hand
B, Glove dominant
hand in same
manner
C, Keep hand in
sleeve and pull on
glove
Cleaning, Disinfection, and
Sterilization
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Cleaning
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This is the removal of all foreign materials, such
as soil and organic material, from objects.
It generally involves the use of water and
mechanical action with or without detergents.
Contaminated disposable objects are usually
discarded; reusable objects must be cleaned
thoroughly and then either disinfected or
sterilized.
When cleaning equipment that is contaminated
by organic material, the nurse applies a mask
and protective eyewear and waterproof gloves.
Cleaning, Disinfection, and
Sterilization
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Disinfection
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It is used to destroy
microorganisms, but
it does not destroy
spores.
Solutions used are
called disinfectants or
bactericidal solutions.
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They are too strong
for human skin and
are used only on
inanimate objects.
The nurse should use
clean gloves to
protect the skin.
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Sterilization
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Method used to kill all
microorganisms,
including spores
Two types
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Physical (uses heat or
radiation)
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Steam under pressure,
boiling water, radiation,
or dry heat
Chemical
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Gas
Chemical solutions
 Iodine, alcohol,
and chlorine bleach
Urinary Catheter Insertion
Standard Steps in Selected
Skills
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All nursing skills must include basic
steps for the safety and well-being of
the patient and the nurse.
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See Handout in your Skills Portfolio
Urinary care and catheterization
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Urinary Elimination
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This is a natural process that individuals
take for granted until it is altered by some
uncontrollable physiological factor.
Patients may require physiological and
psychological assistance from the nurse.
Physiological support may require the use
of an invasive procedure, such as insertion
of a urinary catheter into the bladder.
Psychological assistance may be needed to
help the patient adjust to a visible urine
collection drainage bag.
Urinary care and catheterization
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Catheter
This is a flexible tube that can be inserted into a vessel
or cavity of the body to withdraw or instill fluids.
 Most catheters are made of soft plastic or rubber.
 Catheters may be used for treatment or diagnosis.
 Catheterization of the bladder involves introducing a
urinary catheter through the meatus and urethra and
into the urinary bladder.
 Maintaining adequate urinary drainage
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Urinary catheters are used to
 Maintain urine flow
 Divert urine flow to facilitate healing postoperatively
 Introduce medications via irrigation
 Dilate or prevent narrowing of some portions of the
urinary tract
 May be used for intermittent or continuous drainage
Urinary care and catheterization
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Maintaining adequate urinary drainage
Urinary catheters may be introduced into the
bladder, ureter, or kidney.
 The type and size of urinary catheter used are
determined by the location and cause of the
urinary tract problem.
 Catheters are measured by the French system (Fr).
 Urethral catheters range in size from 14 to 24 Fr
for adult patients.
 Most commonly used size is 16 Fr
 Ureteral catheters are usually 4 to 6 Fr and are
must be inserted by a physician.
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Urinary care and catheterization
A. Simple Urinary Catheter
B. Mushroom or dePezzar
C. Winged tip or Malecot
D. Indwelling with balloon
E. Indwelling with Coude
tip or Tiemann
F. Three way indwelling
(for bladdder irrigation)
(From Lewis, S.M., Heitkemper, M.M., Dirksen, S.R. [2004]. Medical-surgical nursing: assessment and
management of clinical problems. [6th ed.]. St. Louis: Mosby.) Page 575 Foundations of Nursing
Different types of commonly used catheters.
Urinary care and catheterization
A, Condom catheter.
B, Condom catheter attached to leg
bag.
Urinary care and catheterization
(From Potter, P.A., Perry, A.G. [2003]. Basic nursing: essentials for practice. [5th ed.]. St. Louis: Mosby.)
Drainage system must be below the level of the bladder.
Urinary care and catheterization
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Self-Catheterization
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This is used for the patient who experiences
spinal cord injuries or other neurological
disorders that interfere with urinary
elimination.
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Intermittent self-catheterization promotes
independent function for the patient.
Urinary care and catheterization
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Routine Catheter Care
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Perineal care and the cleansing of the first 2 inches of
the catheter every 8 hours are expected at minimum.
The use of powders or lotions on perineum is
contraindicated.
Assess the urethral meatus and surrounding tissues
for inflammation, swelling, and discharge. Note
amount, color, odor, and consistency of discharge.
The urinary tubing and collection bag should be
changed only if there are signs of leakage, odor, or
sediment buildup.
Check the drainage tubing and bag to ensure that no
tubing loops hang below the level of the bladder, that
the tube is coiled and secured onto the bed linen, and
that the tube is not kinked or clamped.
Urinary care and catheterization
(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St.
Louis: Mosby.)
Empty and record urine output from urinary catheter into clean
graduated container.
Urinary care and catheterization
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Discontinuing an Indwelling Catheter
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An indwelling catheter must be removed or
changed after a certain period of time.
Urinary catheters are monitored for necessity
on a daily basis.
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Need for catheter must be documented daily.
It may be removed and replaced by a new
catheter or removed and the patient allowed to
excrete urine via the normal route.
Urinary care
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Bladder Training
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Involves developing the use
of the muscles of the
perineum to improve
voluntary control over
voiding; may be modified
for different problems.
In preparation for the
removal of a urethral
catheter, the physician may
order a clamp/unclamp
routine to improve bladder
tone.
For the patient with stress
incontinence, instruct to
perform Kegel exercises.
For habit training, a voiding
schedule is established.
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Managing Incontinence
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Urinary incontinence occurs
because pressure in the
bladder is too great or
because the sphincters are
too weak.
Kegel exercises
Bladder training
Disposable adult
undergarments or
underpads