Download HERE

Basic procedures in healthcare 1
(SOL / VCA81)
TOPICS:
12a) Emptying of the bladder
12b) Urine sampling and its examination
12c) Bladder catheterization in women and men
12a) Emptying of the bladder
• urination
• factors affecting micturition
• diuresis
• fluid balance
• monitoring of urine (quantity, colour, odour… )
• urinary voiding disorders
12a) Emptying of the bladder
Urination (micturition)
The excretion of urine by the urinary system – kidneys, ureters,
urinary bladder and urethra.
12a) Emptying of the bladder
Factors affecting the micturition:
 growth and development,
 psychosocial factors,
 food and fluid intake,
 drugs,
 muscle tone,
 pathologies (hypertrophy of the prostate, kidney… ),
 surgery (e. g. cystoscopy… ).
12a) Emptying of the bladder
Diuresis
 the definitive amount of urine produced by the kidneys per unit
time (usually one day), an average of 1,5 liters per day,
 ↓ when the lack of fluids and renal impairment (compare to
anuria, oliguria),
 ↑ e. g. at increased fluid intake, diuretic and when DM (compare
to polyuria),
 the dieresis monitoring is important in many diseases and acute
conditions (shock, heart and renal failure with swelling and others).
12a) Emptying of the bladder
Fluid balance
- measuring and recording fluid intake and output over 24 hours,
 use urine bottles, bedpans,
sampling containers for urine
in case there is not introduced
peripheral urinary catheter,
 remember to write – infusion,
sauces, compotes, vomit,
waste drain, diarrhoea,
excessive sweating etc..
12a) Emptying of the bladder
Monitoring of urine – quantity
physiological quantity = 1000 – 2000ml / 24hrs
Disorders of urine:
polyuria – ↑ urine,
> than 3 000ml / 24 hrs
oliguria – ↓ urine,
100 - 500ml / 24 hrs
anuria – urine
< than 100ml / 24 hrs
12a) Emptying of the bladder
Monitoring of urine – colour
physiological – straw yellow,
 dark yellow, reddish = increased concentration of bile pigments,
 blood in the urine = haematuria,
 opacity = proteins, mucus, pus.
*
12a) Emptying of the bladder
Monitoring of urine - odour
fresh urine - an aromatic odour
older urine - sharp pungent odour
acetone - metabolic acidosis
indication urine papers
12a) Emptying of the bladder
Urinary voiding disorders
retention – urinary retention without the ability to emptying,
the arrest of urination
pollakiuria – frequent urge to urinate, accompanied by a small amount
of urine (frequent symptom of the urinary tract inflammation)
nocturia - increased frequency of urination at night
dysuria – pain during urination
stranguria – cutting, burning during urination
urgent urination – a strong sense of urgency with little urine
enuresis nocturna – bedwetting in older children
incontinence – spontaneous loss of urine
12b) Urine sampling and its examination
• general principles of urine sampling
• physical examination of urine
• specific weight of urine
• biochemical urinalysis
12b) Urine sampling and its examination
General principles of urine sampling
 usually morning urine is sampled,
 genital organs hygiene before sampling – washing the urethral orifice with
water,
 sampling into pre-labeled containers, clean, dry, sterile (should consider the
possibility of „staining“ with the container during sampling),
 properly completed requisition.
Specifics of sterile urine sampling
midstream of urine = it means first wash the genital by water, then urine
in a toilet part of the urine, catch the midstream into the sterile container
and the rest of urine pee in the toilet,
 urine obtained during catheterization.
12b) Urine sampling and its examination
Physical examination of urine
 the colour, turbidity, foam, odour, pH, specific weight is evaluated,
 physiological pH of urine – normal 5,0 - 7,0,
 aciduria – lower than 5,0,
 alkaluria – higher than 6,5 - 7,0.
Specific weight of urine - value 1,010 - 1,025g/cm3
 dependent on the amount of dissolved solids (especially chlorides, urea)
and the amount of discharged fluid,
 measurement in the morning with calibrated hydrometer (urometer),
 100 ml urine in graduated cylinder.
12b) Urine sampling and its examination
hydrometer
hydrometer in graduated cylinder
12b) Urine sampling and its examination
Biochemical urinalysis
 determination of values: protein, glucose, ketone bodies, bile
pigments, haemoglobin, amino acids, amylase, creatinine, inorganic
compounds, nitrogen balance, osmolality, hormone levels,
medications…
*
12b) Urine sampling and its examination
Biochemical urinalysis
 pyuria - pus in the urine,
 proteinuria - protein in the urine,
 glycosuria - carbohydrates in the urine,
 acetonurie - ketone bodies in the urine.
12b) Urine sampling and its examination
Individual biochemical examination methods:
 urinary sediment (urine + sediment),
 urinary sediment according to Hamburger,
 balance sampling for the waste ions, urea, uric acid, protein,
creatinine, glycosuria,
 Bence-Jones protein,
 creatinine clearance,
 oestriols,
 vanillylmandelic acid (VMA),
 toxicology urine examination.
12c) Bladder catheterization
• definition
• indication
• types of catheterization
• types of urinary catheters
• tools
• preparation of a patient
• single catheterization procedure of woman with simultaneous sampling of urine
for examination
• single catheterization procedure of man with simultaneous sampling of urine for
examination
• indications for the introducing of a permanent urinary catheter (PUC)
• tools
• procedure in introducing of PUC
• complication while introducing PUC
12c) Bladder catheterization
Catheterization - introducing a sterile catheter (catheter) through the urethra
into the bladder.
Indication:
 emptying the bladder when retention,
 emptying the bladder before the examination, surgery, parturition etc.,
 taking the sterile urine sample to test for cultivation and sensitivity,
 introducing of a permanent urinary catheter (PUC),
 detection of residual urine,
 bladder instillation (irrigation).
12c) Bladder catheterization
Types of catheterization
 Disposable - in order to release disposable bladder content
(the introduction of a catheter, drain urine, removal of catheter,
finish the procedure).
 Permanent – in order to
ensuring intermittent
and permanent urinary
diversion. Functional
character of catheters
corresponds with this purpose.
urinary catheters
12c) Bladder catheterization
Types of urethral catheters
a) Nelaton catheter - straight; used in children and women,
rarely in men,
b) Tiemann catheter - straight with curved conical beak;
used in men,
c) Foley catheter – permanent urinary catheter, most commonly
used for chronic urine drainage into a collection bag; plastic
or silicone; it includes balloon to fix urinary catheter, the balloon is
filled with saline.
The catheter must be sterile and not damaged. Catheters are
aseptically stored in a sealed plastic bag.
PUC marking - indicate the numbers expressing the girth and
average.
12c) Bladder catheterization
disposable catheter
12c) Bladder catheterization
disposable catheter
Nelaton catheter
Tiemann catheter
12c) Bladder catheterization
Permanent catheters
Foley catheters
12c) Bladder catheterization
Tools:
 permanent Foley catheter,
 saline 1/1,
 syringe according to the size of the balloon 5 - 20 ml,
 urine sampling bag, a sterile tube,
 sterile swabs, sterile tweezers,
 disinfectant solution for periurethral disinfection (Octenisept),
 lubricant and aesthetic, e. g. Mesocain gel, Instillagel,
 vomit bowls,
 disposable sterile gloves.
The possibility of using other tools according to the standards
and practices of staff.
12c) Bladder catheterization
Preparation of the patient
 familiarization with procedure,
 ensure privacy,
 appropriate position – on the back in a slightly raised
position, man's lower limbs lying in bed, woman´s
lower limb are bent at knees slightly apart from each
other,
 genital hygiene.
12c) Bladder catheterization
The procedure for a single catheterization of women with
simultaneous sampling urine tests:
 tools preparation,
 hygienic hand disinfection,
 the patient is lying on your back with bent lower limbs,
 inserting vomit bowls next to the legs of the patient,
 use of sterile gloves (or 1 glove on nondominant hand if we use
sterile tweezers to the genital disinfection),
 draping the genitals,
 disinfection of the urethral meatus,
 antiseptic swab hold in sterile tweezers and use it only once,
12c) Bladder catheterization
 open female labia with forefinger and thumb of one hand,
 with the second hand, in which
we hold sterile tweezers
with sterile swabs
and disinfectant,
we gradually disinfect
the orifice of urethra
and its surroundings
(3 swans – right, lest
side and centre),
 we disinfect always
in one direction – from
the top down (ventrodorsal)
– and we never go back!
disinfect the orifice of urethra
12c) Bladder catheterization
 we put used swabs into the vomit bowls,
 we remove the catheter from the prepared package,
 we use to removal either a sterile tweezers or the second nurse
helps us or we have everything prepared on the sterile surface,
 we apply Instillagel (Mezocain gel) on the tip of the catheter,
 we gently introduce the catheter into the bladder,
 we are introducing, until the urine starts leaking into vomit bowls
from the other end of the catheter,
 we let the first stream to drop into the vomit bowl, and then we let
the next one (midstream) flow into a sterile test tube,
 we let the rest of the urine to flow into the vomit bowls or bedpans.
12c) Bladder catheterization
 after bladder emptying, we gently pull the catheter from the
urethra,
 we dry the genital using swabs,
 we adjust the patient´s position and bed,
 we arrange cleaning
the tools,
 we send a urine
sample to the laboratory,
 we record it in
the documentation.
bladder catheterization on a model
12c) Bladder catheterization
The procedure for a single catheterization of men with
simultaneous sampling urine tests:
 a physician puts on sterile gloves,
 we prepare a tube for sampling urine, sterile tampon in a disinfectant
solution and sterile disposable catheter,
 we place vomit bowls in a bed of the patient,
 the physician pulls the foreskin and he disinfects opening of the urethra
using 3 swabs - a circular motion from the orifice of the urethra below,
 we prepare Instillagel or Mesocain gel,
 we give aseptically sterile urinary catheter to the physician,
 the physician pulls the curved end of the catheter in sterile swab with
prepared Mesocain (the physician applies Instillagel directly into the
orifice of the urethra),
Instillagel - gel in a sterile syringe with local anesthetic
and disinfectant antibacterial effect (for introducing of PUC)
12c) Bladder catheterization
 the physician slowly introduces a catheter into the urethra, the
leaking urine is caught in vomit bowls and bedpans,
 midstream urine is caught in a test tube,
 the rest of the urine is let to flow into the vomit bowls and bedpans,
 after emptying of the bladder, the physician gently pulls the catheter
from the urethra,
 we clean the urethral meatus from excess of lubricant,
 we adjust the position of a patient and the bed,
 we arrange cleaning the tools,
 we send a urine sample to the laboratory,
 we record it in the documentation.
bladder catheterization on a model
12c) Bladder catheterization
Indications of introduction of permanent catheter:
 urine retention,
 macro-haematuria (bleeding when bladder tumours,
prostatic adenoma, carcinoma),
 after cystoscopy,
 postoperative catheter introduction (prostate, bladder,
urethra surgery),
 measurement of diuresis (postoperative renal
insufficiency, cardiac decompensation).
12c) Bladder catheterization
Tools:
- the same as in single catheterization,
- plus:
- syringe,
- saline,
- collecting bag,
- hinge on the bed.
urine collection bag
with plastic hinge
12c) Bladder catheterization
Procedure for permanent catheterization:
 the same as when single catheterization,
 nurse assists to the doctor in the introduction of permanent catheter
in a male, another nurse assistance is possible when introducing
of permanent catheter in a female,
 it is appropriate to connect the catheter with collecting bag,
before the introduction of urinary catheter,
 after the introduction of urinary catheter, we drop all the urine and we
introduce the catheter by about 2,5 - 5 cm away from the place where
urine begins flow so we can fill the balloon with saline,
 we apply the saline with syringe (the amount of the catheter indications)
into the other catheter entrance which leads to the intravesical
end of the catheter,
 we perform a leak test by pulling urinary catheter – GENTLY!
12c) Bladder catheterization
 we communicate with the patient during a performance,
 dry genitals,
 adjust the bed
after the procedure,
 we arrange cleaning
the tools,
 we record it in
the documentation.
introduced catheter in men
12c) Bladder catheterization
 Videos
Single catheterization with the collection of urine tests:
- https://www.youtube.com/watch?v=vtZL2t7SP0w
Women catheterization with permanent urinary catheter:
- https://www.youtube.com/watch?v=R1gaOOJ5XgI
Removing the permanent urethral catheter:
- https://www.youtube.com/watch?v=vuH1fygkYsc
12c) Bladder catheterization
Complications of catheterization:
 infection when violation of the principles of antisepsis,
 traumatic damage to the urethra during rough introduction,
 inability to introduce the catheter due to urethral anomalies.
!!! IT IS NECESSARY TO FOLLOW THE PRINCIPLES
OF ANTISEPSIS DURING THE INTRODUCTION !!!
Revision:
 Name the defects of urine creation.
 How do we monitor the fluid balance?
 What are the guidelines we follow for the urine sampling?
 Name the type of bladder catheterization.
 What kinds of catheters do you know?
 List the tools to catheterization.
 List at least 3 indications for PUC introduction.
 Describe the single catheterization procedure of women.
 What complications can occur during catheterization?
 About what will you educate mobile patient with PUC?
*
Reference:
 MIKŠOVÁ, Zdeňka, Marie FROŇKOVÁ, Renáta HERNOVÁ a Marie ZAJÍČKOVÁ,
kapitoly z ošetřovatelské péče 1. Aktualiz. a dopl. vyd. Praha: Grada, 2006, 90s. ISBN
80-247-1442-6
 VELKÝ LÉKAŘSKÝ SLOVNÍK [online]. 2015 [cit. 2015-03-27]. Dostupné z:
www.lekarske.slovniky.cz
 VOŠ ZDRAVOTNICKÁ A STŘEDNÍ ZDRAVOTNICKÁ ŠKOLA HRADEC KRÁLOVÉ.
Ošetřovatelské postupy – zavedení permanentního katetru [online].2015 [cit.2015-0408]. Dostupné
z http://ose.zshk.cz/vyuka/osetrovatelske-postupy.aspx?id=15
 PICTURES * (if it is not stated differently): google.com (key words: „tubes“,
„urine for testing“, „catheters“… )