Worried about catheterizing your patients in your first job as an RN? You're not alone! When new grads talk about nursing procedures that cause them anxiety, it's not necessarily the high-tech interventions that top the list. Instead, inserting a urinary catheter is one of the most dreaded experiences for novice nurses. Here are a few tips to improve your knowledge and strengthen your confidence.
In general, urinary catheters can be classified as straight catheters or indwelling catheters. Straight catheters have one lumen (opening) on the distal end of the catheter and are designed to be inserted into the bladder, kept in place briefly to drain the urine, and then be removed. Foley catheters are designed to remain in place in the bladder, so they have a separate lumen on the distal end for inflating a balloon that rests inside the bladder to hold the catheter in place. While most catheters are linear, coude catheters are designed with a slightly curved, tapered tip for men with prostate problems or a narrow urethra.
Urinary catheters may be made of silicone, latex, or Teflon and come in sizes known as French, varying from a 12 French (small) to an 18 French (large). Most commonly, nurses insert 14-18 French catheters in adults and 5-12 French in children, depending on the person's anatomy.
Before inserting a catheter, make sure you have the right type and size of catheter, and that you know the number of cc's of water the balloon is designed to hold.
Indications for Inserting a Urinary Catheter
There are a number of reasons to use urinary catheters, including:
- To collect sterile urine specimens
- To decompress the bladder
- To drain urine in patients with neurogenic bladders
- To accurately measure urinary output
- To introduce a patent opening into the urinary tract (e.g., in a man with benign prostatic hypertrophy)
- To improve hygiene in incontinent patients
|illustration by ADVANCE
Often, novice nurses feel embarrassed about procedures that involve the genital area, and may be worried about causing trauma to sensitive tissue. It's very helpful to prepare yourself well, explain the procedure to the patient before coming into the room with supplies, and remind yourself why the patient needs the catheter.
In addition, there's always the chance of inserting the catheter into a woman's vagina rather than the urethra. That's why it's important to know normal anatomy of the genital area and to identify landmarks such as the urethra, vagina, and anus. Proper positioning, with the woman lying on her back in a frog-leg position or with her knees flexed, is the key to success.
|illustration by ADVANCE
In men, the urinary meatus is easier to locate. In uncircumcised males, it may be necessary to retract the foreskin before the meatus is visible.
Before entering the patient's environment with an armload of equipment, take the time to sit with the patient and explain the procedure. Share the reason for inserting the catheter, describe the process and emphasize that the procedure may be slightly uncomfortable but should not cause pain.
Most healthcare facilities used packaged kits that contain some, or all, of the equipment and supplies needed for insertion of a urinary catheter. Make sure you have the following at hand before beginning the procedure:
- Sterile gloves and drapes
- Cleansing solution approved by the healthcare facility
- Cotton swabs
- Water-based lubricant or Xylocaine (lidocaine) gel
- Urinary catheter
- Collection container
- Sterile water (for indwelling catheters)
- Collection bag and tubing (for indwelling catheters)