Maintaining Adequate Urinary Drainage

1. Maintaining Adequate Urinary Drainage

2. Urine clears the body of waste material • -aids in the balance of electrolytes • -conditions that interfere with urinary • drainage may create a health crisis • -important to re-establish urine flow as • soon as possible to prevent build up of • toxins in the bloodstream • -urinary catheters are used to maintain urine • flow, divert urine flow to facilitate healing • post-op and dilate or prevent narrowing of • some portion of the urinary tract

3. Catheters • - may be used for intermittent or continuous • drainage • -may be introduced into the bladder, ureter, or • kidney • -type and size determined by location and cause • of the urinary tract problem • -measured by the French system • -Urethral catheters range in size from 12Fr-24Fr • -Ureteralcatheter: 4FR-6Fr and always inserted by • the physician

4. Types of Catheters • -Coude’ -tapered tip, easier to insert when • enlarged prostate is suspected • -Foley -simple uretheral catheter, balloon near the • tip to anchor • -Malecot, Pezzer, or Mushroom –used to drain • urine from the renal pelvis of the kidney, can also • be used for suprapubic drainage • -Robinson –a straight catheter with multiple openings in the • tip to facilitate intermittent drainage • -Ureteral –long, slender catheter passed into the • ureter • -Whistle-tip –has a slanted, larger opening at its tip • to be used if blood is in the urine

5. Coude’ catheter • Robinson catheter • Ureteral catheter

7. -Cystostomy, Vesicostomy or suprapubic • catheter –inserted by the physician through • the abdominal wall above the symphysis • pubis; used to divert urine flow from the • urethra, is connected to a sterile closed • drainage system. • -External (Texas or condom0 catheter – • -drainage system connected to the penis • -noninvasive • -removed daily for cleaning and skin • inspection

8. Nursing Interventions and Patient Teaching • -Principle to prevent and detect infection and • trauma • Aseptic technique for insertion • Record I & O • Adequate hydration • Do not open drainage system after it is in place • except to irrigate the catheter per MD order. • Catheter care twice a day, inspect insertion site • Check system daily for leaks • Avoid placing the drainage bag above the level • of the bladder!

9. -Prevent tension on the system of backflow • wile transferring patient • -Ambulate the patient or turn and • reposition every 2 hours • -Observe characteristics of the urine • -Sterile specimen collected through the • drain port • -Report and record assessment findings

10. Self-Catherization • -Uses for spinal cord injury or other • neurological disorders • -Promotes independent function of the • patient. • -Instruct about surgical asepsis, however • at home there is less risk of cross- • contamination and patient will probably • use a modified clean technique • -Instruct in symptoms of UTIs

11. Bladder Training • -Developing the use of the muscles of the • perineum to improve voluntary control over • voiding • -In preparation for removal of a urethral • catheter, the p[physician may order a clamp/ • unclamp schedule to improve bladder tone • -Kegal exercises –tightening the muscles of the • perineal floor • -Voiding schedule may be established