Bladder catheterization with Nelaton catheter

Authors: Rednenko V.V., Rednenko L.I., Poplavets E.V.

Editor: Rednenko V.V.

Equipment for the practical skill:

• simulator (male and female for a  bladder catheterization 
• medical manipulation table
• disinfection table
• medical couch (bed)
• sterile Nelaton catheter (male or female) in a sterile package
• lubricant (sterile vaseline oil) in vial (boottle)
• an aqueous solution of chlorhexidine bigluconate 0.5 mg / ml in vials of 40 (80, 100, 200) ml
• Janet's syringe
• sterile gauze swab 10 * 10 cm in size - 1 pcs. individually packed
• sterile container for collecting (samling) urine (volume not less than 100 ml)
• non-sterile tray
• badpan
• waterproof sheet
• absorbent sheet
• sterile tray in the package
• waterproof apron
• sterile gloves
• non-sterile gloves
• skin anticeptic
• chemical agent for emergency disinfection of ampoules (vials), disinfection of the external surfaces of medical devices;
• medical waste container
  • "Empty vials"
  • "Packaging"
  • "Plastic"
  • for linen
• working solution of a chemical disinfectant in containers:
  • "Rinsing of MI"
  • "Disinfection of MI"
  • "Disinfection of dressings, PPE"
• medical records

Indications:

• excretion of urine with acute urinary retention (more than 6-12 hours)
• in the second stage of labor
• to collect urine for a menstrual laboratory test or for a bacteriological test
• before insertion of drugs into the bladder
• before bladder irrigation

Contraindications:

• injury to the urethra or bladder
• acute inflammation in the urethra or bladder

Clinical situation:

1. Patient A., a 57-year-old man, was admitted to the surgical department of the central district hospital with a diagnosis of prostate adenoma (benign bladder tumor). The patient has no urination during the day (acute urinary retention). The patient complains of frequent urination without the bladder emptying , severe pain in the lower abdomen, the genitals and perineum. Empty the bladder using a catheter
2. Patient A., a 35-year-old woman, was admitted to hospital treatment with a preliminary diagnosis of "Acute pyelonephritis, menses". The patient complains of general malaise, pain, discomfort in the lower back. To obtain urine for a test during menstruation, the patient needs a bladder catheterization using a urological catheter Nelaton.

Order of the skill performance:

Note. The actions indicated in this text, performed by the right hand, are performed by left-handers with the left

Preparatory stage:

• Identify the patient:
  • say hello to the patient, introduce yourself
  • specify the last name, first name and patronymic of the patient
  • check the patient's name with the prescription sheet
• Get informed consent for the procedure
  • inform the patient about the upcoming manipulation
  • get verbal consent for its implementation
  • instruct the patient about the need for hygienic flushing before bladder catheterization
• Check the equipment at the workplace:
  • check the integrity of the drug vials, the appearance of the drug, the expiration date
  • check the integrity of the packages of sterile medical instruments and sterile dressings, their expiration date
• Position the patient for the procedure
  • place a waterproof sheet on the couch with an absorbent sheet on top
  • invite the patient to remove the underwear from the lower half of the body and take a supine position with the legs bent at the knees and apart at the hips
  • place the badpan between the patient's legs
• Put on your protective equipment
  • put on an apron
  • put on your sleeves
  • perform hygienic handrub (see practical skill “Hygienic handrub”),
  • wear non-sterile gloves

Maine stage:

• Prepare equipment for external genital antiseptic
  • place the tray in front of you
  • open the package with sterile gauze swab
  • open the bottle with chlorhexidine bigluconate solution, take the bottle in your left hand, pour 1-2 ml of solution into the tray
  • take a gauze swab from the package with your right hand, moisten the gauze swab with a solution of chlorhexidine bigluconate, pouring from the bottle onto the gauze swab above the tray
• Give an antiseptic to the external genitalia
  • come to the patient

• • place the gauze in the container "Disinfection of dressings, PPE"
• Prepare catheterization equipment
  • remove gloves with the working surface inward and place in the container "Disinfection of dressing material, PPE" (see practical skill "Removing contaminated gloves")
  • perform hygienic handrub (see practical skill “Hygienic handrub”)
  • open the urine collection container for analysis
  • open the package with the catheter from the connector side to the middle
  • open the vaseline oil bottle
  • open and unfold the outer packaging of sterile gloves on the manipulation table without touching the inner packaging
  • perform hygienic handrub (see practical skill “Hygienic handrub”)
  • put on sterile gloves (see Practical Skill Putting on sterile gloves)
• Remove the catheter from the package
  • take the catheter package with your left hand

  • male	female
    place the proximal end of the catheter between the fourth and fifth fingers of your right hand pull the catheter out of the package intercept the catheter from below with the first and second fingers of the right hand at a distance of 3-4 cm from the distal end	place the proximal end of the catheter between the fourth and fifth fingers of your right hand pull the catheter out of the package intercept the catheter from above with the first and second fingers of the right hand at a distance of 3-4 cm from the distal end

  •  remove the package from the catheter with your left hand by placing the package on the top shelf of the manipulation table
• Lubricate the catheter
  • take a bottle of vaseline oil in your left hand
  • pour a few drops of oil into the tray
  • pour the distal end of the catheter with vaseline oil along the merged edge of the vial above the tray, without touching the catheter with the vial
  • put the vaseline oil bottle on the manipulation table
• Insert the catheter
  • ask the patient to start inserting the catheter

  • male

    female

    take the penis with your left hand between 3-4 fingers and the thumb and forefinger, lift the penis perpendicular to the anterior abdominal wall (vertically), lightly squeeze the glans near the opening of the urethra with the first and second fingers carefully insert the catheter into the opening of the urethra and advance the catheter along the urethra, intercepting each time at a distance of 3-4 cm from the glans penis and gradually lowering the penis down until urine is released through the catheter channel (keep the catheter sterile)

    with the first and second left hands, part the patient's labia carefully insert the catheter into the external opening of the urethra to a depth of 3-5 cm until urine appears

  • direct the proximal end of the catheter into the bed pan and, if necessary, collect urine for laboratory examination:
    • take the urine collection container with your left hand
    • guide the proximal end of the catheter into the container with your right hand
    • collect the amount of urine required for the test
    • guide the proximal end of the catheter into the tray with your right hand
  • place the container of urine with your left hand on the lower shelf of the treatment table
  • with prolonged urinary retention, release urine in portions of 200-300 ml, pinching the catheter for 1-2 minutes (if an overly distended bladder is emptied quickly, bleeding from the dilated veins of the bladder wall may occur)
• Remove the catheter
  • ask the patient about the end of the manipulation
  • carefully remove the catheter with your right hand, pressing the edge of the palm of your left hand over the patient's pubis
  • place the catheter in the "Rinsing of MI" container
• Complete the procedure
  • close the urine container
  • remove the badpan, put it under the couch
  • ask the patient about his health, ask to get dressed.

Final stage:

• when collecting urine for laboratory test, place a container of urine in a container for transporting samples of biological material
• remove gloves, place in container "Disinfection of dressing material, PPE", wash your hands (see practical skill "Hygienic hand washing")
• place a bottle of vaseline oil and a bottle with a solution of chlorhexidine bigluconate in a medical cabinet for storing medicines (if the vaseline oil or chlorhexidine in the bottle runs out, place an empty bottle with a lid in a container to collect empty bottles of medicines)
• inform the nurse about the need to pour urine from the vessel into the toilet, rinse the vessel with running water, deliver it to the place of disinfection
• place the packages from the MI into the container for collecting packages
• wear protective gloves
• remove the apron and place the disposable apron in the container "Disinfection of dressing material, PPE"; if using a reusable apron, disinfect the apron by wiping or sprinkling
• remove the sleeves, place in the container "Disinfection of dressing material, PPE"
• take Janet's syringe out of the package, remove the proximal end of the catheter from the MI flush container, attach Janet's syringe to the connector, rinse the catheter with Janet's syringe
• fill the canal of the catheter with a Janet syringe with a chemical disinfectant from the container "Disinfection MI"
• place Janet's catheter and syringe disassembled into the container "Disinfection MI"
• place the tray in the container "Disinfection MI"
• place the diaper from the couch into a container for collecting of linen
• place the oilcloth from the single-use couch into the container "Disinfection of dressing material, PPE"; when using reusable oilcloth, disinfect the oilcloth by irrigation or wiping
• carry out the subsequent stages of the disinfection of the medical device in accordance with the regulations
• remove gloves, place in the container "Disinfection of dressing material, PPE", carry out hygienic hand washing
• register the performed manipulation in the medical records.
• when collecting urine for laboratory research, arrange for the delivery of a container for transporting samples of biological material to the laboratory, enclosing a referral form for research in a separate package