Urinary Catheter Types and Being Part of the Insertion Team

Slide 1: Urinary Catheter Types and Being Part of the Insertion Team

Slide 2: Learning Objectives

Upon completion of this session, licensed staff who insert or assist in the insertion of urinary catheters will be able to—

• Explain the similarities and differences between the four different types of urinary catheters;
• Prepare for and insert an indwelling urinary catheter using aseptic technique; and
• Summarize effective strategies in preventing CAUTIs.

Slide 3: Indwelling Urinary Catheters¹

Images: Figure l. Routes of entry of uropathogens to catheterized urinary tract.
An image depicts the male and female lower urinary tract system, and the difference in placement of a catheter in the bladder.

Source: Maki DG, Tambyah PA. Engineering out the risk of infection with urinary catheters. Emerg Infect Dis. 2001 Mar-Apr;7(2):342-7.
*CMS, State Operations Manual, 2014.

^1. Maki DG, Tambyah PA. Engineering out the risk for infection with urinary catheters. Emerg Infect Dis. 2001;7(2):342-7. PMID: 11294737.

Slide 4: Alternative Catheter Types

Straight Catheters

• Inserted directly into the urethra and bladder.
• Removed after insertion and drainage of bladder.
• Used intermittently.

Suprapubic Catheters

• Placed surgically directly through skin into the bladder.
• Connected by tubing to a bag used to collect and measure urine.

External "Condom" Catheters for Men

• Does not enter the bladder.
• Four different types to adhere to the penis.
• Connected by tubing used to collect and measure urine output.
• Cannot be used to treat acute urinary retention.

Slide 5: Quiz²

Which of the following are appropriate indications for placing an indwelling urinary catheter?

1. Bladder outlet obstruction
2. Urinary incontinence
3. Incontinence and sacral wound
4. Resident's request for end-of-life
5. Transferred from hospital with catheter

^2. Gould CV, Umscheid CA, Agarwal RK, et al. Centers for Disease Control and Prevention. Guidelines for prevention of catheter-associated urinary tract infections 2009. Atlanta, GA: US Department of Health and Human Services, CDC; 2009. Accessed January 28, 2016.

Slide 6: Preparing to Place an Indwelling Urinary Catheter

• Review the doctor's order and verify that the catheter is clinically indicated.
• Gather your catheter insertion kit and other supplies.
• Use the buddy system—get a second pair of hands to help!

Image: Section of AHRQ poster showing appropriate indications for a urinary catheter.

Slide 7: Catheter Insertion Kit Contents³

• Drape with opening, sterile gloves.
• Antiseptic solution for periurethral cleaning before insertion, swabs and tongs to use for applying antiseptic solution.
• Single-use packet of lubricant.
• Single-use dose of topical lidocaine jelly.
• Sterile urinary catheter, of smallest size effective for patient (14 or 16 French) connected to tubing and bag.
• Catheter securing device.

^3. Willson M, Wilde M, Webb M, et al. Nursing interventions to reduce the risk of catheter-associated urinary tract infection: part 2: staff education, monitoring, and care techniques. J Wound Ostomy Continence Nurs. 2009;36(2):137-54. PMID: 19287262.

Slide 8: Prepping for Catheter Insertion Procedure³

• Cleanse hands and don gloves
• Get your buddy to help at the bedside
• Place resident in the supine position
• For a female—apply topical lidocaine jelly if needed for comfort
• For a male—if uncircumcised, retract foreskin. Inject 10-15 mL of topical lidocaine into urethral meatus; gently pinch tip of penis for several minutes to retain lidocaine
• Inspect catheter kit and remove it from its outer packaging to form a sterile field
• Remove gloves and wash hands!

^3. Willson M, Wilde M, Webb M, et al. Nursing interventions to reduce the risk of catheter‐associated urinary tract infection: part 2: staff education, monitoring, and care techniques. J Wound Ostomy Continence Nurs. 2009;36(2):137-54. PMID: 19287262.

Slide 9: Hygiene and Standard PrecautionsCatheter Insertion Procedure^2,3

• Don sterile gloves.
• Cover resident's lower abdomen and upper thighs with dignity cover.
• Organize contents of tray on sterile field
  • Pour antiseptic solution over swabs in tray compartment.
  • Squeeze sterile catheter lubricant onto tray.

^2. Gould CV, Umscheid CA, Agarwal RK, et al. Centers for Disease Control and Prevention. Guidelines for prevention of catheter-associated urinary tract infections 2009. Atlanta, GA: US Department of Health and Human Services, CDC; 2009. Accessed January 28, 2016.
^3. Willson M, Wilde M, Webb M, et al. Nursing interventions to reduce the risk of catheter‐associated urinary tract infection: part 2: staff education, monitoring, and care techniques. J Wound Ostomy Continence Nurs. 2009;36(2):137-54. PMID: 19287262.

Slide 10: Male Catheter Insertion Procedure

• Using gloved nondominant hand, grasp penis taut and perpendicular to the plane of the resident's body.
• Cleanse the glans of penis using the antiseptic soaked swabs using tongs, in expanding circular motion. Discard used swabs away from sterile field.
• Keep nondominant hand in this position, do not remove!
• Lubricate tip of catheter with sterile lubricant jelly.
• Holding the coiled catheter in dominant hand, gently introduce the catheter tip into the urethral meatus.
  • If using coude catheter, point catheter tip upward to 12 o'clock position.
• Slowly advance the catheter through the urethra into the bladder. If substantial resistance is met, do not force the catheter!
• If tip of catheter is accidentally contaminated by touching anything that is not sterile, discard, and get a new one.

Slide 11: Female Catheter Insertion Procedure

• Using gloved nondominant hand, identify urethra by spreading the labia
  • Spread inner labia slightly with gentle traction and pull upwards toward resident's head.
  • Clean periurethral area and urethral opening using antiseptic soaked swabs using tongs, in expanding circular motion. Discard used swabs away from sterile field.
• Lubricate tip of catheter with sterile lubricant jelly.
• Holding the coiled catheter in dominant hand, gently introduce the catheter tip into the urethral meatus.
• Slowly advance the catheter through the urethra into the bladder. If substantial resistance is met, do not force the catheter!
• If catheter is accidentally contaminated by touching anything that is not sterile, discard, and get a new one.
• If catheter is accidentally inserted in to vagina, discard, and get a new one.

Slide 12: Securing Drainage Bag

• Advance tubing another 3-5 cm once you see urine in the tubing
  • Inflate balloon with 10 cc sterile water
• Once inflated, pull gently on catheter to make sure it's secure
• Secure catheter to medial thigh
• Place drainage bag below the level of the bladder
• Remove personal protective equipment and wash hands immediately

Slide 13: Insertion Avoiding Common Mistakes⁴

• Wash hands BEFORE and AFTER procedure
• Put on your sterile gloves after opening catheter kit
  • If sterile, gloved hand gets contaminated or glove rips, then remove glove, wash hands, and don NEW sterile gloves
• Sterile urinary catheters can get contaminated by touching labia, being inserted into vagina, or touching any other part of body besides cleansed urethra
  • If this happens, STOP procedure and get NEW sterile catheter to use
• Use tongs to cleanse the urethral area with your sterile hand
• Do not switch hands

^4. Manojlovich M, Saint S, Meddings J, et al. Indwelling urinary catheter insertion practices in the emergency department: an observational study. Infect Control Hosp Epidemiol. 2016;37(1):117-9. PMID: 26434781.

Slide 14: References

1. Maki DG, Tambyah PA. Engineering out the risk for infection with urinary catheters. Emerg Infect Dis. 2001;7(2):342-7. PMID: 11294737.
2. Gould CV, Umscheid CA, Agarwal RK, et al. Centers for Disease Control and Prevention. Guidelines for prevention of catheter-associated urinary tract infections 2009. Atlanta, GA: US Department of Health and Human Services, CDC; 2009. Accessed January 28, 2016.
3. Willson M, Wilde M, Webb M, et al. Nursing interventions to reduce the risk of catheter‐associated urinary tract infection: part 2: staff education, monitoring, and care techniques. J Wound Ostomy Continence Nurs. 2009;36(2):137-54. PMID: 19287262.
4. Manojlovich M, Saint S, Meddings J, et al. Indwelling urinary catheter insertion practices in the emergency department: an observational study. Infect Control Hosp Epidemiol. 2016;37(1):117-9. PMID: 26434781.