catheterization

Indications

By inserting a Foley catheter, you are gaining access to the bladder and its
contents. Thus enabling you to drain bladder contents, decompress the
bladder, obtain a specimen, and introduce a passage into the GU tract.
This will allow you to treat urinary retention, and bladder outlet obstruction.

Urinary output is also a sensitive indicator of volume status and renal

perfusion (and thus tissue perfusion also).

In the emergency department, catheters can be used to aid in the diagnosis

of GU bleeding.

In some cases, as in urethral stricture or prostatic hypertrophy, insertion will

be difficult and early consultation with urology is essential.

Contraindications

Foley catheters are contraindicated in the presence of urethral trauma.

Urethral injuries may occur in patients with multisystem injuries and pelvic
factures, as well as straddle impacts. If this is suspected, one must perform
a genital and rectal exam first. If one finds blood at the meatus of the
urethra, a scrotal hematoma, a pelvic fracture, or a high riding prostate then
a high suspicion of urethral tear is present. One must then perform
retrograde urethrography (injecting 20 cc of contrast into the urethra)

Equipment

Sterile gloves - consider Universal Precautions

Sterile drapes
Cleansing solution e.g. Savlon
Cotton swabs
Forceps
Sterile water (usually 10 cc)
Foley catheter (usually 16-18 French)
Syringe (usually 10 cc)
Lubricant (water based jelly or xylocaine jelly)
Collection bag and tubing
Procedure

Insertion of an urinary catheter Insertion of an urinary catheter

in a female in a male

Review the female anatomy Review the male anatomy

in more detail in more detail

1. Gather equipment.
2. Explain procedure to the patient

3. Assist patient into supine position with legs spread and feet together
4. Open catheterization kit and catheter

5. Prepare sterile field, apply sterile gloves

6. Check balloon for patency.

7. Generously coat the distal portion (2-5 cm) of the catheter with
lubricant
8. Apply sterile drape
9. Apply sterile drape

10. If female, separate labia using non-dominant hand. If male, hold the
penis with the non-dominant hand. Maintain hand position until
preparing to inflate balloon.

11. Using dominant hand to handle forceps, cleanse peri-urethral mucosa

with cleansing solution. Cleanse anterior to posterior, inner to outer,
one swipe per swab, discard swab away from sterile field.

12. Pick up catheter with gloved (and still sterile) dominant hand. Hold
end of catheter loosely coiled in palm of dominant hand.

13. In the male, lift the penis to a position perpendicular to patient's body
and apply light upward traction (with non-dominant hand)

14. Identify the urinary meatus and gently insert until 1 to 2 inches
beyond where urine is noted
 15. Inflate balloon, using correct amount of sterile liquid (usually 10 cc but
check actual balloon size)

16. Gently pull catheter until inflation balloon is snug against bladder
neck

17. Connect catheter to drainage system

18. Secure catheter to abdomen or thigh, without tension on tubing

19. Secure catheter to abdomen or thigh, without tension on tubing

20. Place drainage bag below level of bladder

21. Evaluate catheter function and amount, color, odor, and quality of
urine

22. Remove gloves, dispose of equipment appropriately, wash hands

23. Document size of catheter inserted, amount of water in balloon,
patient's response to procedure, and assessment of urine

IV Cannulation
Indications
 Administration of fluids. Administration of fluids.
 Administration of medications. Administration of medications.
 Administration of blood or blood products. Administration of blood or
blood products.
 Radiological imaging using IV contrast

CONTRAINDICATIONS
 Sites close to infection ƒ ƒ
 Veins of fractured limbs
 Where there is an AV fistula present ƒ ƒ
 Oedema ƒ ƒ
  Affected side of CVA ƒ
 Side of Mastectomy Si
 Extra care to be taken on patients with bleeding, clotting
disorders & on warfarin.

Equipment
 Dressing Tray - ANTT
 Non Sterile Gloves / Apron
 Cleaning Wipes
 Gauze swab
 IV cannula (separate slide)
 Tourniquet
 Dressing to secure cannula
 Alcohol wipes
 Saline flush and sterile syringe or fluid to be
administered
 Sharps bin
Procedure
 Wash hands prepare equipment ANTT
 Remove the cannula from the packaging and
check all parts are operational
 Loosen the white cap and gently replace it
 Apply tourniquet
 Identify vein
  Clean the site over the vein with alcohol wipe,
allow to dry
NG TUBE
Indications
Diagnostic

 Evaluation of upper gastrointestinal (GI) bleed (ie, presence, volume)

 Aspiration of gastric fluid content
 Identification of the esophagus and stomach on a chest radiograph
 Administration of radiographic contrast to the GI tract

Therapeutic

 Gastric decompression, including maintenance of a decompressed state

after endotracheal intubation, often via the oropharynx
 Relief of symptoms and bowel rest in the setting of small-bowel obstruction
 Aspiration of gastric content from recent ingestion of toxic material
 Administration of medication
 Feeding
 Bowel irrigation

Contraindications
Absolute contraindications

 Severe midface trauma

 Recent nasal surgery

Relative contraindications

 Coagulation abnormality
 Esophageal varices or stricture
 Recent banding or cautery of esophageal varices
 Alkaline

Equipment
 All necessary equipment should be prepared, assembled and
available at the bedside prior to starting the NG tube. Basic
equipment includes:
 Personal protective equipment
NG/OG tube
Catheter tip irrigation 60ml syringe
Water-soluble lubricant, preferably 2% Xylocaine jelly
Adhesive tape
Low powered suction device OR Drainage bag
Stethoscope
Cup of water (if necessary)/ ice chips
Emesis basin
pH indicator strips

procedure
1. Gather equipment
2. Don non-sterile gloves
3. Explain the procedure to the patient and show equipment

4. If possible, sit patient upright for optimal neck/stomach alignment

5. Examine nostrils for deformity/obstructions to determine best side for

insertion
6. Measure tubing from bridge of nose to earlobe, then to the point
halfway between the end of the sternum and the navel

NAME SAGAL OMER OSMAN

IDNO 7695