MUNI UNIVERSITY
FACULTY OF HEALTH SCIENCE
DEPARTMENT OF NURSING AND MIDWIFERY
ADVAANCED CLINICAL NURSING
CU:5
NAME: OGERNRWOTH VICTOR
SUPERVISOR:MRS.AKAO GRACE
CONTACT.0772594948
STUDENT NUMBER 2001200677
EMAIL;[email protected]
URINE ELIMINATION/BLADDER
IRIGATION
OBJECTIVES
By the end of this lecture
Learners should be able define urinal, bladder irrigation and catheterization.
Demonstrate and illustrate giving and removal of urinal
Understand the indications, and steps in bladder irrigation
Explain the indications and illustrate catheterization
Meeting patients for urine elimination
GIVING URINAL
Urinal is a vessel for receiving urine
INDICATIONS
Used in patient who find it difficult to get out of bed
TYPES
Bowel
trough
Troughs and urinal
EQUIPMENTS
Urinal with end cover( usually attached)
Toilet tissue
Clean gloves
Additional PPE like aproans,gloves,etc
Procedure for giving urinals
Review the patient’s chart for any limitation in physical activities
Bring urinal and other necessary equipment to the bed side stand or over bed table
Perform hand hygiene and put on PPE if indicated
Identify the patient
Provide privacy
Discuss the procedure with the patient and assess the patient’s ability to assist
with the procedure as well as possible hygiene preferences
Put on gloves
Cont.
Assist the patient tom an appropriate position as necessary eg standing on bed
side, lying on one side or back
Cover the patient with the sheet
Removing the urinal
Perform hand hygiene, put on gloves and additional PPE.
Pull back the patient’s bed linen just enough to remove the urinal
Remove the urinal and cover the open end
Place urinal on the bed chair, if possible
Return the patient to a comfortable position
Make sure the linens under the patient is covered and dry
Ensure the call bell is in bench
Offer patient supplies to wash and dry his hands assisting as necessary
Cont.
Put on clean gloves, empty and clean the urinal, measuring the urine in graduated
container as necessary
Discard trash receptacle with used toilet paper per facility policy
remove gloves and additional PPE if used and perform hand hygiene
Document the patient’s tolerance of activities, record the amount of urine voided
on the intake output record, if possible record other unusual character or alteration
in patient’s skin
Bladder irrigation/flash out
This is the procedure used for instilling of a solution into a bladder to provide
cleansing or medication
It requires strict aseptic technique through out the procedure to minimize
contamination and subsequent development of a urinary UTI
cont.
INDICATION
Acute urinary retention
Chronic obstruction that cause Hydronephrosis
Hygienic care of bed ridden patients
Intermittent decompression of neurogenic bladder
Types of catheters
Indwelling catheter
External catheter (condom catheter)
Short term catheters (intermittent catheters)
Hazards of bladder irrigation
Urinary tract infection
Tissue trauma
Urethral irritation
Bladder spasms
Preparation
Use strict aseptic technique if intermittent irrigation is ordered
Medication may be added to irrigation solution
Isotonic irrigation solution are used
Check prescribers order to determine if it’s a continuous or intermittent irrigation
Special consideration
Assess bladder for distension because clots can occur
Assess patient for LAP or cramping
Perform manual irrigation as needed to remove clots reestablish irrigation flow
If resistance is met during manual irrigation do not force irrigation fluids. Notify
the prescriber .
Paedriatics,elderly,and mentally may need closer monitoring because the may not
be able to communicate effectively
Equipments
Clean gloves
Three way Foley catheter with drainage bag in place
Warmed or room temperature sterile irrigation solution.
Sterile infusion tubing
Iv pole
Procedure for irrigation
Review prescriber’s orders and obtain prescribed irrigation solution from
pharmacy,(unless solution is in place at bedside
Place label on irrigation bag if not labeled include all patient’s details
Including date,time,room number, type of solution.
Gather all equipment's
Check patients identification band
Explain procedure and its purpose to patients and provide privacy
Organize equipments within easy reach and drape patients, expose only the access to
irrigation part
Cont.
Don clean gloves and empty and empty, measure urine present in drainage bag
discard urine and gloves in appropriate receptacle
Wash hands
Hang irrigation bag on irrigation pole 24 to 36 inches above bladder
Connect infusion bladder to irrigation solution. Prime drip chamber and flush
tubing with solution.
Close infusion tube clamp and connect infusion tubing to irrigation port on the
three way catheter
Cont.
Open flow clamp on urinary drainage bag
Open flow clamp on infusion tubing and adjust the prescribed hourly rate
Change or add irrigation as needed
Maintaining aseptic technique
Change infusion tubing every 24hours to 48hours
Monitor urine output hourly as ordered, subtracting the amount of irrigant from
the total output from drainage bag
Assess drainage bag frequently and empty as needed
Assess color, clarity odor, and other characteristics of urinary output during
irrigation process and each time drainage bag is emptied
Discard gloves and urine in appropriate receptacle
Catheterization `
Indication for catheterization
Relieving urinary retention
Obtaining a sterile urinary specimen
Emptying the bladder before,during,after procedures
Monitoring renal function or critically ill patient
Increasing comfort for terminally ill patient
Incase of incontinence
To measure the amount of residual urine
Equipments
Top shelves
2 towels
1 drape
2 Receiver
Gauze swabs
Cotton wool swabs
2 galli pots
Bottom
Top shelves 2 Foley catheters of required sizes
2 towels Sterile ky Kelly
1 drape Antiseptic solution
2 Receiver 3 receiver
Gauze swabs Spigot and drainage bag
Cotton wool swabs Sterile surgical gloves
2 galli pots 20mls syringe and needles
Specimen bottle
Catheterization equipments cont.
Bottom Bed side
Plastic aprons Screen
Dressing mackintosh/towel Hand washing equipment
Sterile water Basin
Fluid balance chart Soap
Strapping Hand towel
Measuring jar
Steps in catheterization
Identify the patient
Discuss the procedure and his/her ability to assist
Discuss any allergies with Patients especially iodine and latex
Review the chart for any limitation in physical activity
Bring the catheter kit and other necessary to the bed side
Obtain an assistance
Perform hand hygiene
Provide privacy
Provide for good light
Cont.
Place a trash receptacles within easy reach
Raise the bed within the comfortable working height
Stand on the patients right if your right handed
Assist the patient to the dorsal recumbent with knee flexed, feet about 2 feet apart
with legs abducted
Open sterile catheterization tray on a clean over bed table using sterile technique
Put on sterile gloves
Grasp upper corners of the drape and unfold the drape with touching unsterile
areas
Cont.
Place the sterile drape over the perennial areas.
place the sterile receiver on the drape between the patient’s thigh
Lubricate the end of the catheter without contamination
Place the end of the catheter in the receiver using right glove and insert the
lubricated end gently into the urethra 4-5cm deep
Collect urine without bottle touching the catheter allow 30-40mls
Baloon the catheter with 15-20mls of sterile water
Assist open the urinary bag and plaace on sterile surface
Fix the catheter at inner aspect of the thigh with strapping
Thank the patient and put her in a comfortable position
Clear the trolley and screen
Observe the urine for color,smell,and deposits, odor and specific gravity
Document the procedure
Complication for catheterization
UTI
Urethral bleeding
Urethral stricture
Bladder stones
References
Clinical nursing skills seventh edition by Sandra F.,Smith, Donna J.
