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IMC vs IDC
- 1. Tele-Continuing Nurse Education conductedby GeriCare Topic: IMC vs IDC Date: 10 Jun 2019 Speaker: SSN Jocelyn Loke GeriCare Palliative Care Nurse
- 2. Administrative • Send yournursing home attendance and any feedback to: – [email protected] – Attendance with SNB No. Within 1 week • Next Tele-CNE Presentation will be: – Theme: Dementia Series – 8 Jul (Mon) 2019 @ 2.00 – 3.00 pm – By: Dementia Care Unit (Khoo Teck Puat Hospital)
- 3. IMC vs IDC INDICATIONSOF CATHETERIZATION
- 4. Objectives Give anoverview of urinary incontinence and retention of urine Identify appropriate cases for intermittent catheterization Determine cases not appropriate for IMC Follow the recommended guidelines on the insertion of IMC or IDC Provide nursing care plan
- 5. What Is UrinaryIncontinence? The involuntary leakage of urine. It is the inability to hold urine in the bladder because voluntary control over the urinary sphincter is either lost or weakened. When the pelvic floor muscles are weakened and cannot keep the urethra completely closed, stress incontinence occurs. Sudden pressure on the bladder may cause urine to leak out of the urethra. A cough or sneeze can trigger it
- 6. What is UrinaryRetention? is the inability to empty the bladder What causes Urinary Retention? Obstructive Non-obstructive Stroke Cancer Pelvic injury or trauma Kidney or bladder stones Vaginal childbirth Enlarged prostate (BPH) in men Impaired muscle or nerve function due to medication or anesthesia Accidents that injure the brain or spinal cord
- 7. Intermittent Catheterization The useof IMC is not appropriate for the following: have significant lower limb or truncal contractures hindering proper access to the perineum have significant behavioral problems preventing the procedure to be carried out smoothly and safely are terminally ill with difficult anatomy and/or poor perineal hygiene Prior to initiation of IMC, discuss with the NH DR exclude stool impaction
- 8. Requisites Disposable dressingset Sterile kidney dish Appropriate size catheter (Nelaton or Foley) Sterile gloves and Non sterile gloves Lubricant Gel Antiseptic solution 10mls syringe and WFI plastic ampoule Drainage bag Micropore tape Disposal bag
- 9. General Guidelines Random Bladder scan/ PVRU 200-299mls IMC BD (6am, 10pm) 300-399mls IMC TDS (6am, 2pm, 10pm) 400-499mls IMC QDS (2am, 6am, 2pm, 10pm) 500mls or more Insert IDC
- 10. Nursing Care Plans Whenon IDC: Provide daily cleansing of the urethral meatus with soap and water or perineal cleanser (following NHs policy) Ensure a closed drainage system Ensure no kinks or blockage occur in the tubing Secure the catheter tube to prevent urethra damage Urine bag should be emptied 3 to 4hourly or when 2/3 full Ensure clear bowels before trial off catheter
- 11. Nursing Care Plans Whenoff catheter or IMC: Monitor intake and output ( urinary frequency & bowel movement) Provide 2-4hourly potting Place call bell within reach at all times Instruct to call nurse when there is urge to void Limit fluid and caffeine intake 2-3hours prior to bed time Maintain skin integrity over perineal region
- 12.
Editor's Notes
- #6 What Is Urinary Incontinence? -is the involuntary leakage of urine; in simple terms, to wee when you don't intend to. It is the inability to hold urine in the bladder because voluntary control over the urinary sphincter is either lost or weakened. What causes Urinary Incontinence? -When the pelvic floor muscles are weakened and cannot keep the urethra completely closed, stress incontinence occurs. Sudden pressure on the bladder may cause urine to leak out of the urethra. A cough or sneeze can trigger it. The following can cause the pelvic floor muscles to lose some of their strength: Pregnancy. Childbirth (labor). Menopause - when estrogen levels drop the muscles may get weaker. A hysterectomy - surgical removal of the uterus (womb). Some other surgical procedures. Age. Obesity
- #7 Symptoms of urinary retention may include: Difficulty starting to urinate Difficulty fully emptying the bladder Weak dribble or stream of urine Loss of small amounts of urine during the day Inability to feel when bladder is full Increased abdominal pressure Lack of urge to urinate Strained efforts to push urine out of the bladder Frequent urination Nocturia (waking up more than two times at night to urinate)
- #9 Catheter size that are too big or small are at risk of urethral trauma or leakage. Also if there is a lot of sediments, shld choose a large size catheter. (Fr12/14 for clear urine, Fr16/18 for cloudy urine and Fr18 for blood clots. WFI instead of NS because NS can crystallise and render the balloon porous causing its deflation and the risk of catheter slipping out. The catheter shld be secured (by taping to the inner thigh) so as to minimise movement against the urethra ( which may lead to trauma and injury to the urethra).
- #10 Note: the frequency is based on the patient’s ability to void, post void residual urine and the impact of catherization on a patient’s quality of life. As a good role, the bladder volume should not exceed 500mls
- #11 Only insert IDC when necessary, and to remove as soon as possible.
- #12 Only insert IDC when necessary, and to remove as soon as possible.
- #13 PUBS is associated with gram-negative UTIs, but requires certain circumstances to occur It is most frequently seen in elderly, ill females ( though it also occurs in males) who tend to be chronically catheterized and constipated. Bacteria commonly grown in the urine culture in pts with PUBS includes Ecoli, proteus mirabilis, Klebsiella Pneumoniae, Enterococcus species, pseudomonas aeruginosa and others. If occur, can treat empirically with antibiotics or change IDC & urine bag