Clinical Pearls: Practical Issues For Urinary Catheter Management, by Inpatient Nurse Practitioner
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Hi, my name is Vivien Williams, and I am the Inpatient Nurse Practitioner for the Department
of Urology at Boston Children's Hospital. Today we will be discussing clinical pearls:
how to manage issues related to the Foley catheter.
A Foley catheter system is comprised of two components, the urinary or Foley catheter,
which is inserted here within the urethra, as well as the urinary drainage bag. This
is typically connected to the side of the bed.
Securing the Urinary Catheter.
The catheter should be attached to the thigh or the abdomen in order to decrease meatal
necrosis, trauma, or skin breakdown. The site of securement should be rotated to prevent
skin breakdown. You should change the site every three days.
Always apply a layer of protection underneath the catheter in order to prevent skin breakdown.
Here we'll be using a 2x2 gauze underneath the tubing. We will then secure it with tape
or tegaderm as such.
If available, a catheter securing device can also be used to attach the Foley catheter
to the patient.
You must keep the collection bag below the level of the bladder. It is especially important
during transfers to be cognizant of where the bag is.
One of the most important pieces of assessing a catheter is to be sure there are no kinks
within the tubing. You must also be sure that within the environment there is nothing occluding
the tubing itself. The bag itself must be emptied every three to six hours or when it
is approximately one half to three quarters full.
Never allow this spigot and the non-sterile collection chamber to come into contact. You
also want to assess whether there is an airlock within the bag. In order to do this, you must
open up the bag and allow air to flow within the bag. Separate the front and back part
from the bag and see if this allows the urine to drain. Be sure to close the bag afterwards.
Troubleshooting Problems with Urinary Catheters.
What if there is tension on the urinary catheter?
Prior to securing the catheter, you always want to be sure that the catheter is not on
too much tension, as such, within the urethra. There should be a gentle loop of catheter,
which is secured in place, which does not tug or pull upon the urethra. Tension can
cause bladder spasm. If a patient is having consistent bladder spasm, you could consider
starting the patient on an antispasmotic. If there is tension, the catheter should be
What if there is decreased urine output?
You always want to assess that there is urine within the catheter. If there is no urine
and the patient says that they feel full, it is critical that you assess that there
are no kinks or occlusions within the catheter tubing. And then you could consider flushing
the catheter at the port site with normal saline. Keep in mind this is a sterile technique.
Thank you for watching Clinical Pearls, Care of the Patient with Issues with the Foley
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