In the UK, 1 in 5 patients in hospitals and 1 in 14 in community care are catheterised, according to a publication by the NIH in 2017. Among those with long-term catheters in the community, 60% are men.
With the growing demand for catheterisation, many nurses will be needed to manage catheters now and in the future. So, having more trained nurses in important and also for nurses to fully understand their roles and duty. We can further look at one more stats.
In 2023, the global urinary catheters market was valued at $1.89 billion and is projected to reach $2.25 billion by 2030, reflecting the increasing need for skilled healthcare professionals in this area [ The Marketer’s Research, 2024].
Catheterisation is a common medical procedure that involves inserting a catheter into the bladder to drain urine.
Nurses play a crucial role in this process, from assessment and insertion to ongoing care and removal. This article explores the nurse’s responsibilities in catheterisation, ensuring patient safety and comfort throughout the process.
We’ll cover:
- Understanding catheterisation
- Types of catheters
- The nurse’s role before catheterisation
- The catheterisation procedure
- Post-catheterisation care
- Complications and troubleshooting
- Patient education
- Ethical considerations
- Documentation and record-keeping
Understanding Catheterisation
Catheterisation is the process of inserting a tube (catheter) through the urethra into the bladder to drain urine. It’s used for various reasons, including:
- Urinary retention
- Accurate urine output measurement
- Before, during, or after certain surgical procedures
- Management of incontinence in some cases
Nurses need to understand:
- The anatomy of the urinary system
- Indications for catheterisation
- Potential risks and complications
Types of Catheters
Nurses must certanly be knowledgeable about various kinds of catheters:
1. Indwelling (Foley) catheters
- Remain in the bladder for extended periods
- Have a balloon that’s inflated to keep the catheter in place
2. Intermittent catheters
- Inserted and removed after each use
- Used for short-term drainage
3. External catheters (condom catheters)
- Fit over the penis like a condom
- Used for urinary incontinence in men
4. Suprapubic catheters
- Put through the abdominal wall straight into the bladder
- Require surgical insertion
The Nurse’s Role Before Catheterisation
Before performing catheterisation, nurses have several important responsibilities:
1. Assessment
Nurses must:
- Review the patient’s medical history
- Assess the need for catheterisation
- Check for any contraindications (e.g., urethral trauma)
2. Informed consent
The nurse should:
- Explain the procedure to the patient
- Discuss potential risks and benefits
- Obtain and document informed consent
3. Preparation
This involves:
- Gathering necessary equipment
- Ensuring privacy
- Positioning the patient correctly
4. Infection prevention
Nurses must:
- Perform hand hygiene
- Use aseptic technique throughout the procedure
- Prepare the genital area with antiseptic solution
The Catheterisation Procedure
During the catheterisation procedure, the nurse’s role includes:
1. Maintaining aseptic technique
- Use sterile gloves and equipment
- Avoid contamination of sterile items
2. Insertion of the catheter
- Cleanse the urethral opening
- Insert the catheter gently, following the appropriate technique for male or female patients
- Advance the catheter until urine flows
3. Securing the catheter
For indwelling catheters:
- Inflate the balloon with sterile water
- Gently pull back to ensure proper placement
4. Connecting to drainage system
- Join the catheter to a sterile shut drainage program
- Guarantee the drainage case is below the level of the kidney
5. Patient comfort
- Assess the patient’s level of comfort all through the task
- Provide reassurance and explain each step
As a nurse, taking part in yearly catheterisation training improves your skills and keeps you updated on current procedures. Annual update training ensures you follow the latest guidelines and best practices in patient care.
Post-Catheterisation Care
After catheter insertion, the nurse’s responsibilities include:
1. Immediate post-procedure care
- Ensure proper catheter function (urine draining)
- Clean the perineal area
- Make the patient comfortable
2. Ongoing catheter care
- Perform daily perineal care
- Maintain a closed drainage system
- Empty the drainage bag regularly
3. Monitoring
- Check urine output and characteristics
- Evaluate for signals of illness and other difficulties
- Ensure the catheter remains secure and unobstructed
Complications and Troubleshooting
Nurses play a crucial role in identifying and managing catheter-related complications:
1. Urinary tract infections (UTIs)
- Monitor for signs of infection (fever, cloudy urine, pain)
- Obtain urine samples for culture if infection is suspected
- Administer prescribed antibiotics if needed
2. Blockage
- Check for kinks in the catheter or drainage tube
- Ensure proper hydration to prevent sediment build-up
- Perform bladder washouts if prescribed
3. Catheter displacement
- Assess catheter position regularly
- Reposition if necessary, following proper technique
- Replace the catheter if it has been completely dislodged
4. Bladder spasms
- Assess for causes (e.g., catheter irritation, infection)
- Administer prescribed antispasmodic medications if needed
5. Haematuria (blood in urine)
- Monitor the degree of bleeding
- Ensure adequate fluid intake to prevent clot formation
- Notify the medical team if bleeding is severe or persistent
Patient Education
Educating patients about catheter care is a crucial part of the nurse’s role:
1. Self-care instructions
Teach patients (or caregivers) to:
- Perform hand hygiene before and after touching the catheter
- Keep the genital area clean
- Maintain proper positioning of the drainage bag
2. Signs of complications
Educate patients to report:
- Pain or discomfort
- Signs of infection (fever, cloudy or smelly urine)
- No urine output for several hours
3. Lifestyle adjustments
Discuss:
- Fluid intake recommendations
- Activity levels and limitations
- Sexual activity considerations
Ethical Considerations
Nurses must navigate several ethical considerations in catheterisation:
1. Privacy and dignity
- Ensure patient privacy during the procedure
- Maintain the patient’s dignity throughout catheter care
2. Autonomy
- Regard the patient’s proper to create informed conclusions about their treatment
- Consider alternatives to catheterisation when appropriate
3. Beneficence and non-maleficence
- Weigh the benefits of catheterisation against potential risks
- Take steps to minimise harm (e.g., strict infection control measures)
Documentation and Record-Keeping
Proper documentation is essential for continuity of care:
1. Catheter insertion
Record:
- Date and time of insertion
- Type and size of catheter
- Reason for catheterisation
- Any difficulties during insertion
2. Ongoing care
Document:
- Daily catheter care performed
- Urine output and characteristics
- Patient’s response to having a catheter
3. Removal
Note:
- Date and time of removal
- Reason for removal
- Patient’s ability to void after removal
Catheter Removal
The nurse’s role in catheter removal includes:
1. Assessing readiness for removal
- Review the original reason for catheterisation
- Check if the patient meets criteria for catheter removal
2. Preparing the patient
- Explain the removal procedure
- Position the patient comfortably
3. Removing the catheter
- Deflate the balloon (for indwelling catheters)
- Gently remove the catheter
- Clean the perineal area
4. Post-removal care
- Monitor the patient’s ability to void
- Measure post-void residual if necessary
- Assess for complications (e.g., urinary retention)
Conclusion
The nurse’s role in catheterisation is multifaceted and crucial for patient safety and comfort. It encompasses:
- Assessment and preparation
- Skilled insertion technique
- Ongoing catheter care
- Complication prevention and management
- Patient education
- Ethical practice
- Accurate documentation
By fulfilling these responsibilities, nurses ensure that catheterisation is performed safely and effectively, minimising risks and promoting the best possible outcomes for patients.
Catheterisation, while a common procedure, requires careful attention to detail and a strong commitment to patient-centred care. Nurses must stay updated on best practices and guidelines to provide the highest standard of care in catheter management.
Remember, each patient’s needs are unique, and individualised care is essential. By combining technical skill with compassionate care, nurses play a vital role in making catheterisation as comfortable and safe as possible for patients.
