Indwelling urinary cathether maintenance

INDWELLING URINARY CATHETHER MAINTENANCE

Nikki Arana-Oquendo, NREMT-P. I/C

Universal Precautions

• Hand washing is the single most important thing you can do to protect your patient and yourself.

• If soap and water are not accessible, it is acceptable to use waterless hand gel.

• Waterless hand gel is not recommended/ effective for patients +Cdiff.

Anatomy of the Catheter

Correct Placement

Possible Complications

• Obstruction within the catheter• Kink of the catheter / obstruction• Leak around the catheter• Leak of the catheter or collection bag• Infection• Accidental extraction of catheter with the

balloon inflated

Obstruction Within the Catheter

• Usually clots, sometimes blood• Irrigation recommended• Not within EMS scope of practice• Obstructions are common in post surgical,

urological patients• Excessive bleeding is not common• Transport time >4 hours

Kink of the catheter / obstruction

• Check the catheter /tubing during transport• Check the connection between the catheter

and the urine collection system• Check the site where the foley is secured to

the patient

Leak around the catheterMost Common Causes

• Excessive strain• Leak in the balloon• Aged foley• Inappropriate solution used in balloon causing

balloon breakdown• Apply chux to patient, if >2 hour transport

contact receiving facility for direction• Keep the patient clean and dry

Leak of the catheter or collection bag

• Prior to leaving facility for transport, check the integrity of the catheter connection and collection bag

• If there is an issue have the staff address it before you leave, unless the transfer is a medical emergency (stat transfer).

Infection

• Common• Not to be addressed in the field setting, only

noted in the chart• Amount of urine, appearance of urine and

patient tolerance of catheter

Accidental extraction of catheter with the balloon inflated

• AMS• Expect bleeding• Contact receiving facility• Monitor blood loss• Do not attempt to replace foley unless advised

to do so• Extended transport times

Monitoring the Foley Catheter

• New Foley placement sometimes causes bladder spasm, pain, irritation

• Monitor output, >1000cc out clamp to prevent spasm

• Check foley securing device or secure the foley to the patient to prevent pulling of the catheter

• Make sure the urine collection area is clamped

Questions?