Role of home care nursing for patients with urinary catheterization

What is Urinary Catheterization?

Urinary catheterization is a procedure in which a urinary catheter is inserted in the body to drain out or collect urine from the bladder.

Urinary catheterization is further of two types:

• Indwelling catheterization
• Clean intermittent catheterization or CIC

A catheter is a hollow tube which is available in three types:

• Indwelling catheters: This type of catheter resides in the bladder and is also known as a Foley catheter. It is used for both short and long duration. A nurse usually inserts this catheter into the bladder via the urethra. However, in some cases, it can be directly inserted into the bladder via a small hole in the abdomen and is termed as a suprapubic catheter. An indwelling catheter is changed mainly every six to eight weeks.
• External catheters: This catheter is placed outside the body and is also known as condom catheters. It is helpful for male patients with dementia issues or other serious mental problems instead of any urinary issues. This catheter looks like a condom that covers the head or top of the penis and a tube is connected with it which reaches the drainage bag. Such catheters are apparently more comfortable and easy to carry with lesser chances of infection. However, it has to be changed on a daily basis.
• Short-term catheters: A patient who requires a Cather for a short duration mainly to empty the bladder post-surgery is recommended with this one. It is also referred to as an intermittent catheter or in-and-out catheter since it has to be removed after the bladder empties completely. Usually, a caregiver or the patient himself is trained to use short-term catheters for the purpose of at home care. It can either be inserted via urethra or a created hole in the abdomen.

Why and when is Urinary Catheterization needed?

The urinary catheterization procedure is required to drain out the urine completely from the bladder. A doctor recommends using a catheter when a person cannot control when to urinate and experiences leaky urine or urinary incontinence in extreme cases of urinary retention.

Some of the problems which trigger urinary issues or requires urinary catheterization include:

• Urine flow obstruction or blockage due to blood clots or kidney stones or because of severe prostate gland enlargement
• The spinal injury also imposes the need for urinary catheterization
• Any sort of mental disability or problems like dementia also imposes catheterization need
• Any surgery in the genital area like a hip fracture, hysterectomy, an injury to the bladder nerves, etc.

The purpose of the catheterization procedure can vary from therapeutic reasons like relieving urinary retention, instilling the medication, or diagnostic reasons like for determining the etiology of the genitourinary conditions, etc.

Procedure for Urinary Catheterization

The main principle involved in the urinary catheterization is ideally gender-neutral, however, it has certain important aspects in terms of technicalities which are different in male and female patients. Both are described below individually:

In male: Catheterization procedure involves the insertion of a catheter which is a hollow tube along with an inflatable balloon at the edge. The entire procedure is performed for reliving any sort of urinary obstruction, mainly post-surgical procedures involving urethra. Catheterization is also done in unconscious patients post any sort of surgical anesthesia, cases of coma or any other severe disease conditions during which a bladder needs to be kept empty or decompressed without any obstruction in urine flow. The balloon edge helps in holding the catheter in place for long duration. The procedure of catheterization is a little more difficult and uncomfortable in the male in comparison to females due to the presence of longer urethra.

In female: A catheter in a female is inserted via meatus by holding labia apart. With a gentle push, a Cather is inserted nearly 3 inches deep until the urine starts coming out. Further, a catheter is inserted by 1 inch more and the position can be secured until all urine is passed out. Else if a urinary bag is attached it can be tapped with the leg to prevent leakage.Besides the purpose of immediate drainage by in and out procedure catheters can also be inserted for short-term drainage during or after procedures attaching with a self-retaining bag for the urine, or for long term drainage mainly in the elderly or bedridden patients with chronic urinary issues.
Age is not a constraint for any patient instead catheterization requirement is dependent upon disease condition or chronicity.

Care and Precautions during and after Urinary Catheterization It becomes very important to provide proper care and take every precautionary measure for a patient while on the catheterization process. For the caretaker or healthcare professional around the patient wearing gloves, and face protection becomes mandatory to avoid any spread of infection. Following things must be followed as precautions to ensure proper care:

• Both one-time use catheters, as well as reusable catheters, must be sterile or clean respectively before use to reduce UTI (urinary tract infection) risks.
• The body area must be cleaned properly before inserting the catheter.
• Drinking ample amount of water helps in keeping the urine clear and avoid infections.
• For leave-in catheters attached drainage bag to collect urine must be emptied every eight hours or prior if the bag is full.
• It is important to change the drainage bag to a leg bag after the shower and again back to the night bag before going to bed.
• The drainage bag must be kept at the level below the bladder level and hanging above the floor level.
• The catheter must be secured attaching it with the thigh to prevent any leakage during movement.
• Lying over the catheter must be prevented along with any blockage in urine flow in the tube.
• While changing the drainage bag ensure hands are clean both before and after the process. Also, ensure all connections are secure without twists and turns in the tube.
• Daily hygiene including daily shower is a must to keep the catheter clean.
• A professionally trained nurse or at home caretaker can help in preventing all sorts of infections during cauterization by proper care. Since they are trained in patient care and dealing with every sort of case scenarios.

Keeping the catheter clean is a part of the care and precautionary measure to prevent infections. Some steps can be followed for that:

• For self-cleaning of the catheter, it can be done during shower daily with the help of mild soap, water, and Cath-secure.
• To begin with wash your hands properly with soap and water.
• Using mild soap the genital area must also be cleaned including the urinary opening (urethra). For Men, retracting the foreskin if required and cleaning the whole area is important. For Women, Cleaning must be done from front to back after separating the labia.
• The tip of the catheter must be cleaned before inserting it inside. Holding it until it enters the body comfortably without building any tension or discomfort.
• Rinse the area with water and gently dry it. After t drying Cath-secure can be used to secure the catheter with the leg.

Role of home care nursing for patients with Urinary Catheterization

A patient is recommended with a particular catheter after a complete evaluation by the doctor. Although none of the catheterization processes is difficult to understand for a patient or a family member but a trained nurse or professional can help in a better way. At home service providers like Zorgers can help in getting a well-trained caretaker to look after your loved one dealing with catheterization.
Opting for an at-home caretaker in the form of a well-trained nurse to help a patient with urinary catheterization is the best and safest way to prevent all unwanted infections. During home nursing care entire responsibility of the patient complies with the hires professional. It enables the family to devote all time to the patient for moral support and comfort without stressing about technicalities and care of the catheterization process. A nurse does it all from changing catheters timely to check for any unwanted complications like:

• Any leakage around the catheter
• Presence of any fever or chills
• Any swelling or bleeding around the urethra or catheter
• Presence of any particular odor, stones, sediments, etc in the urine collected in the urinary bag
• Minimal or no drainage of urine collected in the urine bag even after the consumption of sufficient fluids.

Further, a nurse takes all sorts of precautions to prevent infections in the first place. However, infections do happen at times due to some complications. Hence, immediate treatment can be initiated upon consulting the doctor during home care if any signs or symptoms of infection or pain are observed, keeping the patient safe throughout the treatment.

Besides, a home care nurse also helps in all daily chores of the patient and cares for the patient in a professional though effective way. So home nursing care is not just beneficial for the family of the patient but is of utmost need to keep the patient in hands safe hands throughout even in the comfort of the home.