What Are the Key Considerations for the Procedure of Inserting a Urethral Catheter?

Catheterization, also known as urethral catheterization, is a procedure that involves inserting a catheter into the urethra to assist with urine drainage. This procedure is commonly performed on patients who have undergone surgery or are suffering from urethral diseases. Understanding the nursing methods and precautions during catheterization can help avoid common mistakes.

Here are some key points to consider during the catheterization process:

1. Strict aseptic technique: It is crucial to adhere to strict aseptic techniques during catheterization. If the catheter is inserted into the vagina or becomes dislodged, it should be immediately replaced.
2. Control of urine drainage speed and volume: The speed of urine drainage should not be too fast, and the catheter should be clamped after draining 600-800ml of urine.
3. Observation and recording of urine characteristics:
   • Normal urine output is 1500-2000ml/24h. Urine output greater than 2500ml/24h is considered polyuria, and less than 400ml/24h is oliguria. Less than 50ml/24h is anuria.
   • Normal urine color is transparent or pale yellow. Abnormal colors include bloody urine, hemoglobinuria, bilirubinuria, and chyluria.
   • The catheter should be properly secured and kept unobstructed. If blockage occurs, the catheter position should be checked and adjusted promptly. Repeated flushing with nitrofurantoin may be necessary, and the catheter may need to be replaced if necessary.
4. Prevention of urinary tract infections:
   • Routine bladder irrigation is not necessary; however, the urethral orifice should be wiped twice daily.
   • Early removal of the catheter is recommended when the patient's condition is stable.
   • Strict aseptic techniques should be followed, and the urine bag should be replaced daily.
   • For patients with long-term catheterization, the catheter should be replaced weekly.
   • Encourage patients to drink plenty of water during catheterization.
5. Bladder function exercises: Clamping the catheter regularly and releasing it every 3-4 hours (except when using dehydrating medications) can help with bladder function.
6. Prevention of urethral bleeding and leakage: Inserting the catheter too shallowly can cause urethral bleeding due to the balloon pressing against the posterior urethra. Therefore, the catheter should be inserted further until urine is visible, and then inflated or filled with water. The catheter should then be gently pulled out until it is fixed in place. This ensures that the balloon is positioned correctly within the urethral orifice, effectively preventing urethral bleeding or leakage.
7. Post-surgical and traumatic urethral injuries: For patients who have undergone prostate surgery or suffered traumatic urethral injuries, continuous irrigation for 2-3 days is recommended. Early attention to irrigation speed is crucial to prevent excessive bleeding from the surgical site. If the irrigation fluid is bright red, the irrigation speed should be increased to flush out the blood promptly while monitoring blood pressure changes. If there are blood clots or tissue debris blocking the catheter, gentle pressure can be applied to the tube to dislodge them. If this does not work, additional pressure can be applied to break up and expel the blood clots. For patients undergoing bladder surgery, the volume of irrigation fluid injected should not exceed 50ml, and the fluid should be completely withdrawn before reinjecting for repeated flushing.

By following these precautions and nursing methods during catheterization, patients can minimize the risk of complications and ensure a smoother recovery process.