what is the appropriate size of a urinary catheter used for infants?

what is the appropriate size of a urinary catheter used for infants?

Introduction

Goal

You're reading: what is the appropriate size of a urinary catheter used for infants?

Definition of Phrases

Indications

Preparation

Catheter dimension

Process for insertion of urinary catheter

Particular precautions

Documentation

Ongoing nursing administration

Troubleshooting

Removing of urinary catheter

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Problems

Discharge info

Companion paperwork

References

Introduction

Insertion of an indwelling urethral catheter (IDC) is an invasive process that ought to solely be carried out utilizing aseptic approach, Insertion of an indwelling urethral catheter (IDC) is an invasive process that ought to solely be carried utilizing aseptic approach, both by a nurse, or physician if issues or difficulties with insertion are anticipated. Catheterisation of the urinary tract ought to solely be completed when there’s a particular and satisfactory medical indication, because it carries a danger of an infection.


Goal

To make sure the insertion and care of the urinary catheter is carried out in a secure method that minimises trauma and an infection dangers.


Definition of phrases

  • Indwelling Urinary Catheter (IDC): A catheter which is inserted into the bladder, by way of the urethra and stays in situ to empty urine.
  • Oliguric: a discount in urine output.
  • Paraphimosis: happens when the foreskin is left in a retracted place. The ache and swelling could make it troublesome to return the foreskin to the non-retracted place, this will likely scale back blood movement to the tip of the penis which if left untreated might result in necrosis of the glans penis.

Indications

  • To empty the bladder previous to, throughout, or after surgical procedure
  • For investigations
  • To precisely measure the urine output
  • To alleviate retention of urine
  • To alleviate urinary incontinence when no different means is sensible

Preparation

Preparation of the kid and household

  • Acquire affected person/major care givers consent for process
  • Households/major care givers must be given an intensive rationalization of the process. Contain the dad and mom the place potential when offering an age acceptable rationalization of the process to the affected person.
  • Think about the necessity for a referral to play remedy to help in explaining and making ready the affected person for the process. Play therapists are additionally capable of empower the kid to determine distraction strategies, in addition to present help and distraction all through the process.
  • Nursing workers ought to talk about and plan procedural ache administration with the kid and household previous to the process. This will likely embody non pharmalogical (together with distraction strategies) and pharmalogical issues together with Nitrous Oxide or sedation if essential. For extra info concerning this please see the Procedural Ache Administration guideline.

Preparation of Surroundings and Tools

Make sure the affected person’s privateness is maintained all through the process and that they’re stored heat. Guarantee there’s satisfactory gentle to carry out the process.

Put together the next gear:

  • Dressing trolley
  • Catheterization pack and drapes
  • Sterile gloves
  • Applicable dimension catheter (see catheter dimension guideline under)
  • Sterile Lubricant and/or Xylocaine jelly syringe (plain sterile lubricant for infants)
  • Sterile water to inflate balloon (regular saline can crystallise and render the balloon porous, inflicting its deflation and the danger of catheter loss)
  • 5ml/10ml Syringe – as said on catheter packaging
  • Specimen jar
  • Sterile regular saline
  • Straps/tape to safe catheter to leg
  • Drainage bag
  • Waterproof sheet

Catheter dimension

Use an acceptable dimension catheter relying on the age of the kid. Catheters which might be too massive or small are vulnerable to urethral trauma or leakage. The rational for IDC insertion also needs to be thought-about when deciding on catheter, for instance a affected person requiring an IDC put up kidney trauma could require a bigger dimension to supply satisfactory drainage of potential blood clots. Think about silicone catheter if for long run use.

Age Weight Foley Neonate <1200g 3.5 Fr umbilical catheter Neonate 1200-1500g 5 Fr umbilical catheter Neonate 1500-2500g 5 Fr umbilical catheter or dimension 6 Nelaton 0-6 months 3.5-7kg 6 1 12 months 10kg 6 – 8, ideally 8 2 years 12kg 8 3 years 14kg 8-10 5 years 18kg 10 6 years 21kg 10 8 years 27kg 10-12 12 years varies 12-14

Process for insertion of urinary catheter

The necessity for an IDC must be mentioned with the sufferers’ medical group previous to insertion. Medical approval for IDC insertion must be ordered and/or documented. The next must be accomplished consistent with the RCH Aseptic Approach Process.

Feminine youngster

  • Carry out hand hygiene
  • Place youngster in supine place with knees bent and hips flexed
  • If soiling evident, clear genital space with cleaning soap and water first
  • Carry out hand hygiene
  • Open dressing pack (aseptic discipline) and put together gear wanted utilizing aseptic approach
  • Pour sterile regular saline onto tray
  • Carry out aseptic hand wash and don sterile gloves
  • Apply sterile drapes/towel
  • Separate labia with one hand and expose urethral opening. In neonates, the urethral meatus is instantly above the hymeneal fringes.
  • Utilizing swabs held in forceps within the different hand clear the labial folds and the urethral opening. Transfer swab from above the urethral opening down in direction of the rectum. Discard swab after every urethral stroke into waste bag or designated waste space.
  • Take away catheter wire if a 6Fr catheter is used
  • Lubricate catheter
  • Insert catheter into the urethral opening, upward at roughly 30 diploma angle till urine begins to movement.
  • Inflate the balloon slowly utilizing sterile water to the amount advisable on the catheter. Test that youngster feels no ache. If there’s ache, it might point out the catheter is just not within the bladder. Deflate the balloon and insert the catheter additional into the bladder. ALWAYS guarantee urine is flowing earlier than inflating the balloon. Notice that in a toddler underneath 6 months a balloon is just not sometimes used. On this case be particularly conscious that strapping is safe.
  • Withdraw the catheter barely till resistance is felt and fasten to drainage system
  • Take away gloves and carry out hand hygiene
  • Safe the catheter to the thigh with both a catheter securement gadget or tape
  • Clear trolley and eliminate used articles into yellow biohazard bag
  • Carry out hand hygiene

Male youngster

  • Carry out hand hygiene
  • Place youngster in supine place
  • If soiling evident, clear genital space with cleaning soap and water first
  • Carry out hand hygiene
  • Open catheter pack (aseptic discipline) and put together gear wanted utilizing aseptic approach
  • Pour sterile saline onto tray
  • Carry out aseptic hand wash and don sterile gloves
  • Elevate the penis and retract the foreskin if non-circumcised. Don’t drive the foreskin again, particularly in infants. A sterile gauze swab can be utilized to carry the penis.
  • Utilizing different hand, clear the urethral opening with swabs held in forceps. Use a round movement from the urethral opening to the bottom of the penis. Discard swab into waste bag or designated waste space.
  • For boys older than 3 years insert the Xylocaine gel into the urethra. Gently maintain the urethra opening closed and wait 2 – 3 minutes to present the gel time to work. For infants apply sterile lubricant to catheter earlier than insertion. Publish urology surgical procedure think about using two syringes of xylocaine gel to extend lubrication of the urethra and reduce danger of trauma.
  • Take away the wire if utilizing a 6Fr catheter
  • Maintain the penis with slight upward pressure and perpendicular to the kid’s physique. Insert the catheter.
  • When the primary sphincter is reached (at degree of pelvic ground muscle mass) gently deliver the penis right down to face the kid’s toes, apply fixed light stress. If resistance is felt the next methods must be thought-about:
    • Take away the catheter and utilise a 2nd tube of lubricant
    • Enhance traction on penis and apply light stress on the catheter
    • Ask the kid to take a deep breath
    • Ask the kid to cough and bear down e.g. attempt to move urine
    • Gently rotate the catheter.

If unable to move the catheter search help from treating medical group or Urology registrar. DO NOT use drive as it’s possible you’ll harm the urethra.

  • Advance the catheter and gently insert it utterly into the urethra till the connection portion.
  • ALWAYS guarantee urine is flowing earlier than inflating the balloon.
  • Inflate the balloon slowly utilizing sterile water to the amount advisable on the catheter. Test that youngster feels no ache. If there’s ache, it might point out the catheter is just not within the bladder. Deflate the balloon and insert the catheter additional into the bladder. Notice that in a toddler underneath 6 months a balloon is just not sometimes used. On this case be particularly conscious that strapping is safe.
  • Withdraw the catheter barely until resistance is felt and fasten to drainage system
  • Reposition the foreskin if relevant
  • Take away gloves and carry out hand hygiene
  • Safe the catheter to the thigh with both catheter securement gadget or tape
  • Clear trolley and eliminate used articles into yellow biohazard bag
  • Carry out hand hygiene

Particular precautions

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Fast drainage of huge volumes of urine from the bladder could lead to hypotension and/or haemorrhage. If involved clamp catheter if the amount appears extreme. Launch clamp after 20 minutes to permit extra urine to empty. A medical evaluation of the kid must be requested.

For put up obstructive diuresis IV substitute of fluid and electrolytes could also be required. This must be mentioned with the treating medical group.

Documentation

Insertion of the IDC must be documented within the LDA exercise.

  • Together with catheter sort, size and dimension
  • Quantity of water instilled into balloon
  • Doc all procedures and cares involving IDC cares

Ongoing nursing administration

  • Measure urine output as indicated 1 – 4 hourly, assessing the color and focus of urine output.
  • Until in any other case specified by the treating group, regular paediatric urine output is 1-2ml/kg/hr. Report any variation from this to the treating medical group.
    • Sure medication will enhance diuresis, resembling diuretics and ACE inhibitors.
    • If oliguric guarantee catheter is just not blocked (see hassle capturing under).
    • File fluid steadiness. A fluid steadiness which retains the urine dilute will reduce the danger of an infection. This is probably not potential because of the medical situation of the kid.
  • The IDC insertion website and securement must be assessed not less than as soon as a shift, to make sure the IDC is just not pulling on the genitals and never twisted.
  • IDC drainage luggage must be emptied as soon as a shift at a minimal.
  • Place drainage bag to stop backflow of urine or contact with the ground. Gravity is necessary for drainage and prevention of urine backflow. Make sure the drainage bag is under the extent of the bladder, is just not kinked or twisted and is secured.

Drainage system

Adherence to a sterile constantly closed methodology of urinary drainage has been proven to markedly scale back the danger of buying a catheter related an infection. Due to this fact breaches to the closed system must be prevented.

Think about altering the catheter tube and/or bag based mostly on medical indicators together with an infection, contamination, obstruction or if system disconnects. If the gear is broken or leaks, exchange system and/or catheter utilizing aseptic approach and sterile gear.

Hygiene

  • Routine hygiene must be maintained with routine bathing/showering, together with every day clear IDC insertion website with heat soapy water and extra regularly if build-up of secretions is clear
  • Uncircumcised boys ought to have the foreskin gently eased down over the catheter after cleansing.
  • All the time test the strapping of the catheter is safe after hygiene is carried out.

An infection surveillance

  • Think about every day the necessity for the IDC to stay in situ. Take away as quickly as now not required to scale back danger of Urinary Tract An infection (UTI).
  • Cloudy, offensive smelling or unexplained blood stained urine is just not regular and desires additional investigation.

Specimen assortment

  • Urine for for urinalysis or tradition must be collected contemporary from the needleless sampling port of catheter tubing (not drainage bag), this must be accomplished consistent with the Aseptic Approach Process.
    • Clamp under the sampling level.
    • Scrub sampling level vigorously with 70% alcohol and chlorhexidine (0.5% or 2%) soaked gauze or swabs for not less than 15 seconds and permit to air dry
    • Entry port with a 10ml syringe to gather pattern
    • Unclamp catheter
  • Giant volumes e.g. 24hr assortment, could be collected from drainage bag.

Troubleshooting

  • Catheter not draining/ blocked/affected person oliguric
  • Test catheter/tubing not kinked
  • Test catheter continues to be secured to affected person leg and that it hasn’t migrated out of bladder
  • Assess affected person’s hydration standing to make sure they don’t seem to be dehydrated. Think about the necessity to carry out a bladder scan to evaluate bladder quantity. Escalate to medical group if involved.
  • The patency of a catheter could be checked by way of the sampling port or catheter tubing. A blocked catheter must be flushed by way of the catheter tubing, that is of specific significance in case of blood clots or mucus (for instance after a bladder increase).

The next strategies to test for patency and/or flush a catheter must be accomplished following the Aseptic Approach Process.

Checking catheter patency by way of Needleless Sampling Port Checking catheter patency and flushing by way of Catheter Tubing

  • Clamp catheter under the sampling level.
  • Scrub sampling level vigorously with 70% alcohol and chlorhexidine (0.5% or 2%) soaked gauze or swabs for not less than 15 seconds and permit to air dry previous to accessing port
  • Connect luer lock syringe and gently flush 10mls of regular saline into the catheter.
  • Pull again on the syringe to withdraw saline/urine.
  • If saline is just not coming again on suction, gently reinject 10mls of regular saline and let urine drain by itself with out sucking again on the syringe. It might be that the catheter tip is caught to the bladder wall. So make sure the saline is flushing simply and urine is subsequently flowing again by itself, with none suction.
  • At no time ought to drive be used to instil fluid when checking for patency or flushing a catheter.
  • Clamp catheter and disconnect the catheter bag.
  • Connect a catheter tipped syringe (Toomey Syringe) to the catheter tubing (the place the catheter bag has been disconnected) and gently flush 10mls of regular saline into the catheter.
  • Pull again on the syringe to withdraw saline/urine.
  • If saline is just not coming again on suction, gently reinject 10mls of regular saline and let urine drain by itself with out sucking again on the syringe. It might be that the catheter tip is caught to the bladder wall. So make sure the saline is flushing simply and urine is subsequently flowing again by itself, with none suction.
  • At no time ought to drive be used to instil fluid when checking for patency or flushing a catheter.
  • Think about attaching a brand new/clear drainage bag to the catheter.

Catheter leaking

  • Make sure the catheter continues to be draining and that the urine is just not overflowing round a blocked catheter. See above for suggestions concerning catheters not draining.
  • If the catheter is a balloon catheter, be certain the balloon continues to be inflated. Maintain the catheter tubing securely in the identical place and empty the balloon to verify the quantity that has been positioned initially within the balloon continues to be current. If not, reinflate the balloon to its preliminary quantity with water. Deflation of the balloon occurs simply with a 6Fr catheter.
  • Test catheter dimension is right for age/dimension of the kid. Use of a balloon catheter in neonates ought to solely be with session with the treating medical group.
  • Think about the necessity to take away and reinsert a brand new catheter in session with the treating medical group.

Removing of urinary catheter

Tools required for elimination:

  • Normal precaution PPE
  • 5ml/10ml Syringe – as said on catheter packaging
  • Waterproof sheet
  • Kidney dish / receiving container

Process:

  • Clarify process to youngster and household and achieve consent.
  • Test quantity of water used to inflate IDC balloon.
  • Collect gear required for elimination
  • Guarantee affected person privateness and have affected person in supine place.
  • Place waterproof sheet and/or kidney dish between affected person legs.
  • Carry out hand hygiene & don gloves.
  • Deflate balloon utterly and take away any straps/tapes
  • Gently withdraw catheter on exhale if potential, with rotation actions if essential.
    • Keep in mind that after inflated, the balloon gained’t deflate to its whole preliminary flat state and the balloon portion of the catheter will stay bigger than the catheter itself.
      • If resistance felt and catheter can’t be simply eliminated don’t drive, go away catheter in situ and seek the advice of medical group.
      • Think about slicing the catheter on the balloon inflation level to make sure the balloon is deflated.
      • As soon as eliminated examine catheter for intactness. Report if not intact.
  • Carry out hand hygiene.
  • Doc catheter elimination within the LDA exercise.
  • Observe for urine output put up catheter elimination.
  • If the affected person has not handed urine 6 – 8hours put up catheter elimination assess the affected person’s hydration standing and contemplate the necessity to carry out a bladder scan. Focus on findings with the treating medical group.

Problems

  • Lack of ability to catheterise: guarantee acceptable catheter dimension has been chosen based mostly on the age/dimension of the kid. Guarantee satisfactory procedural ache aid and distraction is in place in the course of the process.
    • Escalate to the treating medical group and contemplate the necessity for a referral to the urology group.
    • In younger ladies, the urethra could be troublesome to localise and the catheter can go straight within the vagina. On this case, go away the primary catheter within the vagina and use one other one to put instantly above, which will likely be extra more likely to go within the urethra.
  • Urethral damage could happen from trauma sustained throughout insertion or balloon inflation in incorrect place: it is extremely necessary to make sure the catheter is within the bladder earlier than inflating the balloon, this may be confirmed by visualising the stream of urine previous to balloon inflation.
  • Haemorrhage
  • False passage (catheter pushed by way of urethral wall): The danger of false passage is definitely greater when utilizing a smaller catheters, guarantee catheter dimension utilised is acceptable for youngster’s age and dimension.
  • Urethral strictures following harm to urethra. This can be a long run downside
  • An infection
    • To minimise danger of an infection insertion of IDC’s should be carried out utilizing surgical aseptic approach with single use sterile gloves.
    • Common hygiene must be maintained while IDC is in situ.
    • The place potential keep away from disconnecting the IDC circuit to minimise danger of contamination
    • Monitor for and report indicators of an infection together with fever, offensive smelling urine, unexplained blood or cloudy urine.
  • Psychological trauma
  • Paraphimosis resulting from failure to return foreskin to regular place following catheter insertion:
    • To minimise danger, keep in mind to interchange the foreskin to regular place in non-circumcised sufferers and test at catheter care or nappy change that the foreskin is in place.

Discharge info

  • Some kids will likely be discharged from the hospital with their IDC insitu. It is very important train the households the best way to take care of the catheter, the best way to carry out hygiene, the best way to monitor the output and the best way to troubleshoot. Consult with Youngsters Well being Information Reality Sheet: Indwelling urinary catheter


Companion paperwork

Different RCH IDC sources accessible:

  • Youngsters Well being Information Reality Sheet: Indwelling urinary catheter

  • RCH Educating and supporting clear intermittent catheterisation for fogeys and youngsters

References

  • Anderson, C., & Herring, R. (2019). Pediatric Nursing Interventions and Abilities. In M. Hockenberry, D. Wilson, & C. Rodgers (Eds.), Wong’s Nursing Care of Infants and Kids (pp. 701-704) St. Louis, Missouri: Elsevier.
  • Australia and New Zealand Urological Nurses Society, (2014). Catheterisation Scientific Tips
  • Australian Tips for the Prevention and Management of An infection in Healthcare (2019) pages 137-140 newurbanhabitat.com/guidelines-publications/cd33
  • Fasugba, O., Koerner, J., Mitchell, B. G., & Gardner, A. (2017). Systematic evaluation and meta-analysis of the effectiveness of antiseptic brokers for meatal cleansing within the prevention of catheter-associated urinary tract infections. Journal of Hospital An infection, 95(3), 233-242.
  • Galiczewski, J. M. (2017). An intervention to enhance the catheter related urinary tract an infection price in a medical intensive care unit: direct remark of catheter insertion process. Intensive Essential Care Nursing. 40:26-34. Intensive & Essential Care Nursing, 41, 2. newurbanhabitat.com/10.1016/j.iccn.2017.04.002
  • Gould, C., Umscheid,C., Agarwal,R., Kuntz,G., Pegues, D., & the Healthcare An infection Management Practices Advisory Committee (HICPAC). (2009) Guideline for prevention of catheter related urinary tract infections (2009) Up to date: June 6, 2019. newurbanhabitat.com/infectioncontrol/pdf/pointers/cauti-guidelines-H.pdf
  • Authorities of Western Australia Division of Well being (2015). Indwelling Catheter: Blockage. Scientific Guideline, Girls’s and New child Well being Service, King Edward Memorial Hospital.
  • Authorities of Western Australia Division of Well being. Urethral Catheterisation Neonatal Guideline. (2019).
  • Holroyd, S. (2019). Indwelling catheterisation: evidence-based follow. Journal of Group Nursing, 33(5), 40-46.
  • NHS Southern Well being, Urinary Catheter Care Tips (2020)
  • Pradhan, S. Ok., & Das, Ok. (2017). Urinary Bladder Catheterization. Sensible Procedures in Pediatric Nephrology, 4.
  • Royal Faculty of Nursing Catheter Care RCN Steerage for Healthcare Professionals (2019)
  • Rowe, J. (2020). Urinary catheter administration. Starship Hospital New Zealand.

Proof desk

Indwelling urinary catheter insertion and administration proof desk

Please keep in mind to learn the disclaimer.

The event of this nursing guideline was coordinated by Liam Cunningham, RN, Day Medical Unit, and authorised by the Nursing Scientific Effectiveness Committee. Up to date September 2020.

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