TOWN OF FAIRFIELD PUBLIC HEALTH NURSING

Transcription

1 TOWN OF FAIRFIELD PUBLIC HEALTH NURSING PROGRAM: School Health APPROVED BY: Board of Health School Medical Advisor POLICY & PROCEDURE: Clean Intermittent Catheterization DATE: 5/9/94 DEFINITION: POLICY Clean intermittent catheterization is the periodic emptying of urine from the bladder by means of a straight catheter using clean technique. PURPOSE: To remove urine from the bladder; to maintain renal and bladder health; to decrease the frequency of urinary tract infections, to provide social continence; to establish a bladder training program; to avoid the use of an indwelling catheter; to foster independence, and to maintain skin integrity. SCHOOL PERSONNEL WHO MAY APPROPRIATELY PROVIDE CARE OR ASSIST THE STUDENT: School Nurse, R.N., or L.P.N. CONSULTATION: Those responsible for providing care, training and supervision may need to obtain consultation from their clinical supervisor or from other health care providers in the community. DELEGATION DECISION: By the School Nurse. TRAINING AND SUPERVISION: To be determined/provided by the School Nurse. CIRCUMSTANCES WHICH REQUIRE SCHOOL NURSE ACTION: Evidence of change in urine consistency, clarity, color or odor; unusual pain; inability to insert catheter; allergic symptoms; inadequate urine output. PHYSICIAN S ORDER REQUIRED: Yes. PARENT/GUARDIAN PERMISSION REQUIRED: Yes. SPECIAL CONSIDERATIONS: 1. Allergy to latex products (including catheters, gloves, and balloons), especially in children with Myelodysplasia (Spina Bifida) is not uncommon. Symptoms range from rash and iticaria at the contact site to watery eyes, wheezing and respiratory distress. 2. If the student can perform self-catheterization, the school nurse can delegate general supervision of this procedure to a physical therapist, occupational therapist. occupational therapist, teacher, teacher aide, school health aide, or certified personnel. 2.

2 3. In children, a size 8-10 French catheter is usually appropriate. For a small infant, however, a size 5 French feeding tube may be used in lieu of a catheter. Older children and adolescents may require as large as a size 14 French catheter. 4.. For a student who requires intermittent urinary catheterization, the Individualized Health Care Plan should include: EQUIPMENT: - The student s medical diagnosis and possible complications arising from the condition or treatment. - The student s baseline GU status including urine color, amount, pattern of continence. - Usual position of student during catheterization. - Fostering independence in performing the procedure, depending on the student s ability. Provided by the parent: PROCEDURE a) Catheter (type and size prescribed by the physician). b) Water soluble lubricant for catheter tip. c) Towel to place under student if necessary. d) Calibrated container to collect and measure the urine. e) Storage containers for catheters. f) Storage container for other supplies. g) Mirror for teaching if applicable. h) Any other specialized equipment required for student. i) Cleaning equipment: soap and water, cotton balls. j) Paper towels. k) Plastic lined waste container. 1) Disposable gloves. m) Other personal protective equipment (gown, mask, goggles) if soiling or splattering is likely. 3.

3 STEPS: a) Provide an environment that is comfortable and provides total privacy. b) Reassure the student and explain each step of the procedure at the student s level of understanding. c) Wash your hands with soap and water. Put on gloves. d) If student is to participate in doing the procedure, have him wash his hands. Gloves are not needed for the student. e) Set our supplies. Squeeze lubricant onto tip of catheter. Placing catheter tip on clean paper towel. Put opposite end of catheter into collection container. For Male Catheterization: a) Position the student: He may be catheterized lying supine, standing, or sitting. If able, he may stand at the toilet. Assist student as needed with removal of pertinent clothing. b) Cleanse the penis in the following manner: Hold the penis below the glans. If the student is not circumcised, retract the foreskin enough to expose the meatus. Wash the glans with soapy cotton balls as follows: Begin at the urethal opening. In a circular manner, wash away from the meatus. Repeat twice. Use a clean cotton ball each time you wash the penis. (Always start at the meatus and wash toward the base of the penis so to remove bacteria away from the cleanest area.) Rinse off soapy residue with wet cotton balls. Assess the perineal area for redness, swelling, skin eruptions, discharge, or unusual odor. b) Lift the penis perpendicular to the body to straighten the urethra. d) Tell the student when you are going to insert the catheter. Locate the meatus. Ask student to breathe deeply. Hold the tip of the penis erect and insert the catheter gently into the meatus. Some resistance may be met at the bladder sphincter. As student to breathe deeply again and continue insertion using gently but firm pressure. Do not force catheter. If pain or unusual resistance occurs, stop the procedure, withdraw catheter, and notify the parent and physician. c) Insert the catheter until there is a good flow or urine. When the flow stops, insert the catheter Slightly more and then withdraw a little to make sure all urine is drained. Rotate the catheter Gently so that the catheter openings have reached all areas of the bladder. (It is also helpful to have the child bear down a couple of times while the catheter is in place.) Some students may require manual crede of the bladder to aid emptying this must be ordered by the physician. c) When the bladder is empty, pinch catheter and gently withdraw. d) If the student is not circumcised, pull the foreskin over the glans after the catheter is removed. c) Assist student as needed to redress. 4.

4 For Female Catheterization a) Position the student. She may be catheterized lying supine or sitting with legs fixed at hips and Knees. If able, she may sit on the toilet with legs straddled. A female student who cannot lie supine or sit for the procedure may be placed in a side-lying position with the upper leg drawn up in a knee-chest position. b) With one hand, separate the labia and hold open with fingers. With the other hand, cleanse with Soapy cotton balls in a direction from the top of the labia toward the rectum. Wash three times, one down each side and then once down the middle using a clean cotton ball each time. Rinse off soapy residue with wet cotton balls. Assess the area for redness, swelling, skin eruptions, discharge, or unusual odor. c) Tell the student when you are going to insert the catheter. Ask student to breathe deeply. Locate urinary meatus. The meatus may be difficult to visualize. It may appear as a small dimple or be concealed in the anterior wall of the vagina. Gently insert the catheter until urine begins to flow. d) When urine flow stops, insert catheter slightly more. If no more urine is obtained, withdraw catheter slightly and rotate catheter gently so that catheter openings have reached all areas of the bladder. It is also helpful to have the child bear down a couple of times to insure that all urine has been completely drained. Some students may require manual crede of the bladder to aid emptying this must be ordered by the physician. e) When the bladder is completely empty, pinch catheter and gently withdraw. f) Assist student as needed to redress. Completion of Procedure for Both Male and Female Catheterization a) Measure the urine volume obtained. Observe urine for color, clarity, odor, or foreign particles (blood mucous) b) Wash catheter with soap and water. Rinse and dry the catheter thoroughly. Store in appropriate container for next use. c) Dispose of urine down toilet. Wash collection container with soap and water and dry thoroughly. d) Remove gloves and wash hands. Have student wash hands if applicable. e) Report to parent and physician as needed, any abnormal findings such as discomfort, swelling, redness, change in color, clarity, or odor of urine. DOCUMENTATION: Document the date and time of clean intermittent catheterization; amount, color, clarity of urine; presence of foul odor or foreign particles in urine, presence of redness, swelling, skin eruptions, or discharge in perineal area; the student s tolerance for the procedure, any teaching done with the student or parent. A flow sheet may be useful for documentation. 5. REFERENCES:

5 Bierle, Timaru et als; Project School Care Children Assisted By Medical Technology in Educational Settings; Guidelines for Care, Children s Hospital, Boston, MA Larson, Georgianna; Managing the School Age Child with a Chronic Health Condition, DCL Publishing Co., Wayzata, Minnesota, Multnomah Education Service District; 1993, Procedural Manual for Quality Nursing Intervention in the School. Third Edition, Portland, Oregon. Multnomah Education Service District; 1993; Procedural Manual for Quality Nursing Intervention in the School, Third Edition, Portland, Oregon, Phillips Smith, Donna, et als; Comprehensive Child and Family Nursing Skills, Mosby Yearbook, Ind., St. Louis, Missouri, State of Connecticut Department of Education, Service Students with Special Health Needs, Hartford, CT., SHM, Vol. II, Sec. 4, Spec.Hlth Care Needs