Elimination, Catheters and Ostomies
Urinary catheters, CAUTI prevention, enemas and ostomy care
Urinary catheter insertion
- Sterile technique; female: dorsal recumbent; male: hold penis upright at ~60–90°.
- Female: if the catheter enters the vagina, leave it as a landmark and insert a new sterile catheter into the urethra.
- Inflate the balloon only after urine returns (advance a little further first, to the hilt in males).
- Secure to the thigh (or abdomen for males) to prevent pulling.
- Bladder scanner: post-void residual >~150–200 mL suggests retention (follow protocol).
CAUTI prevention
- Insert only when truly needed (not for incontinence or convenience); remove as soon as possible (nurse-driven removal protocols).
- Closed drainage system; bag below the bladder and off the floor; no dependent loops.
- Daily perineal and meatal care with soap and water.
- Don't routinely irrigate or change the catheter; collect specimens from the sampling port with sterile technique.
- After removal: should void within ~6–8 h; measure the first voids.
Enemas and bowel care
- Left side-lying (Sims') position: follows the shape of the colon.
- Adult: insert the lubricated tip 3–4 in (7.5–10 cm); bag no higher than ~18 in above the anus.
- Cramping: lower the bag or pause; have the patient breathe slowly.
- "Enemas until clear": usually a maximum of 3 (follow orders).
- Digital removal of impaction can trigger a vagal response: watch for bradycardia.
Specimens
- Clean-catch midstream urine: clean front to back; start voiding, then collect midstream.
- 24-hour urine: discard the first void, then collect every void, ending with a final void at the same time the next day. Keep on ice or refrigerated as instructed. If a void is missed, restart.
- Stool for occult blood (FIT test is preferred: no diet restriction).
Ostomies
Stoma check
- Normal: moist, pink to beefy red, slightly raised. Swelling decreases over 6–8 weeks.
- Pale: anemia. Dusky, purple, brown or black: poor blood supply: report immediately.
- Mild bleeding on cleaning is normal (it's very vascular).
Pouching
- Cut the opening ~⅛ in (2–3 mm) larger than the stoma.
- Empty when ⅓–½ full; change the wafer every 3–7 days or if leaking.
- Skin barrier on clean, dry skin; check for irritation.
| Ileostomy | Colostomy (descending/sigmoid) | |
|---|---|---|
| Output | Liquid, continuous, enzyme-rich (skin damage) | Formed stool; may become regular |
| Risks | Dehydration, low Na⁺ and K⁺; food blockage | Constipation |
| Teach | Fluids 2–3 L/day; chew well; limit high-fiber foods that can block (nuts, popcorn, corn); ER tablets may pass whole | Odor control; some can irrigate to regulate |
Body image: encourage looking at and touching the stoma; ostomy nurse (WOC nurse) referral; support groups.