Question

a patient at your nursing home faculty has chronic urinary retention problems prior to admission. The patient has been straight catheter at home for the past week. The nurse prior to you reports that the patient states feeling very confident in following infection control procedures when inserting the Foley catheter. You ask the reporting nurse if she witnessed his first catheter insertion since admission and she tells you that she has not witness him performing this skill. During your shift he develops a mild fever of 100.8 F, Tylenol was given for the fever with good effect. Report only minor pelvic pain. Following VS are HR-102, BP-101/70 and RR-18. What signs and symptoms indicates potential infection with the above findings?

You decide that you will witness the next time the patient performs this skill on himself to determine if infection control procedures are followed. When you observe the patient performing this skill, it is observed that some infection control measure are not followed. What could the patient have done to break the infection control and sterile technique measures?

a few days later a urologist consult results in a Foley catheter being inserted. During the day the patient wears a leg bag and is switched to a Foley bag in the evening. The CNA comes to tell you that she noticed that his leg bag has been very full of urine backing up upon switching it out on her shift the past few days. The aide also reports that tonight the urine was cloudy and odorous. When taking the vital signs an elevated temperature is noted. What could have been the cause of the infection?

List principles of infection control and Foley care that could have prevented this from happening?

Answer 1

UTI SYMPTOMS

• fever
• A burning sensation when urinating
• Passing frequent, small amounts of urine
• Urine that appears cloudy
• Urine that appears red, bright pink or cola-colored — a sign of blood in the urine
• Strong-smelling urine
• Pelvic pain, in women — especially in the center of the pelvis and around the area of the pubic bone

2. The patient would not have wore hand gloves properly before inserting tube or would have touched the uriteral end of tube bare on surface

3,

1. Gather equipment.
   
2. Explain procedure to the patient
   
3. Assist patient into supine position with legs spread and feet together
   
4. Open catheterization kit and catheter
   
5. Prepare sterile field, apply sterile gloves
   
6. Check balloon for patency.
   
7. Generously coat the distal portion (2-5 cm) of the catheter with lubricant
   
8. Apply sterile drape
   
9. If female, separate labia using non-dominant hand. If male, hold the p enis with the non-dominant hand. Maintain hand position until preparing to inflate balloon.
   
10. Using dominant hand to handle forceps, cleanse peri-urethral mucosa with cleansing solution. Cleanse anterior to posterior, inner to outer, one swipe per swab, discard swab away from sterile field.
    
    
11. Pick up catheter with gloved (and still sterile) dominant hand. Hold end of catheter loosely coiled in palm of dominant hand.
    
12. In the male, lift the p enis to a position perpendicular to patient's body and apply light upward traction (with non-dominant hand)
    
13. Identify the urinary meatus and gently insert until 1 to 2 inches beyond where urine is noted
    
14. Inflate balloon, using correct amount of sterile liquid (usually 10 cc but check actual balloon size)
    
15. Gently pull catheter until inflation balloon is snug against bladder neck
    
16. Connect catheter to drainage system
    
17. Secure catheter to abdomen or thigh, without tension on tubing
    
18. Place drainage bag below level of bladder
    
19. Evaluate catheter function and amount, color, odor, and quality of urine
    
20. Remove gloves, dispose of equipment appropriately, wash hands
    
21. Document size of catheter inserted, amount of water in balloon, patient's response to procedure, and assessment of urine