Elimination Procedures
Urinary Catheterization
- Strict sterile technique is mandatory to prevent UTI and maintain patient safety throughout the procedure.
- Insert catheter 2-3 inches past the point where urine begins to flow to ensure proper balloon placement in the bladder.
- Never force catheter insertion - resistance may indicate urethral obstruction or anatomical abnormality.
- Position patient supine with knees flexed and separated
- Cleanse urethral meatus with antiseptic solution (front to back for females)
- Insert lubricated catheter using sterile technique
- Inflate balloon only after urine flow is established
- Secure catheter to prevent tension and trauma
Memory Aid: "CLEAN" - Cleanse, Lubricate, Enter slowly, Advance properly, Never force
Key Points
- Always use smallest appropriate catheter size (14-16 Fr for adults)
- Keep drainage bag below bladder level to prevent reflux
- Empty drainage bag when 2/3 full or every 8 hours
Bowel Elimination Procedures
- Enema administration requires proper positioning (left side-lying/Sims position) to follow natural bowel anatomy.
- Insert enema tubing 3-4 inches for adults and hold solution container 12-18 inches above rectum for proper flow rate.
- Stop procedure immediately if patient experiences severe cramping, bleeding, or inability to retain solution.
| Enema Type | Volume | Purpose |
|---|
| Cleansing | 750-1000mL | Remove feces/prepare for procedure |
| Retention | 150-200mL | Medication administration |
| Return-flow | 200-300mL | Stimulate peristalsis/remove flatus |
Wound Care Fundamentals
Wound Assessment
- Document wound dimensions using length × width × depth measurements in centimeters for accurate healing progression.
- Assess wound edges, drainage characteristics, and surrounding tissue to identify signs of infection or healing complications.
- Report immediately: increased pain, purulent drainage, red streaking, or fever indicating possible infection.
Clinical Scenario: Patient has 3cm × 2cm × 1cm surgical incision with serosanguineous drainage. Wound edges are approximated with no erythema. This indicates normal healing process.
Memory Aid: "WOUND" - Width/length/depth, Odor, Undermining, Necrotic tissue, Drainage
Sterile Dressing Changes
- Maintain sterile field throughout procedure by keeping sterile items above waist level and avoiding contamination.
- Remove old dressing with clean gloves, then don sterile gloves for wound cleansing and new dressing application.
- Cleanse wound from center outward using new gauze for each stroke to prevent introducing bacteria.
- Gather supplies and explain procedure to patient
- Position patient comfortably with wound accessible
- Remove old dressing with clean technique
- Assess wound and surrounding skin
- Cleanse wound using sterile technique
- Apply new sterile dressing and secure appropriately
- Document findings and patient response
Key Points
- Never recap needles - use sharps container immediately
- Change dressings when soiled, loose, or per facility protocol
- Use Montgomery straps for frequent dressing changes to protect skin
Commonly Confused Concepts
| Clean Technique | Sterile Technique |
|---|
| Handwashing with soap | Surgical hand scrub |
| Clean gloves | Sterile gloves |
| Used for intact skin | Used for open wounds/invasive procedures |
| Reduces microorganisms | Eliminates all microorganisms |
Quick Check:
□ Can you identify when to use clean vs. sterile technique?
□ Do you know proper catheter insertion depth?
□ Can you list signs of wound infection?
Study Tips & Memory Aids
- Practice sterile technique in lab settings until movements become automatic and natural.
- Create step-by-step checklists for complex procedures to ensure no steps are missed during patient care.
- Use visual cues like wound measurement tools and drainage color charts for accurate assessments.
Common Pitfalls to Avoid:
• Contaminating sterile field by reaching across it
• Forcing catheters when resistance is met
• Using same gauze multiple times when cleansing wounds
• Forgetting to assess pain before and after procedures