Outline the procedure for providing peri-care to a patient with a urinary catheter, emphasizing prevention of urinary tract infections (UTIs) and comfort measures.
Providing peri-care (perineal care) to a patient with a urinary catheter requires a meticulous procedure that prioritizes infection control, comfort, and dignity. The goal is to keep the peri-area clean to prevent urinary tract infections (UTIs), which are a significant risk for patients with indwelling catheters. This detailed procedure outlines each step, emphasizing both hygiene and patient comfort.
Before beginning, gather all necessary supplies and prepare the environment. This includes a clean basin, warm water, mild soap or perineal cleanser, washcloths (at least two), a towel, gloves, a waterproof pad or underpad, and any other supplies, such as a barrier cream, if required. Ensure the patient is comfortable and has privacy. Close the door or draw the curtain to maintain patient dignity. Explain the procedure to the patient and encourage them to participate as much as they are able. For example, inform the patient that you will be cleaning their perineal area, why this is important, and what they can expect during the process, if the patient is able to understand. Always put on gloves before providing care to the patient.
Position the patient appropriately. If the patient is able, they can bend their knees and separate their legs to allow easy access to the peri-area. If the patient is unable to bend their legs, or if they are bedridden, position them on their back and gently elevate their legs using pillows, if necessary. Be sure to position the patient so that you have easy access to the peri-area without straining. Place a waterproof pad underneath the patient's hips and buttocks to protect the bedding from getting wet. For example, make sure the patient is lying in a comfortable position and that you can easily reach all necessary areas to provide care.
Next, begin cleaning the peri-area. Fill the basin with warm water and add a small amount of mild soap or perineal cleanser. Wet one washcloth and gently cleanse the peri-area, using a clean part of the washcloth for each stroke. For females, cleanse from front to back to avoid introducing bacteria from the rectal area into the urinary tract. Clean the labia majora, labia minora, and the urethral meatus. Be sure to use a new portion of the washcloth for each stroke, or use a new washcloth for each area. For males, cleanse the tip of the penis, moving in a circular motion away from the urethral opening. Retract the foreskin (if present), cleanse, and then gently return the foreskin to its original position to avoid phimosis or paraphimosis. Ensure that the entire peri-area is thoroughly cleansed, including the pubic area and the skin folds. For example, use gentle strokes to clean each area, and move from front to back in female patients to avoid contamination.
Pay special attention to the area around the urinary catheter insertion site. Clean the catheter tubing by gently wiping it with a clean washcloth, moving away from the insertion site. Stabilize the catheter at all times while cleaning to avoid pulling or displacement. Avoid using harsh chemicals, and use only mild soap or the appropriate perineal cleanser, and rinse thoroughly with clean warm water. Using clean, dry washcloths, pat dry the peri-area gently, and also the catheter insertion site. For example, use a clean, dry washcloth to gently pat dry the peri-area and the catheter tubing; do not rub, as this can cause irritation.
Assess the catheter insertion site for any signs of infection or irritation such as redness, swelling, discharge, or pain. Also assess the peri-area for any unusual changes, such as skin breakdown or rashes. Report any unusual signs to the nurse as soon as possible. For example, if you notice any redness, swelling, or discharge at the insertion site, this needs to be reported immediately to the nurse.
If necessary, apply a barrier cream to the peri-area to provide a protective layer against moisture and irritation. This is especially important for patients who are at higher risk of skin breakdown or irritation, or who have urinary or fecal incontinence. For example, if the patient is incontinent, a barrier cream might help prevent skin breakdown. In addition, if the patient has a wound in the peri-area, a barrier cream will help prevent contamination of the wound.
Remove and dispose of all soiled supplies, including gloves, washcloths, waterproof pads, and any other disposable items. Dispose of them in the appropriate waste container, and always wash your hands thoroughly with soap and water, or use hand sanitizer when soap and water is not available.
Reposition the patient to a comfortable position, and ensure the catheter tubing is positioned so that it is not kinked or causing pressure on any area of the patient's body. Ensure that the catheter bag is positioned below the level of the bladder to prevent backflow, which could lead to infection. Also make sure the tubing has slack to allow the patient to move comfortably without pulling on the catheter. For example, make sure the catheter bag is placed below the patient’s bladder and that the tubing is not causing any discomfort.
Document the peri-care procedure, including the date and time of the care, the patient's tolerance of the procedure, the appearance of the peri-area and catheter insertion site, any signs of redness, swelling, or irritation, and any unusual findings. Note if a barrier cream was applied. Also document if the patient stated they were comfortable during the process or had any issues. Clear and accurate documentation provides necessary information for other healthcare staff. For example, document any redness, discharge or swelling that you observed as well as the fact that the procedure was completed.
Educate the patient on the importance of peri-care and the signs of a UTI, which include fever, chills, increased urination, and pain or burning upon urination. If the patient is alert and able, encourage them to report any unusual symptoms or discomfort to the healthcare staff. In addition, educate the patient on the importance of maintaining adequate hydration, as that is also a way to prevent infections. For example, inform the patient that they need to report any burning or pain during urination.
In summary, providing peri-care to a patient with a urinary catheter requires a thorough, step-by-step approach, that focuses on infection prevention and comfort. Key steps include preparing the environment, positioning the patient, cleaning the peri-area thoroughly, paying specific attention to the catheter insertion site, applying barrier creams if required, proper disposal of supplies, and documenting all findings. This careful process will help prevent infections, promote comfort, and ensure the patient's well-being.