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MODULE OF SKILL LABORATORIUM PRACTICE

BLOCK : GENITOURINARY SYSTEM

TOPIC : CATHETERIZATION PROCEDURE

I. GENERAL OBJECTIVE

After finishing skill practice of catheterization procedure, the student will be able to insert urinary catheter by using appropriate technique, and remove the catheter when appropriate.

II. SPESIFIC OBJECTIVES

At the end of skill practices, the student will be able to:

a. Demonstrate internal catheterization procedure by using sterile techniques

b. Demonstrate external catheterization procedure with appropriate technique

c. Demonstrate procedure of removing an indwelling catheter

III. SYLLABUS DESCRIPTION

1. Sub Model Objective

After finishing skill practice of catheterization procedure, student will be able to insert both Foley, nelaton and condom catheter by using proper technique, and remove the catheter.

2. Expected Competencies

a. Students demonstrate procedure of Foley and nelaton catheter insertion

b. Students demonstrate procedure of applying condom catheter

c. Students demonstrate procedure of removing indwelling catheter

3. Topics

a. Catheterization Procedure

b. Procedure for removing indwelling catheter

4. Methods

a. Presentation

b. Demonstration

c. Coaching

d. Self practices on anatomic models

5. Laboratory Facilities

a. Skills Laboratory

b. Trainers

c. Anatomic Model for Catheterization Procedure

d. Student Learning guide

e. Trainer’s guide

f. References

g. Catheterization sets

6. Venue

Skills Laboratory

7. Organizer

Block of genitourinary system of Clinical Skills Program, Medical School Padjadjaran University, Hasan Sadikin Hospital.

8. Evaluation

a. Skill demonstration in model unit

b. Point nodal evaluation

c. OSCE

COURSE STUDY GUIDE : CATHETERIZATION PROCEDURE

|No |Topic |Sub |Learnin|R.P |Media |

| | |Topic |g | | |

| | | |Objecti| | |

| | | |ves | | |

| | |0 |1 |2 | |

|Assessment | | | | |

|1. |Assess the patient and check the order of catheterization need | | | | |

|2. |Determine whether the catheter is using for intermittent or continuesly | | | | |

|3. |Determine if the procedure is to be straight, condom, or indwelling catheter | | | | |

|4. |Assess need for perineal care and collection of a specimen | | | | |

|Planning | | | | |

|5. |Wash your hand thoroughly by using antiseptic hand soap | | | | |

|6. |Select specific type and size of catheter | | | | |

|7. |Collect appropriate equipment, including catheterization set, light source, bath| | | | |

| |blanket or sheet for draping, and extra equipment as individually determined | | | | |

|Implementation | | | | |

|8. |Introduce yourself to the patient with using therapeutic communication | | | | |

|9. |Identify the patient, including: name, medical record, and sex | | | | |

|10. |Explain the procedure, and give detail answer when she/he ask certain questions | | | | |

| |with simply words | | | | |

|11. |Draw bed curtains or door, and position and drape the patient: | | | | |

| |a. Pediatric patient or confused patient seek | | | | |

| |an assistant from others | | | | |

| |b. Male position in supine position | | | | |

|12. |a. Arrange the lamp in order to ease when we explore meatus urethra. If we find | | | | |

| |the perineum is soiled then we are doing perineal care firstly. | | | | |

| |b. Open catheterization set and arrange sterile field. Arrange the sterile | | | | |

| |equipments by using sterile hemostat forceps | | | | |

| |c. Prepare cleansing swabs on sterile basin | | | | |

| |d. If drainage bag is in separate package, open it and attach to bed | | | | |

| |e. If sterile drape is on top of set, grasp drape by side that is to be non | | | | |

| |sterile and place under patient. | | | | |

| |f. Open catheter by tear the pack outward with both hand out of the pack then | | | | |

| |put it on sterile field | | | | |

| |g. Open sterile syringe by tear the pack outward with both hand out of pack then| | | | |

| |put it on sterile field | | | | |

| |h. Open cleansing solution and pour over swabs into solution container. Then | | | | |

| |pour normal sterile water into solution container. | | | | |

| |i. Open anesthetic jelly | | | | |

| |j. Put on sterile gloves | | | | |

| |k. Set antiseptic swabs for cleansing the perineal or penile glans by pouring | | | | |

| |into sterile solution | | | | |

| |l. Place second drape with center hole on top perineum or penile glans | | | | |

| |m. Put the urine container underneath perineum or penis | | | | |

| |n. Set up the specimen container and its cap upside down | | | | |

|13. |a. After meatus is identified, cleanse the area surrounding the meatus, using | | | | |

| |swabs held in forceps. Use circular motion on males. Swab from anterior to | | | | |

| |posterior on females. Use one swab for each area. Discards swabs away from | | | | |

| |sterile field. | | | | |

| |b. Use non dominant hand to expose the meatus | | | | |

| |c. In the male, retrograde injection of 10 to 15 mL of a water-soluble | | | | |

| |lubricant-anesthetic (e.g., 2% lidocaine hydrochloride jelly) and placement of a| | | | |

| |urethral clamp for 5 to 10 minutes to allow the anesthetic to contact the | | | | |

| |mucosal surfaces are recommended before any urethral instrumentation. In the | | | | |

| |female, the lubricant-anesthetic can be placed directly on the catheter or a | | | | |

| |cotton-tipped applicator coated with lubricant-anesthetic can be placed in the | | | | |

| |urethra before catheterization. | | | | |

| |d. Use sterile hand to move tray containing catheter close to patient, and to | | | | |

| |pick up catheter | | | | |

| |e. In the male patient, the penis is placed on stretch perpendicular to the | | | | |

| |body (pointing slightly toward the umbilicus) without compressing the urethra | | | | |

| |and then the catheter is placed in the urethral meatus by holding the catheter | | | | |

| |at the tip until the branched of the catheter | | | | |

|15. |If using a straight catheter, obtain a specimen and drain the bladder | | | | |

|16. |If using an indwelling catheter, fill the balloon by instilling sterile water as| | | | |

| |required volume that depend on its size | | | | |

|17. |Pull out the catheter by gently movement due to assure the internal fixation is | | | | |

| |right | | | | |

|18. |Connect the bag to the catheter | | | | |

|19. |Tape the catheter to the patient-for a to the lower abdomen | | | | |

|20. |Place urine bag beside bed rail by using urine bag hanger | | | | |

|21. |Assist patient to comfortable position | | | | |

|22. |Gather and discard disposable equipment. Clean non disposable equipment | | | | |

|23. |Wash your hand thoroughly by using antiseptic hand soap | | | | |

|Evaluation | | | | |

|24. |Evaluate the following criteria: | | | | |

| |Indwelling catheter draining properly or straight catheter inserted and removed | | | | |

| |without discomfort | | | | |

| |b. Correct external fixation | | | | |

| |c. Patient comfortable | | | | |

|Documentation | | | | |

|25. |Document the following : | | | | |

| |a. Date and time of catheter insertion | | | | |

| |b. Type and size of catheter | | | | |

| |c. Whether a specimen was obtained | | | | |

| |d. Amount of urine | | | | |

| |e. Description of urine | | | | |

| |f. Patient’s response to procedure | | | | |

| |g. Name of operator | | | | |

1 PROCEDURE FOR REMOVING AN INDWELLING CATHETER

|No. |PROCEDURE | | | |Comment |

| | |0 |1 |2 | |

|Assessment | | | | |

|1. |Verify the order | | | | |

|2. |Determine whether a urine specimen is needed | | | | |

|Planning | | | | |

|3. |Wash your hand thoroughly by using antiseptic hand soap | | | | |

|4. |Obtain necessary equipment: | | | | |

| |a. Paper towels | | | | |

| |b. A syringe to remove the fluid from balloon catheter | | | | |

| |c. A small container to catch urine | | | | |

| |d. Clean gloves | | | | |

|Implementation | | | | |

|5. |Identify the patient | | | | |

|6. |Explain that catheter is to be removed and what to expect | | | | |

|7. |Prepare patient by proper draping. Put on clean gloves | | | | |

|8. |Withdraw the catheter | | | | |

| |a. Place paper towels under catheter | | | | |

| |b. Use syringe to remove fluid from balloon | | | | |

| |c. Pinch catheter and pull it out smoothly | | | | |

| |d. Wrap the catheter in paper towel | | | | |

| |e. Hold and of catheter up to allow urine to drain from tubing | | | | |

|9. |Assist patient to comfortable position | | | | |

|10. |Measure urine output | | | | |

|11. |Dispose of the equipment | | | | |

|12. |Remove gloves and wash your hands thoroughly with antiseptic hand soap | | | | |

|Evaluation | | | | |

|13. |Evaluate using the following criteria : | | | | |

| |a. Catheter removed without difficulty | | | | |

| |b. Patient voiding adequate amounts (approximately 250 ml) at regular interval | | | | |

| |c. Patient is continuing to increase fluid intake | | | | |

|Documentation | | | | |

|14. |Documentation the following : | | | | |

| |a. Time of catheter removal | | | | |

| |b. Urine output | | | | |

| |c. Patient’s response | | | | |

CRITERIA OF PERSONAL PERFORMANCE EVALUATION

|SCALE |PERFORMANCE ACHIEVEMENT |COMMENT |

|1 |If students are doing the task that only fill less than 35% of whole |LOW |

| |items for each step precisely | |

|2 |If student are doing the task that only fill 35% - 60% from whole |MILD |

| |items for each step precisely | |

|3 |If student are doing the task that only fill 60% - 78% from whole |MODERATE |

| |items for each step precisely | |

|4 |If student are doing the task that fill at least 80% from whole items |EXCELLENT |

| |for each step precisely | |

SKILL LABORATORIUM PRACTICE ARRAGEMENT

SCHEDULE OF PRACTICE

|No. |Subject |Allocated Time |Tutor |

|1. |Brief Description about catheterization procedure : | | |

| |Purpose of Procedure | | |

| |Type of catheterization method | | |

| |Indication for each method | | |

|2. |Catheterization Procedure Demonstration : | | |

| |Indwelling/Straight catheter | | |

|3. |Removing Indwelling Catheter Demonstration | | |

|4. |Tutorial Practice for each student | | |

| |

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