临床技能5.1留置导尿

1、留置导尿技术UrinaryCatheterization博士生导师副护师南方医学南方医院护理部导尿术roduction将无菌导尿管经的方法。By inserting bladder and contents,roduceaitsFoley catheter,contents. Thusyou are gaining acs to theenabling you to drain bladderpress sagethebladder,obtainaspecimen,ando the GU tract. This will allow you to treaturinary retention,

2、 and bladder outlet obstruction.主要内容一、目的二、症三、尿管的种类四、五、准备解剖特点六、操作程序七、注意事项八、并发症一、目的Indications解除尿潴留协助细菌培养监测尿量尿力学测量：容量、压力及残余尿鉴别尿闭与尿潴留进行或造影等协助治疗如胱内化疗二、症ContraindicationsFoleycatheters arecontraindicatedhepresenceofurethral trauma.周围有严重炎急性急性急性全身炎炎性疾病三、导尿管的种类Urethral catheter types 直头 Straight tip 弯头 Coud

3、e tip 三腔 3-way catheter irrigationCatheters are sized in units called FrenchOne French equals 1/3 of 1 mmCatheters vary from 12 (small) FR to 48 (large) FR (3-16mm) in size四、Male Urethral解剖特点Anatomy长约1820cm三个狭窄：内口、膜部和两个弯曲：耻骨下弯和耻骨前弯耻骨下弯固定无变化耻骨前弯则随位置不同而变化。如将向上提起，耻骨前弯即可四、女性解剖特点Relevant anatomy女性长约45cm短

4、、直、粗,富于扩张性位于更容易发生下方,与的口、相邻比五、准备Preparation洗手术者准备戴、帽子导尿的目的的病情的合作程度充盈度局部皮肤核对、评估解释操作的目的和过程。准备导尿包，条件允许备数个碘伏棉球。物品准备必要时备：围屏、毛毯用物EquipmentSterile glovesSterile drsCleansing solution Cotton swabs ForcepsSterile water (usually 10 cc)Foley catheter (usually 16-18 French) Syringe (usually 10 cc)Lubricant (xylo

5、caine jelly) Collection bag and tubing六、操作程序Procedure备物 Gather equipment.、评估、解释 Explain procedure to the patient（仰卧屈膝位）Assist patient操作者站在o supineition with legs spread and feet together右侧，脱去对侧裤腿，盖在近侧腿部，对侧用被遮盖，两腿外展、足部相抵，。六、操作程序Procedure清洁（第一次）：将小橡胶单和治疗巾垫于臀下，放治疗盘于部。顺序：从外向里，由上向下。持男口，自女钳夹棉球（1%新洁尔灭）进行初步

6、：依次为、大腿内侧1/3、阴囊。提起将向后推，口向外旋转擦拭对侧近侧口、及对侧。（3次）。沟近侧：近侧沟（分开）对侧口每只棉球只用一次。污棉球、手套置弯盘内移至床尾。六、操作程序Procedure在两腿之间按无菌技术操作打开导尿包Open catheterization kit and catheter术者戴好无菌手套、铺洞巾，将弯盘移至洞巾旁。Prepare sterile field, apply sterile gloves检查气囊完Check balloon for patency润滑导管前端Generously coat the distal portion (2-5 cm) of

7、the catheter with lubricant第二次男：左手用无菌纱布裹住，将口、向后推，口。右手持镊夹取无菌棉球、（螺旋3次）、加强女别口：用左手拇、食指分开并固定，右手用镊子夹棉球分口口、两侧、加强口须2次。每只棉球只用一次，污棉球置床尾弯盘内。顺序：由里向外，由上向下Apply sterile dr. If female, separaabia using non-dominannd. If male, hold thepenis with the non-dominannd. Using dominannd to handle forceps, cleanse peri-ure

8、thral mucosa with cleansing solution. Cleanse anterior toswipe per swab, discard swab away from sterile field.terior, inner to outer, one六、操作程序Procedure右手从尾部抓住尿管，让尿管轻轻盘绕在手心男定：左手用无菌纱布固，右手持导尿管前端，将向上提起，使之与腹壁成60角，对准口轻Pick up catheter with gloved (and still sterile) dominann轻约20-22cm。coiled in palm of do

9、minannd.he male, lift the penis to a插管。见尿液流出再itionpendicularto2-3cm。patients body and apply lightupwarddominantractionnd) .(withnon-Identify the urinary meatus and gently insert until 1 to 2 inch女：左手固定，右手持导尿管前端，对准尿道口轻轻约4-6cm。六、操作程序Procedure将尿液入弯盘内或按需尿标本根据导尿管的气囊容积向气囊内注入等量生理盐水（约10-20ml）Inflate balloon

10、, using correct amount of sterile liquid (usually 10 cc but check actual balloon size)轻拉导尿管有阻力感，即证实导尿管已固定于内。Gently pull catheter until inflation balloon i接尿袋Connect catheter to drainage system无张力固定ug against bladder neckSecure catheter to abdomen or thigh, without tenon tubing六、操作程序Procedure袋低于Place

11、 drainage bag below level of bladder评价尿管功能及尿液的量、颜色、气味等Evaluate catheter function and amount, color, odor, and quality of urine脱手套、正确处理医疗废物、洗手Remove gloves, dise of equipment appropriay, wash handssize of catheter inserted, amount of water in balloon, patients response to procedure, and assessment of

12、 urine七、并发症Complications预防保持、尿，保证充足摄入量通畅，避免导尿管受压、堵塞防止逆行保持，集尿袋不得超过耻骨联合（高度）口清洁The main complications are tie trauma and infection.After 48 hours of catheterization, most catheters are colonized with bacteria.Catheters cso cause renal inflammation, nephro-cysto-lithiasis, andpyelonephritis if left in for prolonged periods.The alternatives to urethral catheterization include suprapubic catheterization and external condom cat