臨床技能5.1留置導(dǎo)尿

1、留置導(dǎo)尿技術(shù)UrinaryCatheterization博士生導(dǎo)師副護(hù)師南方醫(yī)學(xué)南方醫(yī)院護(hù)理部導(dǎo)尿術(shù)roduction將無(wú)菌導(dǎo)尿管經(jīng)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.主要內(nèi)容一、目的二、癥三、尿管的種類四、五、準(zhǔn)備解剖特點(diǎn)六、操作程序七、注意事項(xiàng)八、并發(fā)癥一、目的Indications解除尿潴留協(xié)助細(xì)菌培養(yǎng)監(jiān)測(cè)尿量尿力學(xué)測(cè)量：容量、壓力及殘余尿鑒別尿閉與尿潴留進(jìn)行或造影等協(xié)助治療如胱內(nèi)化療二、癥ContraindicationsFoleycatheters arecontraindicatedhepresenceofurethral trauma.周?chē)袊?yán)重炎急性急性急性全身炎炎性疾病三、導(dǎo)尿管的種類Urethral catheter types 直頭 Straight tip 彎頭 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解剖特點(diǎn)Anatomy長(zhǎng)約1820cm三個(gè)狹窄：內(nèi)口、膜部和兩個(gè)彎曲：恥骨下彎和恥骨前彎恥骨下彎固定無(wú)變化恥骨前彎則隨位置不同而變化。如將向上提起，恥骨前彎即可四、女性解剖特點(diǎn)Relevant anatomy女性長(zhǎng)約45cm短

4、、直、粗,富于擴(kuò)張性位于更容易發(fā)生下方,與的口、相鄰比五、準(zhǔn)備Preparation洗手術(shù)者準(zhǔn)備戴、帽子導(dǎo)尿的目的的病情的合作程度充盈度局部皮膚核對(duì)、評(píng)估解釋操作的目的和過(guò)程。準(zhǔn)備導(dǎo)尿包，條件允許備數(shù)個(gè)碘伏棉球。物品準(zhǔn)備必要時(shí)備：圍屏、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備物 Gather equipment.、評(píng)估、解釋 Explain procedure to the patient（仰臥屈膝位）Assist patient操作者站在o supineition with legs spread and feet together右側(cè)，脫去對(duì)側(cè)褲腿，蓋在近側(cè)腿部，對(duì)側(cè)用被遮蓋，兩腿外展、足部相抵，。六、操作程序Procedure清潔（第一次）：將小橡膠單和治療巾墊于臀下，放治療盤(pán)于部。順序：從外向里，由上向下。持男口，自女鉗夾棉球（1%新潔爾滅）進(jìn)行初步

6、：依次為、大腿內(nèi)側(cè)1/3、陰囊。提起將向后推，口向外旋轉(zhuǎn)擦拭對(duì)側(cè)近側(cè)口、及對(duì)側(cè)。（3次）。溝近側(cè)：近側(cè)溝（分開(kāi)）對(duì)側(cè)口每只棉球只用一次。污棉球、手套置彎盤(pán)內(nèi)移至床尾。六、操作程序Procedure在兩腿之間按無(wú)菌技術(shù)操作打開(kāi)導(dǎo)尿包Open catheterization kit and catheter術(shù)者戴好無(wú)菌手套、鋪洞巾，將彎盤(pán)移至洞巾旁。Prepare sterile field, apply sterile gloves檢查氣囊完Check balloon for patency潤(rùn)滑導(dǎo)管前端Generously coat the distal portion (2-5 cm) of

7、the catheter with lubricant第二次男：左手用無(wú)菌紗布裹住，將口、向后推，口。右手持鑷夾取無(wú)菌棉球、（螺旋3次）、加強(qiáng)女別口：用左手拇、食指分開(kāi)并固定，右手用鑷子夾棉球分口口、兩側(cè)、加強(qiáng)口須2次。每只棉球只用一次，污棉球置床尾彎盤(pán)內(nèi)。順序：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右手從尾部抓住尿管，讓尿管輕輕盤(pán)繞在手心男定：左手用無(wú)菌紗布固，右手持導(dǎo)尿管前端，將向上提起，使之與腹壁成60角，對(duì)準(zhǔn)口輕Pick up catheter with gloved (and still sterile) dominann輕約20-22cm。coiled in palm of do

9、minannd.he male, lift the penis to a插管。見(jiàn)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，右手持導(dǎo)尿管前端，對(duì)準(zhǔn)尿道口輕輕約4-6cm。六、操作程序Procedure將尿液入彎盤(pán)內(nèi)或按需尿標(biāo)本根據(jù)導(dǎo)尿管的氣囊容積向氣囊內(nèi)注入等量生理鹽水（約10-20ml）Inflate balloon

10、, using correct amount of sterile liquid (usually 10 cc but check actual balloon size)輕拉導(dǎo)尿管有阻力感，即證實(shí)導(dǎo)尿管已固定于內(nèi)。Gently pull catheter until inflation balloon i接尿袋Connect catheter to drainage system無(wú)張力固定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評(píng)價(jià)尿管功能及尿液的量、顏色、氣味等Evaluate catheter function and amount, color, odor, and quality of urine脫手套、正確處理醫(yī)療廢物、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、并發(fā)癥Complications預(yù)防保持、尿，保證充足攝入量通暢，避免導(dǎo)尿管受壓、堵塞防止逆行保持，集尿袋不得超過(guò)恥骨聯(lián)合（高度）口清潔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