留置导尿技术课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,二级,三级,四级,五级,留置导尿技术,留置导尿技术,1,将无菌导尿管经尿道插入膀胱的方法。,By inserting a Foley catheter, you are gaining access to the bladder and its contents. Thus enabling you to drain bladder contents, decompress the bladder, obtain a specimen, and introduce a passage into the GU tract. This will allow you to treat urinary retention, and bladder outlet obstruction.,经尿道导尿术,耻骨弓上导尿术,Introduction,导尿术,将无菌导尿管经尿道插入膀胱的方法。Introduction导,2,主要内容,一、目的,二、禁忌症,三、尿管的种类,四、尿道,解剖,特点,五、,准备,六、,操作程序,七,、,注意,事项,八,、,并发症,主要内容,3,解除尿潴留,协助诊断,细菌培养,监测尿量,尿流,动力学测量：膀胱容量、压力及残余尿,鉴别尿闭与尿潴留,进行尿道或膀胱造影等,协助治疗,如胱内化疗,Indications,一、目的,解除尿潴留 Indications一、目的,4,Contraindications,Foley,catheters are contraindicated in the presence of,urethral trauma,.,二、禁忌,症,尿道,周围有严重,感染,急性前列腺炎,急性附睾炎,急性尿道炎,全身出血性疾病,ContraindicationsFoley cathete,5,Catheters are sized in units called French,One French equals 1/3 of 1 mm,Catheters vary from 12 (small) FR to 48 (large),FR (3-16mm) in size,三、导尿管的种类,Urethral catheter types,直头,Straight tip,弯头,Coude tip,三腔,3-way catheter irrigation,Catheters are sized in units c,6,Male Urethral,Anatomy,四、男性,尿道解剖特点,男性尿道长约,18,20cm,三个狭窄,：尿道外,口，尿道内口、膜部,两个弯曲,：耻骨下弯和耻骨前弯,耻骨下弯固定无变化,耻骨前弯则随阴茎位置不同而变化,如将阴茎向上提起，耻骨前弯即可消失,。,Male Urethral Anatomy四、男性尿道解剖,7,女性尿道长约,4,5cm,尿道短、直、粗,富于扩张性,尿道外口位于阴蒂下方,与阴道口、肛门相邻,比男性更容易发生尿道的,感染,Relevant,anatomy,四、女性尿,道解剖特点,女性尿道长约45cmRelevant anatomy四、女,8,术者准备,洗手,戴口罩、帽子,病人准备,核对、评估,解释操作的目的和过程。,物品准备,一次性导尿包，条件允许备数个碘伏棉球。,必要时备：围屏、毛毯,Preparation,五、准备,导尿的目的,病人的病情,病人,的合作程度,膀胱充盈度,局部皮肤,术者准备洗手戴口罩、帽子病人准备核对、评估解释操作的目的和过,9,Equipment,Sterile,gloves,Sterile drapes,Cleansing,solution,Cotton,swabs,Forceps,Sterile water (usually 10 cc),Foley catheter (usually 16-18 French),Syringe (usually 10 cc),Lubricant,(xylocaine,jelly),Collection bag and tubing,用物,EquipmentSterile gloves用物,10,Procedure,备物,Gather,equipment,.,查对、评估、解释,Explain,procedure to the,patient,体位（,仰卧屈,膝位,）,Assist,patient into supine position with legs spread and feet,together,操作者,站在病人右侧，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，暴露,外阴。,六、操作程序,Procedure备物 Gather equipment.六,11,清洁会阴（第一次消毒）：,将小橡胶单和治疗巾垫于病人臀下，放治疗盘于会阴部。,消毒顺序：从外向里，由上向下。,持,血管钳夹消毒棉球（,1%,新洁尔灭）进行初步消毒,男病人：,依次,为阴阜、大腿内侧,1/3,、阴茎,、阴囊,。提起,阴茎将包皮向后推，暴露尿道口，自尿道口向外旋转擦拭尿道口、龟头及冠状沟（,3,次）,。,女,病人,：,阴阜,对侧大阴唇近侧大阴唇对侧大小阴唇沟近侧大小阴唇沟（分开）对侧小阴唇近侧小阴唇尿道口,肛门。,每只棉球只用一次。,污棉球,、手套置弯盘内移至床尾,。,Procedure,六、操作程序,清洁会阴（第一次消毒）：持血管钳夹消毒棉球（1%新洁尔灭）进,12,在,病人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,检查气囊完好性,Check,balloon for,patency,润滑导管前端,Generously,coat the distal portion,(2-5 cm),of the catheter with,lubricant,Procedure,六、操作程序,在病人两腿之间按无菌技术操作打开导尿包Procedure六、,13,第二次消毒,男,病人,：左手用,无菌纱布裹住阴茎，将包皮向后推，暴露尿道口。,右手持镊夹取无菌棉球消毒尿道口,、,龟头、冠状沟,（螺旋,3,次）、加强消毒,尿道口,女病人,：,用左手拇、食指分开并固定小阴唇，右手用镊子夹棉球分别消毒尿道口、两侧小阴唇、加强消毒尿道口,尿道口须消毒,2,次。每只棉球只用一次，污棉球置床尾弯盘内。,消毒顺序：由里向外，由上向下,Apply sterile drape.,If,female, separate labia using non-dominant,hand.,If,male, hold the penis with the non-dominant,hand.,Using,dominant hand to handle forceps, cleanse peri-urethral mucosa with cleansing solution.,Cleanse,anterior to posterior, inner to outer, one swipe per swab, discard swab away from sterile field,.,第二次消毒,14,留置导尿技术课件,15,右手,从尾部抓住尿管，让尿管轻轻盘绕在手心。,Pick,up catheter with gloved (and still sterile) dominant hand. Hold end of catheter loosely coiled in palm of dominant hand,.,插管。,见,尿液流出再,插入,1-2,英寸,(1inch=2.54cm),。,Identify,the urinary meatus and gently insert until 1 to 2 inches beyond where urine is noted,男病人,：左手用无菌纱布固定阴茎，右手持导尿管前端，将阴茎向上提起，使之与腹壁成,60,角,，对准尿道口轻轻插入约,20-22cm,。,In,the male, lift the penis to a position perpendicular to patients body and apply light upward traction (with non-dominant hand) .,女病人,：左手固定小阴唇，右手持导尿管前端，对准尿道口轻轻插入约,4-6cm,。,Procedure,六、操作程序,右手从尾部抓住尿管，让尿管轻轻盘绕在手心。男病人：左手用无,16,留置导尿技术课件,17,留置导尿技术课件,18,留置导尿技术课件,19,留置导尿技术课件,20,将尿液引流,入弯盘内或按需采集尿标本,根据导尿管的气囊,容积向气囊内注入,等量灭菌注射用水,（,约,10-20ml,）,Inflate balloon, 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膀胱内。,Gently pull catheter until inflation balloon is snug against bladder neck,接尿袋,Connect,catheter to drainage,system,无张力固定,Secure catheter to abdomen or thigh, without tension on,tubing,Procedure,六、操作程序,将尿液引流入弯盘内或按需采集尿标本Procedure六、操作,21,留置导尿技术课件,22,留置导尿技术课件,23,引流袋,低于膀胱,Place 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, dispose of equipment appropriately, wash hands,记录,Document,size of catheter inserted, amount of water in balloon, patients response to procedure, and assessment of urine,Procedure,六、操作程序,引流袋低于膀胱Procedure六、操作程序,24,留置导尿技术课件,25,Complications,The main complications are tissue trauma and infection.,After,48 hours of catheterization, most catheters are colonized with,bacteria.,Catheters can also cause renal inflammation,nephrocystolithiasis, and pyelonephritis if left in for prolonged periods,.,尿,路,感染和尿道损伤,保持,引流通畅，避免导尿管受压、扭曲、堵塞,防止逆行感染,，集尿袋,不得超过耻骨联合（膀胱高度,）,保持,尿道口,清洁,七、并发症,ComplicationsThe main complica,26,留置导尿技术课件,27,严格遵守无菌原则，每个棉球使用一次。,插导尿管缓慢轻柔，切忌过快过猛而损伤尿道粘膜，尤忌前后反复拉动导尿管。,第一次放尿不超过,1000ml,，以免虚脱或发生膀胱粘膜充血,。,女病人导尿如误入阴道，应重新更换导尿管。,尿管留置时间越短越好，临床上一般不超过,7,天。,第二次消毒结束直接送管，手不可放开。,尿袋高度不可高于膀胱。,八、注意,事项,严格遵守无菌原则，每个棉球使用一次。插导尿管缓慢轻柔，切忌,28,谢谢,谢谢,29,