Catheterization

• Tracheostomy
• Chest Tubes
• Urinary Catheters
 Tracheostomy
A tracheostomy is an operation performed under
sterile technique that involves incising the skin over
the trachea and then making a surgical wound in the
trachea.
This provides for an airway during upper –airway
obstruction. To prevent skin breakdown,
tracheostomies are always covered with a dressing.
 Care for Tracheostomy patient
• Establish communication (yes/no questions with
simple sign language). Little need for complicated
messages
• Avoid written communication because they are
extremely ill, they have difficulty in using written
communication
• Be sensitive and keep the patient anxiety level low.
(You might need a lot of time to explain procedure
over and over again)
• When patient forgets procedure he/she will
 Care for Tracheostomy patient

• To minimize the possibility of infection,

tracheostomy should only be touched under
sterile condition.
• In emergency a radiographer will be expected to
perform suction to remove secretions.
 The patient must be well aerated with 5 to 10 breaths of oxygen
before suctioning
 This can be accomplished using an ambubag hooked to an
oxygen source.
 The patency of the suction catheter must be tested by aspirating
normal saline through it.
 Procedure for suctioning
• Insert the catheter in the stoma without suction
until the patient coughs or until resistance is met.
Then withdraw the catheter about 1 cm before
beginning suction.
• Apply suction intermittently and withdraw the
catheter in a rotating motion. Activate suctioning
by placing the thumb over the hole in the suction
line to cause the suction to pull from the end of
the tube where it is placed in the patient’s body.
 Procedure for suctioning
• Assess the airway by auscultation of the lungs. Use
a stethoscope to listen to the sounds of inspiration
and expiration over the chest wall. Breath sounds
are the result of free movement of air into and out
of the bronchial tree. The duration, pitch and
intensity of sounds indicate whether breathing is
normal or abnormal.
• Repeat procedure until the airway is clear. Never
suction for longer than 15seconds, and allow the
patient to rest in between.
Chest tubes
 Chest Tubes
Chest tubes are used to remove fluid, blood, and air
from the pleural cavity. They assist in reinflating
collapsed lungs (Atelectasis) and alleviating
pneumothorax (i.e air in the thoracic cavity). They are
also used in cases of thoracotomy and heart surgery.
Normally, the pleural cavity contains no air or blood,
containing instead a thin layer of lubricant that allows
the pleurae to slide and move over one another
without friction.
 Compartments for drainage
1. Collection chamber: collects fluids leaving the lungs
2. Water seal chamber: it contains water and prevents them air from
the atmosphere from entering the cavity through the chest tube.
3. Suction control chamber: it also contains water, the amount of
which regulates the amount of suction. This suction removes
unwanted air or fluid from the pleural cavity.
4. Additional chamber: a water seal vented to the atmosphere to
prevent potential pressure build up.
 Chest Tubes- images
Chest radiographs are taken before and after the insertion of the chest
tubes to ensure proper placement.
Chest radiographs are also taken to confirm that the tubes can be
removed.
Series of images
1. An initial radiograph confirms full lung expansion
2. A second is performed 2 hours after clamping to verify continued
expansion
3. A third film is obtained after removal of chest tubes again to confirm
full lung expansion.
 Caution
• Be careful when entering and leaving the patient
room. The tube might have been trapped in the x ray
unit.
• Patients might also come to the unit in a wheel chair
or stretcher if they have had the tubes on for while.
Be careful not to get the tube trapped in any way.
• The exterior assembly of the chest tubes must always
remain lower than the patient’s chest.
• Caution is necessary when moving and positioning
the patient to prevent compromising the integrity of
the tubes.
• Urinary Catheters
 Urinary Catheters

Urinary catheterization is the insertion of a tube into

the bladder using aseptic technique. The two main
types of urinary catheters are
• Foley (a retention balloon type)
• The straight type
On insertion of the foley catheter, the balloon is filled
with sterile water to hold the catheter in place.
Catheters that remains in place are called indwelling
catheter.
 Uses of Urinary Catheters

1. Empty the bladder (before surgery, radiologic

or other examinations)
2. Relieve retention of urine or bypass
obstruction
3. Irrigate the bladder or introduce drugs
4. Permit accurate measuring of urine output
5. Relieve incontinence
 Sizes of Catheters
Sizes rages from 8-18 in even numbers based on
the French system and diameter ranges from
2.6mm to 5.9mm.
 Types of Catheter
• Plastic catheter- short term use only
• Latex catheter – 2 to 3 weeks
• Polyvinyl chloride catheter – 4-6 weeks
• Pure silicon catheter – 2 to 3 months

Catheter can interrupt the body’s defense

mechanism against disease.
 Care for patients with catheters in the X-
ray department.
• Urine collection bag should always be kept below the bladder
• Urine Bags should never be dragged on the floor
• Watch drainage bag and tube when moving a patient in a
wheel chair.
• When you empty a collection bag make sure you record it out
put.
• Don’t forget to reclamp the stopcock after empting the bag
• Any fluid or water intake of the patient should be recorded
Always check from the nurses or ward when ever there is a
question on recording intake and output.
 Catheterizing a patient
Normally this process is done by nurses from the
patient’s ward depending on the setting.
In some institutions the radiographer might be
responsible for catheterizing a patient
undergoing a voiding cystogram as an out
patient.
 Items needed for catheterization
• Sterile catheter
• Sterile collecting bag/ container to receive urine
• Syringe with sterile water / normal saline
• Sterile gloves
• Antiseptic solution
• Sterile cotton balls and sterile forceps
• Lubricant (water soluble jelly)
• Sterile drape for sterile field
 Procedure for performing urinary
catheterization
1. Wash hands, provide privacy, explain procedure
and secure consent.
2. Place female patient in the lithotomy position;
position male patients supine and expose the
genital
3. Open the kit and put on the gloves, which will
remain sterile during the entire procedure.
4. Place the sterile drape around the penis for a male
patient or under the buttocks for a female patient
 Procedure for performing urinary
catheterization
5. Test foley catheters before using them.
6. Pour antiseptic over the cotton balls.
7. Coat the catheter tip with sterile lubricant
8. Expose the urinary meatus using the non
dominant hand. This hand is no longer considered
sterile.
9. With female patients, separate the labia majora
and minora. For male patients, hold the penis with
the foreskin retracted.
 Procedure for performing urinary
catheterization
10.Clean the urinary meatus with a cotton ball
held by forceps. For male, circle the urinary
meatus once and repeat. For female, wipe
the labia minora from top to bottom, discard
the cotton, and then clean the urinary
meatus from top to bottom. It is extremely
important not to let the labia or foreskin
contaminate the meatus before or after
cleansing.
 Procedure for performing urinary
catheterization
11.Insert catheter slowly with the dominant hand
until urine flows. For females, this is about ½
inch, for males, it is about 8 inches. Always apply
gentle pressure, and never force a catheter.
12.Reattach the syringe to the balloon port and fill
the balloon. A light tug on the catheter ensures
that the balloon is holding the catheter in place .
 Removal of urinary catheter
The radiographer has the responsibility of
removing a urinary catheter after procedure
such a voiding cystourethrograms.
Items needed for such procedure are; a emesis
basin, scissors and several paper towels.
 Procedure for removal of urinary catheter

1. Wash hands, wear gloves, provide privacy, explain the

procedure to the patient, and secure consent.
2. Uncover the patient and place the basin under the
catheter valve. Cut the tip of the balloon valve with the
scissors, and allow the water from the balloon to drain
into the basin.
3. Once the flow of water has ceased, place the towels
under the catheter and pull gently. Stop and notify a
nurse or physician if any resistance is noted.
4. When the catheter has been completely removed, wrap
it in the towels, cover the patient, and discard the
catheter.