Obstetrical Nursing / A Text-Book on the Nursing Care of the Expectant Mother, the Woman in Labor, the Young Mother and Her Baby

by Carolyn Conant Van Blarcom

The Bladder. The question of helping the patient to void after delivery is one of extreme importance, because she will almost certainly have difficulty in emptying her bladder, and yet catheterization is not to be resorted to unless absolutely necessary. As a rule the patient should be encouraged to try to void from four to eight hours after delivery. If she is unable to do so at first there are several aids which the nurse should employ before admitting the patient’s inability to empty her bladder. Inducing her to drink copious amounts of hot fluids is the first step. Very often she will then void if placed upon a bedpan containing water hot enough to give off steam, and more warm, sterile water is poured directly upon the urethral outlet; or hot and cold sterile water may be dashed, alternately, upon the meatus.

The sound of running water is often helpful as well as the application of hot stupes over the supra-pubic region. When everything else fails, success frequently follows the application of a partly filled hot-water bottle over the bladder, held in place by a tight binder, particularly if the patient rests upon a pan of steaming water at the same time.

The danger of infecting the bladder, by carrying lochia into it upon the catheter, is so great that some doctors choose what they regard as the lesser of two evils, and allow the patient to be assisted to the sitting position, if she has not a serious tear. Not infrequently the patient’s inability to void is due to the fact that she is unaccustomed to using a bedpan, and would have difficulty in using one under any conditions, but is able to void while sitting up. As the danger of infection is greater two or three days after delivery than at first, because of the beginning decomposition of the lochia, it is very evidently important to help the patient to establish the habit of voiding from the beginning, for if she is catheterized once there is great likelihood that she will need to have it continued for some days.

If the first attempts are unsuccessful, therefore, but the patient thinks that she may be able to void later, if the efforts are repeated, catheterization is sometimes delayed for as long as sixteen to eighteen hours after delivery in the hope that it may be avoided altogether.

When the most persistent and painstaking efforts fail, and catheterization is necessary, the nurse must remember the extreme gravity of her responsibility and preserve asepsis throughout the procedure. Although there is extreme danger of infection, it can be prevented as a rule, and its occurrence is therefore regarded as almost inexcusable.

In preparing for catheterization, the nurse should drape the patient as for a vaginal examination, making sure that she is warmly covered, and place her on a sterile douche- or bedpan. If it is done at night she should place the light in a position at once safe and advantageous. She should have at hand on a tray: sterile forceps; cotton pledgets; two glass catheters (in case one should be broken or become contaminated); a disinfecting solution such as bichlorid, 1–4,000 or lysol 1 per cent.; a sterile receptacle in which to receive the urine; sterile towels and a dressing basin or paper bag for the used pledgets.

The preparation of the nurse’s hands, at this point, varies in different hospitals, but always the greatest care is taken to bring nothing unsterile in contact with the vulva and meatus.

According to one method, the nurse scrubs her hands for three minutes and prepares the patient as for a vaginal examination, removes the douche pan and places a sterile towel over the vulva. She then scrubs and soaks her hands as described in Chapter XII, puts on sterile gloves, places a sterile towel over the patient’s abdomen and slips one under her hips. She should then separate the labia with the gloved fingers of the left hand, drawing the fingers upward a little to make the meatus more prominent. The inner surface of the labia is then bathed with pledgets soaked with the disinfecting solution, with downward strokes, each pledget being used but once. Five or six pledgets should be used, one after the other, to sponge the meatus, each pledget being placed squarely against the orifice, without touching the adjacent tissues, and given a slight, downward twisting motion and discarded. The bowl may then be placed in position to receive the urine, and the catheter picked up with the fingers, by its open end. The rounded end must be carefully inspected to insure against using one that is cracked or broken, after which it is slowly and gently introduced into the urethra for two or three inches. If the urine does not flow freely the catheter may be slightly withdrawn and light pressure made upon the bladder.

Before removing the catheter the nurse must locate the fundus and assure herself that it is in a proper position. If it is pushed up or to one side she will know that the bladder is still distended, and that more urine must be withdrawn. After the bladder has been emptied the nurse should place one finger over the open end of the catheter and remove it slowly.

Another method of catheterization differs from the one just described, in the preparation of the nurse’s hands. In this instance she simply washes her hands well with soap and hot water and wears neither gloves nor finger cots.