Mini cath on peds

[fromfaraway]

Fellow ER nurses,

I've been an ER nurse for many years but only for 2 years I've been exposed to pediatric cases. I'm struggling with the policies of straight cathing kiddos. While I'm aware of the risk of contamination of urine samples from wee bags I still feel like in our ED parents are not aware of this being even an option. Our docs state that we'll need a urine sample and that the the way to get those for kids pre- potty trained is a mini Cath. While I understand that a mini cath is cleaner than a urine collection bag, I still feel that parents are not given the educated choice. Parents have asked me to stop the cath half way through because it appears to be painful and I don't blame them. I still have to meet the parent that knew that there was an alternative to the cath, like the collection bag.

And then there is intact males. Nurses pulling back forcefully the foreskin in order to get a urine sample from a 6 month old. This just doesn't seem to be right to me. You can easily get a sample without pulling back the foreskin on those young ones in my experience. I guess I'm just adjusting to peds in the ER and I'm rather finding it disturbing to the point where it is giving me anxiety.

[OldDude]

^

The best way to learn exactly where you're aiming is to have a very experienced person show you. It's often easier to see at the time of cleansing because you can use a tiny bit of pressure in your downward motion with the swabstick and see a peek of the urethral meatus. When you are ready to use the catheter, the approach is different than an adult female. It's neither a straight or upward approach, but almost better if you come from from above (not cephalo, but directly above) and angle ever-so-slightly towards the feet. I sometimes hold the catheter like a pencil so I can direct this precisely. I just checked and there are a couple of videos on YT ("Catheterization of the Urethra in Girls" - in that one, which I'm not linking, you can see around 6:10 exactly what I'm talking about; a tiny slightly darker area just above the lady partsl tissue which is the target. You can also take note of the way they hold and manipulate the catheter to see the approach I'm talking about).

Took the words right out of my mouth...the tissue around the lady partsl opening is usually more generous, especially in infants, and the meatus sits right above that...I stick the end of the catheter in the tube of opened lubricant until I'm ready to pick it up so it'll be ready to go after cleaning...as JKL said hold the catheter where the tube has plenty of flex, insert it almost straight down and you'll get urine every time - unless they pee while your cleaning, and as mentioned above, have an open urine cup to grab and catch what urine you can! A crying child makes for a fuller/faster collection tube!! Practice, practice, practice.

[AnnieOaklyRN, BSN, RN, EMT-P]

I have never gotten an adequate urine sample from a bag, it either leaks everywhere or the child doesn't have enough urine in the bladder to make them go, and we wait and wait. I am sure it isn't to comfortable having a bag taken of your genitals that is full of glue either!!

Also if the child does have a UTI, or if a UTI gets missed by dip stick, you have now eliminated the ability to culture the urine, since it will be grossly contaminated with lots of different flora. This means if the child is not responding to the prescribed antibiotics within a couple of days they cannot do a sensitivity test to figure out what antibiotics will actually work, so now you have prolonged the illness and risked further injury to the kidneys.

Is the clean catch straight cath urine uncomfortable for the child, yes. Do they like it, no. Do the parents like seeing it, no. Does it still need to be done, yes. Just like an IV would still need to be done, etc. It is your job as the nurse to educate the parents about why you are doing it that way and why it is important to get a clean sample so that they would have a better understanding, just as you would explain any other uncomfortable procedure. The more you do of these they quicker and better you will get.

Annie

[KelRN215, BSN, RN]

I always found the urine bags useless. They fell off more often than not and I bet I could count on one hand how many successful samples I got from them in almost 5 years of acute care.

Lots of people have mentioned using them when they just need to check for pH, blood or glucose. We didn't use them for any of that, ever. Does nowhere else throw cotton balls in diapers for kids who just need that kind of stuff? When I worked in the hospital, we had a bunch of kids who needed routine UAs- kids on chemo to check for blood and pH, kids on high dose steroids to check for glucose, kids on the keto diet to check for ketones- and if they were incontinent, we did it by throwing cotton balls in the diaper and then squeezing the urine out of them or putting them in an empty syringe and using the syringe plunger to force the urine out of the cotton.

[OldDude]

...we did it by throwing cotton balls in the diaper and then squeezing the urine out of them or putting them in an empty syringe and using the syringe plunger to force the urine out of the cotton.

Kel...I will admit it here for the whole world to hear...I have never heard of this before now. This is so simplistically brilliant! Thank you for sharing that info. I can't wait to try it instead of jacking around with those dumb urine bags

[stephen1992]

Most of my pediatric Caths in the ED are part of workups trying to prevent a lumbar puncture. Very much so worth it to prevent that.