sexta-feira, 7 de setembro de 2007

Sondagem vesical


É a introdução de um cateter estéril através da uretra até a bexiga, com o objetivo de drenar a urina. Deve-se utilizar técnica asséptica no procedimento a fim de evitar uma infecção urinária no paciente.
Tem por finalidades:
- Esvaziar a bexiga dos pacientes com retenção urinária;
- Controlar o volume urinário;
- Preparar para as cirurgias principalmente as abdominais;
- Promover drenagem urinária dos pacientes com incontinência urinária;
- Auxiliar no diagnóstico das lesões traumáticas do trato urinário.

Observações:

A sondagem vesical só é aconselhada:
- Na incontinência urinária: somente em casos especiais, preferindo-se usar absorventes, calças plásticas, especiais ou URUPEN nos homens: o Urupens é um tipo de condom adaptado externamente ao pênis, ligado a uma extensão e este ao coletor de urina.
- Na retenção urinária, quando as medidas para estimular a micção forem ineficazes: (verificar se trata se de retenção urinária ou anúria. Se houver hipertensão dolorosa da bexiga, é retenção urinária; abrir torneira próximo ao paciente; despejar água morna na região perineal, colocar bolsa de água quente na região abdominal; promover privacidade do paciente.)

Procedimentos na Sondagem de Alívio Feminina

a) Com pacote de sondagem:
- Reunir o material: pacote de cateterismo vesical esterilizado, cuba-rim, cuba redonda, bolas de algodão ou gaze, pinça Pean ou similar, sonda uretral (nº 10 a 14), luvas estéreis, biombo, frascos com PVP-I e soro fisiológico, geléia anestésica, tubo de ensaio para colher amostra (se necessário), campo fenestrado, saco plástico de lixo;
- Cercar a cama com biombo;
- Encaminhar a paciente para higiene íntima ou faze-la se necessário;
- Colocar o material na mesa de cabeceira e prender o saco de lixo;
- Colocar a paciente em posição ginecológica, protegendo-a com um lençol;
- Abrir com técnica asséptica o pacote de cateterismo sobre a cama entre as pernas da paciente;
- Colocar na cuba redonda o anti-séptico e o lubrificante na gaze;
- Abrir o invólucro da sonda vesical, colocando-a na cuba rim;
- Colocar a luva com técnica asséptica;
- Lubrificar a sonda;
- Colocar o campo fenestrado no períneo e aproximar a cuba rim;
- Afastar os pequenos lábios com o polegar e o indicador da mão esquerda e com a mão direita fazer anti-sepsia no períneo com as bolas de algodão ou gaze embebida na soluça anti-séptica, usando a pinça Pean. A anti-sepsia deverá ser no sentido púbis-ânus; na seqüência: grandes lábios, pequenos lábios, vestíbulo; usar a bola de algodão uma vez e despreza-la;
- Limpar a região com soro fisiológico, obedecendo-os mesmos princípios de assepsia descritos;
- Afastar com a mão direita a cuba redonda e a pinça;
- Continuar a manter, com a mão esquerda, exposto o vestíbulo e, com a mão direita, introduzir a sonda lubrificada (a mais ou menos 10 cm), colocar a outra extremidade na cuba-rim para receber a urina drenada;
- Retirar a sonda (quando terminar a drenagem urinária) e o campo fenestrado;
- Controlar o volume urinário, colher amostra da urina ou guardá-la para o controle de diurese;
- Deixar a unidade e o material em ordem.


Procedimento na Sondagem de Demora Feminina

- Reunir o material: idêntico ao de alívio, substituindo a sonda de polivinil pela sonda de demora e acrescentando seringa de 10ml, água destilada de 10ml, agulha 30x8, esparadrapo, bolsa coletora de sistema fechado.
- Repetir a técnica da sondagem vesical de alívio;
- Após a passagem da sonda insuflar o balãozinho com soro fisiológico, através da válvula existente na extremidade da sonda e puxa-la até sentir-se a ancoragem do balão no trígono vesical;
- Retirar o campo fenestrado;
- Conectar a sonda na extensão do coletor e prende-lo na grade da cama.
- Retirar as luvas;
- Fixar a sonda com uma tira de esparadrapo na coxa da paciente saindo por cima da mesma.

Procedimento no Cateterismo Masculino

- Repetir a técnica do cateterismo feminino com as seguintes diferenças: colocar o paciente em decúbito dorsal e com as pernas afastadas; após enluvar as mãos colocar 8ml de geléia anestésica na seringa com auxilio de outra pessoa; segurar o pênis com uma gaze (mão esquerda), mantendo-o perpendicular ao abdome; fazer a anti-sepsia, afastando o prepúcio com o polegar e o indicador da mão esquerda, e, com a pinça montada, fazer a anti-sepsia do meato uretral para a periferia (trocar as luvas se usar material descartável); injetar a geléia anestésica na uretra com a seringa ou bisnaga esterilizada, pressionar a glande por 2 a 3 minutos, a fim de evitar refluxo da geléia; introduzir a sonda até a sua extremidade (18-20cm) com movimentos para baixo, como o pênis elevado perpendicularmente e baixar o pênis lentamente para facilitar a passagem na uretra bulbar; recobrir a glande com o prepúcio, a fim de evitar edema da glande; fixar a sonda na coxa ou na região hipogástrica (profilaxia de fístulas uretrais).

296 comentários:

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Para se reduzir a curvatura uretral e a pressão no ângulo peniano-escrotal a melhor maneira de fixar o cateter seria na região supra-pubiana, evitando-se assim a coxa

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