CATHETERIZATION
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DR AFZAL JUNEJO
ASSOCIATE PROFESSOR
SURGERY , LUMHS .
Urethral Catheterization A Simple Plan
Catheterisation
Drainage…
Indications
 Management
of acute urinary retention
or bladder outlet obstruction.
 Urine output measurement in critically
ill patients.
 During surgery to assess fluid status.
 During and following specific surgeries
of the genitourinary tract or adjacent
structures (ie, urologic, gynecologic,
colorectal surgery).
Reference: Schaeffer AJ. Placement and management of urinary bladder catheters. UpToDate ® (2010)
Indications – Copied from
UTD
 Management
of hematuria associated with
clots.
 Management of immobilized patients (eg,
stroke, pelvic fracture).
 Management of patients with neurogenic
bladder.
 Management of open wounds located in the
sacral or perineal regions in patients who are
incontinent.
.
Reference: Schaeffer AJ. Placement and management of urinary bladder catheters. UpToDate ® (2010)
Indications – Copied from
UTD
 Intravesical
pharmacologic therapy (eg,
bladder cancer).
 Improved patient comfort for end of life
care.
 Management of patients with urinary
incontinence following failure of
conservative, behavioral, pharmacologic
and surgical therapy.
Reference: Schaeffer AJ. Placement and management of urinary bladder catheters. UpToDate ® (2010)
Urethral Catheterization Indications
 Collection
of uncontaminated specimen
 Intermittent bladder decompression
 Urologic study of anatomy of urinary
tract
Indications simplified
Indications for catheterisation
 Retention
of urine
 Monitor urine output / acutely ill patient
 Pre/peri/post-operatively
 Assessment and investigations
 Treatment (e.g. to instil chemotherapy)
 Irrigation of bladder
 Bypass an obstruction
 Management of incontinence (as a last
resort)
Urethral Catheterization –
Absolute contraindications
 Known
urethral trauma blood at meatus,
fractured penis, etc.
Relative contraindications
urethral stricture,
 recent urinary tract surgery (ie, urethra,
bladder),
 presence of an artificial sphincter..
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Reference: Schaeffer AJ. Placement and management of urinary bladder catheters. UpToDate ® (2010)
Catheter Selection
 Points
to consider;
Size
Balloon size
 Length
Material (consider latex allergy)
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Drainage system
(closed / link system)
Catheter size
 Urinary
catheters are sized using French (F)
units. The French number divided by 3 is the
outer diameter of the catheter in millimeters.
Ranges:
Infant: 8F
Child/adolescent: 10-12
Adult and large adolescent: 14-18F
(female/male)
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Most common: 14F to 16F used in large, older
adolescents and adults
Balloon size
5 – 10 ml balloon usually with fluid to
inflate (15-30cc balloons may be used
in patients with prostate surgery)
Catheter Materials
 Short-term
materials
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May stay in up to 3/52
Latex
PTFE coated latex
Siliconised latex
PVC
 Long-term
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materials
May stay in up to 3/12
Silicone elastomer
(silastic)
Hydrogel coated
latex
Silver coated latex
100% silicone
100% silicone +
hydrogel coating
Types of Catheters
Many
styles
and
colors
from
which
to
choose
Straight Catheter
The rounded tip of this intermittent catheter reduces urethral trauma
as the catheter is passed. Urine enters the lumen of the catheter
through two "eye" holes.
Courtesy of http://www.vetmed.wsu.edu/courses_samDX/urinary.htm
intermittent or straight
intermittent or straight
catheter
Foley catheter or retention or
indwelling catheter
Foley Catheter (indwelling)
Silicone Catheter
Other Catheters
Coude
Mushroom (Pezzer)
is a intermittent catheter with
a tapered curved tip that is
designed to be easier to insert
when enlargement of the
prostate is suspected.
The mushroom-shaped tip this
continuous catheter secures it in the
patient's bladder after percutaneous
placement. It may be sutured to your
patient's abdomen or flank, or you may
need to tape it in place.
Other Urinary Equipment
Three-way Foley for
Continuous Bladder
Irrigation
Continuous
Bladder
Irrigation
Catheter Clamp
External Urinary Device
 Condom
or Texas
Catheter
 Female external
Urinary Collection
system
(In infants/young
children; referred to
as urine collection
bag)
Drainage System: closed
system
 Overnight
drainage
bag / 2 litre bed bag
 The bag attaches
directly to the
catheter and stays
there for 7 days
 Don’t break/open the
system!
Link drainage system
Urethral Catheterization procedure
Procedure
Patient preparation
- information
- consent
Aseptic technique
- to prevent the transmission of microorganisms , thus reducing risk of
infection
Insertion procedure
Gather
supplies
• Catheter kit
• Uro-Jet ®
• 14-16 Fr latex catheter
• Drainage bag, sterilization
solution & sterile gloves.
Equipment
 Catheter
pack
 Two pairs sterile gloves
 Sachet of normasol (to clean round urethral
meatus)
 10ml syringe
 Ampoule of sterile water for injections (if not in
pack with catheter)
 Lubricant e.g. instillagel
6ml for females and 11ml for males
 An
appropriate catheter
 Drainage system
Catheter kit
Insertion procedure
Unpack
supplies
• Unpack kit
• Place catheter and UroJet® on sterile field
• Pour sterilization
solution in cup
Insertion procedure
Prep &
Drape
• Don sterile gloves. Place
syringe onto Foley.
• Sterilize the external
urethral orifice.
• Drape the field and
transfer equipment
Insertion procedure
Insert Foley
• With non-dominant hand stretch
penis or open labia.
• With dominant hand, insert
Foley. Insert to hilt and ensure
that there is urine flow prior to
balloon inflation.
• Replace forekin, attach drainage
bag.
Urethral Catheterization procedure
 Normal
male urethra - 20 cm from tip of
external meatus to internal meatus
 Best to “insert full hilt”
before inflating balloon
 Sometimes helped by
straightening urethra
and pulling up
Urethral Catheterization procedure
 Female
urethra short, straight, and
usually wide caliber BUT meatus is not
always obvious
 Urethra = 4 cm + tip &
balloon = 4 cm  about
1/2 the catheter inserted
before inflating balloon
Documentation
 Date
inserted & date
due to be changed
 Rationale for
catheterisation
 Any problems
encountered
 Size inserted
 Batch
/ lot number
 Expiry date
 Fluid used in balloon
Type & volume
 Volume
of urine
drained
 Drainage system used
Acute Urinary Retention difficulties
Acute Urinary Retention difficulties
Coude catheters
Complications of long-term
:
catheterization
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UTI,
septicemia,
urethral injury,
hematuria
Bacteriuria
Chronic renal inflammation
Pyelonephritis
Nephrolithiasis
Cystolithiasis
Bladder cancer
 Indwelling
foley catheters are a major source of
UTI’S.
 Direct relationship between duration a f/c is in
the patient and incidence of infection.
 Risk factors:
 Female
 Advanced age
 Duration
 Diabetes
 Renal insufficiency
Bacteria is a function of time with a f/c:
 Single event – risk < 1%
 4 days – risk increases to 30%
 30 days – risk 95-100%
Monitor for Complications
 Foul
smelling urine
 Thick, cloudy urine with or without sediment
 Painful urination (dysuria)
 Fever, chills
 Urethral swelling around the catheter
 Bleeding into or around the catheter
 Catheter draining little or no urine despite
adequate fluid intake
 Leakage of large amounts of urine around the
catheter
Care
 Meatal
hygiene
 Minimise handling
 Maintain asepsis
 Do not allow bag to become too full
 Keep drainage bag below level of
bladder
Suprapubic Catheterization
Suprapubic
catheterization allows
 bladder drainage by inserting a
catheter or tube into the bladder
through a suprapubic (above the
pubis) incision or puncture.
4/12/2015
Miss Iman Shaweesh
50
Suprapubic Catheterization
 It
may be a temporary measure to
divert the flow of urine from the urethra
when the urethral route is impassable
(because of
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injuries,
strictures,
prostatic obstruction,
after gynecologic or other abdominal surgery
after pelvic fractures.
Suprapubic Catheterization
may also be used on a long-term
basis
for women with urethral
destruction secondary to long-term
indwelling urethral catheters
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