What are the risks associated with intra-urethral Foley catheter balloon inflation in spinal cord-injured patients. How can healthcare professionals prevent complications related to catheter placement. What lessons can be learned from a retrospective case series on this topic.

Understanding Indwelling Urinary Catheters: Design and Function

Indwelling urinary catheters are essential medical devices used for bladder drainage in various clinical scenarios. These semi-rigid yet flexible tubes are designed to drain the bladder while blocking the urethra. The ideal catheter should closely mimic the normal physiological and mechanical characteristics of the urinary system.

Key features of an optimal catheter design include:

• Thin-walled and continuously lubricated
• Collapsible and conformable to protect urethral integrity
• Secure placement without relying on a balloon
• Ability to imitate intermittent bladder washing with urine

Over the years, catheter products have undergone significant improvements in composition, texture, and durability. Modern catheters typically feature a smooth surface with two drainage eyes at the tip, facilitating efficient urine drainage. These drainage eyes are usually placed either laterally or in opposition, with the latter generally providing better drainage capabilities.

Catheter Tips: Variations for Specific Needs

Catheter tips come in various designs to address different clinical requirements:

1. Straight-tipped catheter: The most commonly used design
2. Coudé-tipped catheter (Tiemann catheter): Angled upward at the tip to navigate the male urethra’s upward bend
3. Carson catheter: Features a slightly larger bulb to overcome restrictions
4. Council catheter: Includes a reinforced hole at the tip
5. Whistle-tipped catheter: Open at the end for draining large amounts of debris

Catheter Size and Length: Choosing the Right Fit

Catheter size is crucial for patient comfort and effective drainage. Catheters are sized using the French (Fr) gauge system, with sizes ranging from 6 to 18 Fr. Each French unit equals 0.33 mm in diameter.

Is there an optimal catheter size for most patients? Generally, healthcare professionals recommend using the smallest catheter size that allows for adequate drainage, typically 14 to 16 Fr. Larger catheters (18 Fr or above) are not recommended due to potential complications:

• Increased risk of bladder neck and urethral mucosa erosion
• Higher likelihood of stricture formation
• Impaired drainage of periurethral gland secretions
• Potential for pain and discomfort

Balloon Size: A Critical Factor in Catheter Function

The retention balloon is a crucial component of indwelling catheters, preventing expulsion and ensuring proper positioning. Balloon sizes are typically labeled as either 5 mL or 10 mL, but both are usually inflated with 10 mL of sterile water as per manufacturer instructions.

Why is proper balloon inflation important? Correct inflation ensures:

• Symmetrical positioning of the catheter tip
• Minimized patient discomfort
• Reduced risk of bladder wall irritation

Larger balloons (30 cc – 60 cc) are generally reserved for specific clinical situations, such as facilitating drainage or providing hemostasis in postoperative settings. However, routine use of larger capacity balloons should be avoided for long-term catheterization due to potential complications.

Risks of Improper Balloon Inflation

Underfilling or overfilling the balloon can lead to several issues:

• Incorrect positioning of the catheter tip
• Increased risk of bladder wall irritation and trauma
• Incomplete bladder emptying, leading to increased infection risk
• Catheter bypassing (urine leakage around the catheter)

Common Misconceptions About Catheter Balloon Size

A prevalent misconception among healthcare providers is that using a larger balloon size can prevent catheter leakage or urine bypassing. However, this approach often leads to more problems than solutions.

Why can larger balloons be problematic? Larger balloons can:

• Increase contact between the balloon or catheter tip and the bladder wall
• Trigger bladder spasms, forcing urine around the catheter
• Lead to bladder neck and urethral erosion with long-term use

It’s important to note that 30 mL balloons have specific clinical applications, such as providing traction on the prostate gland to stop bleeding after prostate surgery or controlling bleeding in women following pelvic surgery. However, these larger balloons are not suitable for routine, long-term catheterization.

Catheter Materials and Balloon Integrity

The choice of catheter material plays a significant role in the long-term effectiveness of the device. Some catheter materials have been found to lose water from the inflated balloon over time, which can compromise the catheter’s positioning and function.

What factors influence balloon integrity? Key considerations include:

• Material composition of the catheter and balloon
• Duration of catheterization
• Patient-specific factors (e.g., urine composition, body temperature)

Healthcare providers should be aware of these potential issues and monitor catheter function regularly, especially in long-term catheterization cases.

Risks of Intra-Urethral Foley Catheter Balloon Inflation in Spinal Cord-Injured Patients

Spinal cord-injured patients present unique challenges when it comes to catheterization. The risk of intra-urethral Foley catheter balloon inflation is particularly concerning in this population.

Why are spinal cord-injured patients at higher risk? Several factors contribute:

• Altered sensation in the urethral and bladder areas
• Potential anatomical changes due to long-term immobility
• Increased susceptibility to urinary tract infections
• Challenges in communicating discomfort or pain during catheterization

Intra-urethral balloon inflation can lead to severe complications, including urethral trauma, stricture formation, and increased risk of infection. Healthcare providers must exercise extreme caution and follow proper techniques when catheterizing spinal cord-injured patients.

Lessons Learned from a Retrospective Case Series

A retrospective case series analyzing intra-urethral Foley catheter balloon inflation incidents in spinal cord-injured patients provides valuable insights for improving catheterization practices.

What key lessons can be drawn from this case series? Important takeaways include:

• The critical importance of proper catheter placement technique
• The need for ongoing education and training for healthcare providers
• The value of using imaging guidance in challenging cases
• The importance of patient-specific risk assessment before catheterization

By learning from these cases, healthcare providers can implement strategies to minimize the risk of intra-urethral balloon inflation and improve patient outcomes.

Preventing Complications: Best Practices for Catheterization in Spinal Cord-Injured Patients

To reduce the risk of intra-urethral balloon inflation and other complications in spinal cord-injured patients, healthcare providers should adhere to best practices for catheterization.

What strategies can help prevent catheterization complications? Key recommendations include:

• Thorough patient assessment before catheterization
• Use of appropriate catheter size and type
• Proper lubrication and gentle insertion technique
• Confirmation of correct catheter placement before balloon inflation
• Regular monitoring and maintenance of indwelling catheters
• Prompt recognition and management of potential complications

By implementing these best practices, healthcare providers can significantly reduce the risk of intra-urethral balloon inflation and other catheter-related complications in spinal cord-injured patients.

The Role of Technology in Improving Catheterization Safety

Advancements in medical technology offer promising solutions for enhancing catheterization safety, particularly for high-risk populations like spinal cord-injured patients.

How can technology improve catheterization practices? Innovative approaches include:

• Ultrasound-guided catheter placement
• Smart catheters with sensors for detecting proper positioning
• Advanced materials that reduce the risk of infection and biofilm formation
• Virtual reality training systems for healthcare providers

While many of these technologies are still in development or early adoption stages, they hold significant potential for reducing catheter-related complications and improving patient outcomes.

Future Directions in Catheter Design and Management

As our understanding of catheter-related risks and complications evolves, so too does the field of catheter design and management. Researchers and medical device manufacturers are continuously working to improve catheter safety and effectiveness.

What future developments can we expect in catheter technology? Promising areas of research include:

• Biodegradable materials for short-term catheterization
• Antimicrobial coatings to reduce infection risk
• Improved balloon designs for better retention and reduced complications
• Integration of artificial intelligence for real-time monitoring and complication prediction

These advancements have the potential to significantly reduce the risks associated with catheterization, including intra-urethral balloon inflation, particularly in vulnerable populations like spinal cord-injured patients.

As we continue to learn from retrospective case series and clinical experiences, the field of urinary catheterization will undoubtedly see further improvements in patient safety and outcomes. Healthcare providers must stay informed about these developments and incorporate new best practices into their clinical routines to ensure the highest standard of care for their patients.

Designs – Indwelling Urinary Catheters

Catheters are semi-rigid but flexible tubes. They drain the bladder but block the urethra.

The challenge is to produce a catheter that matches as closely as possible to the normal physiological and mechanical characteristics of the voiding system.

This requires construction of a thin-walled, continuously lubricated, collapsible (conformable) catheter to protect the integrity of the urethra; a system to hold the catheter in place without a balloon; and a design to imitate the intermittent washing of the bladder with urine.

Catheter products have changed significantly in their composition, texture, and durability since the 1990s.

The catheter should have a smooth surface with two drainage eyes at the tip that allow for urine drainage.

Drainage eyes are placed either laterally or opposed. Opposing drainage eyes generally facilitate better drainage.

Catheter Tips

The most commonly used catheter is a straight-tipped catheter.

A Coudé-tipped catheter, or Tiemann catheter, is angled upward at the tip to assist in negotiating the upward bend in the male urethra.  

This feature facilitates passage through the bladder neck in the presence of obstruction from a slightly enlarged prostate gland (e.g., in benign prostatic hyperplasia) or through a narrowed stricture in the urethra.

The Carson catheter is a slightly larger bulb to assist in negation of restrictions. 

The Council catheter features a reinforced hole at the tip of the catheter.

A whistle-tipped catheter is open at the end and allows drainage of large amounts of debris (e.g., blood clots).

Catheter Size and Length 

Each catheter is sized by the outer circumference and according to a metric scale known as the French (Fr) gauge (range is 6 to 18 Fr), in which each French unit equals 0.33 mm in diameter.

The golden rule is to use the smallest catheter size (termed bore), generally 14 to 16 Fr, that allows for adequate drainage.

The use of large-size catheters (e.g., 18 Fr or larger) is not recommended because catheters with larger diameters can cause more erosion of the bladder neck and urethral mucosa, can cause stricture formation, and do not allow adequate drainage of periurethral gland secretions, causing a buildup of secretions that may lead to irritation and infection. Also, large size catheters can cause pain and discomfort.  

Balloon Size

A retention balloon prevents the catheter from being expelled. The preferred balloon size may be labeled either 5 mL or 10 mL, and both are instilled with 10 mL of sterile water for inflation per manufacturer’s instructions. Larger balloons (30 cc – 60 cc) are generally used to facilitate drainage or provide hemostasis when necessary, especially in the postoperative period. The balloon of the catheter usually sits at the base of the bladder, obstructing the internal urethral orifice. 

A fully inflated balloon allows the catheter tip to be located symmetrically. If a 5 mL balloon is inflated with more than 10 mL of water, irritation may occur unilaterally on the bladder wall from increased pressure of the balloon.

The specified amount of inflation ensures a symmetrical shape and allows for the catheter to maintain position in the bladder while minimizing patient discomfort   Underfilling or overfilling may interfere with the correct positioning of the catheter tip, which may lead to irritation and trauma of the bladder wall.

A balloon with a fill size greater than 10 mL, such as a 30 mL balloon, is not recommended because the 10 mL size keeps residual urine minimal, thus reducing the risk of infections and irritation.

The catheterized bladder is in a collapsed state as a result of constant urine drainage. However, a 30 mL balloon will allow persistence of a small pool of undrained urine, so the bladder emptying is not complete and the undrained urine can leak around the catheter (referred to as “catheter bypassing”)..

The use of a larger balloon size is mistakenly believed by many nurses to be a solution to catheter leakage or urine bypassing around the catheter. However, a large balloon increases the chance of contact between the balloon or catheter tip and the bladder wall, leading to bladder spasms that may cause urine to be forced out around the catheter.

A 30 mL balloon is used primarily to facilitate traction on the prostate gland to stop bleeding in men after prostate surgery or to stop bleeding in women after pelvic surgery.

Routine use of larger capacity balloons (30 mL) should be avoided for long-term use as they can lead to bladder neck and urethral erosion.

Several catheter materials have been found to lose water from the inflated balloon over time in the bladder with 100% silicone catheters losing as much as 50% of their volume within 3 weeks.

In men, the catheter should be passed initially to the bifurcation (the “Y” junction where the balloon arm and catheter meet) to ensure that the balloon will not be inflated in the urethra. 

Catheter Materials

A wide range of catheter materials are available, and the material selected should be chosen by: 

1. how long the catheter will remain in place,
2. comfort,
3. the presence of latex sensitivity,
4. ease of insertion and removal, and
5. ability to reduce the likelihood of complications such as urethral and bladder tissue damage, colonization of the catheter system by microorganisms, and encrustation

Note: Prior to insertion, all indwelling catheters should be visually inspected for any imperfections or surface deterioration.

1. Latex Catheter: The possibility of a latex allergy is an important consideration as many urinary catheters are constructed from latex or a related material. 

There are reported increases in allergies and reactions in patients with long-term use of all urinary latex and rubber catheters. Patients who have asthma and other allergies are at increased risk for these allergies. Latex allergy can result in symptoms such as skin irritation, rashes, and blisters. Urethritis and urethral strictures can also result from latex allergies.  Coatings such as silicone and polytetrafluoroethylene (PTFE) are used to coat latex catheters.

2. Hydrogel coating, which remains intact when used, has demonstrated the ability to reduce the high level of cytotoxicity associated with latex catheters. However, coated latex catheters do not protect against an allergic reaction to the underlying latex because the coating wears off.

Bonded hydrogel-coated latex catheters may be longer lasting than silicone catheters because their hydrogel coating prevents bacterial adherence and reduces mucosal friction. Hydrogels or polymers coat the catheter, absorbing water to produce a slippery outside surface. This results in the formation of a thin film of water on the contacting surface, thus improving its smoothness and lubricity. These properties might act as potential barriers to bacterial infection and reduce the adhesion of both gram-positive and gram-negative bacteria to catheters. 

3. Silicone- and hydrogel-coated catheters usually last longer than PTFE-coated catheters. If the person is latex sensitive, silicone catheters should be used. Avoiding latex catheters may also decrease the incidence of encrustation. All-silicone (100%) catheters are biocompatible and are believed to have encrustation-resistant properties.  Silicone catheters are thin-walled, rigid catheters with a larger diameter drainage lumen. 

4. Antimicrobial-coating: A major problem with Foley catheters is that they have a tendency to contribute to urinary tract infections (UTI). This occurs because bacteria can travel up the catheters to the bladder where the urine can become infected. In an attempt to prevent bacterial colonization, catheters have been coated with silver alloy or nitrofurazone, a nitrofurantoin-like drug.

This has been helpful, but it has not completely solved this major problem. An additional problem is that Foley catheters tend to become coated over time with a biofilm that can obstruct the drainage. This increases the amount of stagnant urine left in the bladder, which further contributes to the problem of urinary tract infections. When a Foley catheter becomes clogged, it must be flushed or replaced.

Both nitrofurazone-coated and silver alloy-coated catheters seem to reduce the development of asymptomatic bacteriuria during short-term (< 30 days) use.
Despite their unit cost, there is a suggestion that these devices might be a cost-effective option if overall numbers of infections are significantly reduced through their use.

• Antibiotic-coated catheters were found in a meta-analysis to prevent or delay bacteriuria in short-term catheterized, hospitalized patients.   However, in 2012, nitrofurazone impregnated catheters were taken off the market.  
• Silver is an antiseptic that inhibits growth of gram-positive and gram-negative bacteria. Silver alloy-coated catheters are thought to cause less inflammation and have a bacteriostatic effect because they reduce microbacterial adherence and migration of bacteria to the bladder.
  Because they prevent bacterial adherence, these catheters also minimize biofilm formation through their release of silver ions that prevent bacteria from settling on the surface.  
  There appear to be few adverse effects, and microbial resistance to the active agent is unlikely. 

Catheter Drainage BagsDrainage bags and an anchor for the drainage tube are parts of the design of an indwelling urinary catheter system.  These may include a: leg drainage bag, overnight drainage bag, and a spare leg strap or a device to secure the catheter tubing to the leg.  Drainage bags that cannot be worn and concealed are commonly referred to as “nighttime or overnight bags,” or “large capacity bags,” or “bedside bags”. Drainage bags that can be worn and concealed are commonly referred to as “leg bags” or abdominal bags, commonly referred to as “belly bags.”  Leg bags generally hold 300- 900 cc whereas an overnight bag can hold up to 2000cc.  It is recommended that reusable drainage bag be replaced every 30 days.   

The current design of urinary drainage bags prevents the introduction of bacteria into the closed indwelling urinary catheter system.  There are anti-reflux bags, single use bags, closed urinary drainage systems, and bags with urine sampling ports.  A leg bag cannot be characterized as closed because of the need to regularly open the leg bag for drainage and connect to an overnight drainage bag in most cases.  To minimize opening of a catheter system, a leg bag can be attached to a larger bag for overnight drainage. 

References: 
1. Brosnahan J, A. Jull, et al. Types of urethral catheters for management of short-term voiding problems in hospitalized patients. Cochrane Database of Systematic Reviews, 2004, (1): CD004013.
2. Gray M. Does the construction material affect outcomes in long-term catheterization? JWOCN, 2006, 33: 116-121.
3. Lawrence EL. and IG. Turner. Materials for urinary catheters: A review of their history and development in the UK. Med Engineering Phys, 2005, 27: 443-453.
4. Leuck AM, Johnson JR, Hunt MA, Dhody K, Kazempour K, Ferrieri P, et al. Safety and efficacy of a novel silver-impregnated urinary catheter system for preventing catheter-associated bacteriuria: a pilot randomized clinical trial. Am J Infect Control. 2015;43:260-5. DOI: 10.1016/j.ajic.2014.11.021.
5. Newman D. The indwelling urinary catheter: Principles for best practice. JWOCN, 2007, 24: 655-661.
6. Pickard R, Lam T, MacLennan G, Starr K, Kilonzo M, McPherson G, et al. Antimicrobial catheters for reduction of symptomatic urinary tract infection in adults requiring short-term catheterisation in hospital: a multicentre randomised controlled trial. Lancet. 2012;380:1927-35. DOI: 10.1016/S0140-6736(12)61380-4.  
7. Politano AD, Campbell KT, Rosenberger LH, Sawyer RG. Use of silver in the prevention and treatment of infections: silver review. Surg Infect (Larchmt). 2013;14:8-20. DOI: 10.1089/sur.2011.097.
8. Weissbart SJ, Kaschak CB, Newman DK. Urinary drainage bags. In: Newman DK, Rovner ES, Wein AJ, editors. Clinical Application of Urologic Catheters and Products.  Switzerland: Springer International Publishing; 2018, 133-147.
9. Zugail AS, Pinar U, Irani J. Evaluation of pain and catheter-related bladder discomfort relative to balloon volumes of indwelling urinary catheters: A prospective study.  Investig Clin Urol. 2019 Jan;60(1):35-39. doi: 10.4111/icu.2019.60.1.35. Epub 2018 Dec 6.

Urinary catheterisation – Tests & treatments

It’s possible to live a relatively normal life with a long-term urinary catheter, although it may take some getting used to at first.

Before being discharged from hospital, a specialist nurse will give you detailed advice about looking after your catheter.

Catheter equipment

You will be given a supply of equipment to take with you when leaving hospital, and told where to get further supplies in the future. In most cases, catheter equipment is available on prescription from pharmacies.

You will also be shown how to empty and change your equipment.

Self-catheterisation

If you have been taught to use intermittent catheters, you should insert them several times a day to drain urine into a toilet or bag. These catheters are usually designed to be used once and then thrown away.

How often intermittent catheters need to be used differs from person to person. You may be advised to use them at regular intervals spaced evenly throughout the day, or only when you feel you need the toilet.

Indwelling catheters

Indwelling catheters can either drain into a bag attached to your leg, which has a tap on the bottom so it can be emptied, or they can be emptied into the toilet or suitable receptacle directly using a valve.

Bags should be emptied before they become completely full (around half to three-quarters full). Valves should be used to drain urine at regular intervals throughout the day to prevent urine building up in the bladder.

Both bags and valves should be replaced and thrown away about every 5 to 7 days.

At night, you will need to attach a larger bag to your valve or regular bag. This should be placed on a stand next to your bed, near the floor, to collect urine as you sleep. Depending on the type of night bag you have, it may need to be thrown away in the morning or it may be emptied, cleaned and reused for up to a week.

The catheter itself will need to be removed and replaced at least every 3 months. This will usually be done by a doctor or nurse, although sometimes it may be possible to teach you or your carer to do it.

Preventing infections and other complications

Having a long-term urinary catheter increases your risk of developing urinary tract infections (UTIs), and can also lead to other problems, such as blockages.

You will be advised about measures to take to minimise these risks, such as:

• regularly washing your hands, body and catheter with warm water and soap – it’s particularly important to clean your hands before and after touching your equipment
• ensuring you stay well hydrated – you should aim to drink enough fluids so that your urine stays pale
• preventing constipation – staying hydrated can help with this, as can eating high-fibre foods such as fruits, vegetables and wholegrain foods
• avoiding kinks in the catheter and making sure any urine collection bags are kept below the level of your bladder at all times

Read more about the risks of urinary catheterisation.

Your regular activities

Having a urinary catheter shouldn’t stop you from doing most of your normal activities. You will be advised about when it is safe for you to go to work, exercise, go swimming, go on holidays, and have sex.

If you have an intermittent or suprapubic (inserted through your tummy) catheter, you should be able to have sex as normal.

Indwelling catheters can be more problematic, but it’s still usually possible to have sex with them in place. For example, men can fold the catheter along the base of their penis and cover them both with a condom.

In some cases, you may be taught how to remove and replace the catheter so you can have sex more easily.

When to seek medical advice

You should contact a district nurse or nurse practitioner (you may be given a phone number to call before discharge from hospital) or your GP if:

• you develop severe or persistent bladder spasms (similar to stomach cramps)
• your catheter is blocked, or urine is leaking around the edges
• you have persistent blood in your urine, or are passing large clots
• you have symptoms of a UTI, such as pain, a high temperature (fever) and chills
• your catheter falls out (if it’s indwelling and you haven’t been taught how to replace it)

If your catheter falls out and you can’t contact a doctor or nurse immediately, go to your nearest accident and emergency (A&E) department.

Support groups and further information

Living with a catheter can be a challenge and you may find it useful to seek more information and advice from support groups and other organisations.

Urological and gynecological catheters – Articles

Urological and gynecological catheters

Catheters are medical instruments intended for emptying the bladder, introducing drugs or instruments through it during surgery. Manipulations associated with the installation of a catheter are called “catheterization”. Catheterization is also used for cystourethrography or monitoring of urine output after surgery in critically ill patients. Catheters are also used in pediatrics for diagnostics during sterile collection of urine for culture, when the baby cannot urinate on its own.

Types of urological and gynecological catheters and their purpose

Depending on the duration of use, two types of catheters for urine diversion are distinguished:

• Nelaton straight catheter. If it is necessary to divert urine once, this type of catheter is used. Straight catheters are soft, single lumen devices that are used for sterile urine collection for diagnosis or intermittent catheterization in neurogenic bladders. It can be used by men, women and adolescents for self-catheterization.
• Foley balloon catheter. These models are used in cases where long-term catheterization of the bladder is required. This need may be due to a number of diseases. Its feature is the presence of a special cylinder, which, when filled with liquid, inflates, ensuring the stable position of the system for a long time and preventing its spontaneous loss. A Foley catheter is prescribed for monitoring urination, for preventing or releasing in case of obstruction, continuous irrigation, and also for radiography when the bladder is completely filled.

The urologist prescribes a specific type of catheter based on the size of the urethra, the patient’s condition and physiological characteristics, and catheterization is usually performed by a nurse or family doctor.

Materials for urological and gynecological catheters

All urinary diversion catheters, both female and male, are available in soft and rigid. Soft products are made from elastic materials such as PVC, silicone, latex rubber and rubber. For the production of rigid urological and gynecological catheters, metal and special plastic composites are used.

Silicone products are suitable for patients allergic to latex. Optimally rigid prior to insertion, they soften at body temperature, making insertion easier and eliminating the need for lubrication.

The most commonly used soft catheter for urinary retention is a flexible, small diameter tube. There is a hole at the rounded end. The opposite end is made in the form of an expanding funnel.

Rigid models are used in rare cases of urinary retention. For example, a rigid metal catheter is prescribed for prostate adenoma. It is usually introduced by the doctor himself in order to avoid complications as a result of infection, as well as injuries to the urethra or rupture of the bladder.

In the presence of various diseases of the urinary system, such as infectious urethritis, spasms of the urinary sphincter, anuria, the catheter is not installed.

Design and types of Foley catheters

Foley catheter is designed for long-term catheterization (up to 30 days) of the bladder. It consists of a two or three lumen tube, at the distal end of which there is an inflatable balloon in the form of a cuff. Its capacity is marked at the proximal end. The inflated balloon secures the device in the bladder.

The closed end of the two-way catheter has two side holes. The three-way catheter has three separate ports:

• for balloon inflation;
• for urine excretion;
• for drug administration.

This design of the catheter makes it possible to reduce the diameter of its body to a minimum, which allows it to be inserted without much difficulty and used even in children.

The catheter is in a sterile blister pack. Sterilization was carried out with ethylene oxide.

All products are color-coded connector for quick sizing. Some models have a radiopaque band.

Foley catheterization for women and men

Women’s Foley catheters are shorter than men’s products. The installation of a catheter for women takes place in several stages:

• The patient should be in a supine position with her hips apart. Before starting manipulations, a thorough toilet of the genitals should be carried out. Then treat the urethra with an antiseptic. The inner end of the Foley catheter is lubricated with glycerin, a special gel, vaseline oil, or other jelly-like agent.
• Separate the labia majora and labia minora and insert the inner end of the catheter into the urethral opening by 3-5 cm, keeping it at a distance of 5-10 cm from the tip. The outer end should be directed to the urine collection tray. It is very important to keep the lips apart at the same time until the catheter is inserted to the desired depth. If the lips touch, then microbes can enter the treated area, and the entire preparatory procedure will have to be repeated.
• As soon as urine appears, advance the catheter another 3-7 cm.
• Drain all urine and fill the balloon with 5-15 ml of isotonic sodium chloride solution from a syringe through an additional channel.
• Check that the catheter is secure and connect the urinal to it. The connection point must be treated with a napkin.
• Attach the system to the inner thigh with adhesive tape.
• At the end of catheterization, remove the liquid from the balloon using a syringe.

Catheter placement for a man follows the same pattern:

• After pulling the foreskin, the glans penis is treated with an antiseptic solution.
• The catheter is inserted into the opening of the urethra to a depth of 20-25 cm. In this case, the penis should be raised to the abdomen or located perpendicular to the surface. In the deep part of the urethra, the catheter may meet the resistance of the clamped sphincter. To overcome it, you can rotate the catheter along the axis a little at the same time as the introduction.
• As soon as the handpiece reaches the bladder, urine will begin to flow.
• Urine is drained and with a syringe to be connected to the port, saline is then injected.
• A urinal is attached to the catheter and the system is fixed on the inner thigh with a patch.

Use warm saline to flush out the balloon catheter. If a precipitate or flakes appears in the urine, then it is recommended to use a solution of furacilin. A 50 or 100 ml syringe is suitable for rinsing.

A used reusable Foley catheter is subject to three steps in the processing of medical instruments: disinfection, pre-sterilization cleaning and sterilization. Disposable models are disinfected and disposed of.

Glavmed offers a wide range of urological and gynecological drainage devices: Nelaton catheters, two-way and three-way balloon Foley catheters, made of quality materials from trusted manufacturers. We offer both disposable and reusable products.

Glavmed LLC provides services for equipping medical and research institutions with medical equipment and consumables of the highest quality. We cooperate with both State and commercial medical organizations in Russia and the CIS countries. Delivery of goods is made in the shortest possible time. Our competent employees are always ready to consult and answer all your questions.

Bladder catheterization | Dobromed

Quite often, during pathological processes in the human body, more often of a urological nature, it becomes necessary to drain the bladder, that is, to create an artificial outflow of urine from the bladder reservoir cavity. In modern medical practice, this process is carried out using a whole set of modified devices (catheters) made of various materials. Bladder catheterization is used for both diagnostic and therapeutic purposes.

What causes the need for catheterization MP

Indications for the drainage procedure are individual and depend on many reasons. Usually, these are patients with urological problems. The drainage system is necessary: ​​

• when examining the urethral tract for the presence of obstruction in patients who have lost the ability to perform independent micturition, which led to their long delay (more than 12 hours) and the development of an acute pain syndrome, which may be the result of dysfunction of the bladder innervation, a strong inflammatory the process in the urethra, the presence of calculi or tumor formations in the organs of the urinary system themselves and in the tissues adjacent to it;
• for laboratory monitoring of urine for microflora – for greater reliability of the results, sterile urine is taken directly from the reservoir bladder cavity;
• if necessary, a cystourethrographic examination – diagnostics with a contrast agent;
• for washing the bladder cavity from stagnant urine, pus, or blood clots formed as a result of infectious and inflammatory processes, or surgical interventions;
• indications for catheterization are patients who have undergone surgical interventions on the organs of the urinary system, which contributes to the processes of complete regeneration and recovery;
• and finally, patients who are in a state of coma and who have lost the ability to independently mict;
• the patient has infectious urethritis;
• pathological disorders that prevent the flow of urine into the bladder cavity;
• trauma to the bladder organ and urethral tract;
• presence of blood in the urethra and scrotum;
• signs of urinary reflux;
• potential complications in the form of acute prostatitis or penile fracture;
• a real risk of infection of the MP from the outside.

Bladder drainage methods

Depending on the condition of patients and the purpose of drainage, bladder catheterization in women and other patients of various ages can be one-time, performed periodically (intermittent catheterization) or installed for a permanent period. For each specific case, its own drainage system is selected.

• if it is necessary to withdraw urine from the reservoir bladder cavity for diagnostic evaluation of the urinary tract condition and collection of urine for laboratory monitoring;
• in pregnant women with urological problems, to stabilize the condition just before childbirth;
• if necessary, medicinal irrigation of the MP reservoir tissues.

Disposable catheters are used for this purpose. The duration of the procedure does not exceed 2 minutes, and the minimal presence of a drainage tube in the body minimizes the risks of additional infection and the development of other complications.

The permanent catheterization procedure has been used since the middle of the last century for chronic urinary problems. The drain is left in the bladder reservoir for a long time. It is installed by the urethral route, or by means of a cystostomy (an incision in the pubic area of ​​the abdomen). But, as studies show, prolonged drainage contributes to the formation of calculi (stones) in the urinary excretion system and increases the risk of malignant tumors in the bladder.

According to international studies and the recommendations of the association of urologists – indwelling catheters should not be placed for more than 2 weeks.

The method of intermittent drainage has been widely used since the end of the 20th century to replace permanent drainage. The method is based on 4, 6 single catheterization during the day, which imitates the normal processes of urine excretion by single drainage. This technique represents the lowest risk of developing functional disorders in the kidneys, infectious and other disorders. It can be used for many months and years without causing any harm to health.

Types of urinary drainage systems

There are various types of bladder catheters, differing in material, size and modification, for women, men and children, soft (rubber), hard or rigid (metal) and semi-soft (synthetic), equipped with additional internal channels (from 1 to 3), for permanent and temporary drainage. Consider some of them used in medical practice:

• Nelaton (Robinson) drainage system – the simplest version of a rubber or polymer catheter. Designed for intermittent drainage in uncomplicated cases. Made from polyvinyl. Under the influence of body temperature becomes soft. Equipped with two side openings and a closed rounded end. They are used for both men and women, they differ only in length – for women from 12 cm to 15, for men, up to 40 cm. Sizes are marked with different color coding. A special hydrophilic coating, when interacting with moisture, makes it slippery, which does not require additional lubrication, and minimizes the risk of additional infection;

• Mercier (Timman) system – equipped with an elastic curved tip, two holes and one outlet channel. It is used in complex infectious and inflammatory processes against the background of adenomatous growths in the prostate, or stenosis of the urethral tract;
• Nelaton system with Timman tip – has the characteristics of a basic system, but the curved tip of the above device helps to drain patients with a prostate;
• catheter for long-term use of the Pezzera system. It has the form of a conventional rubber tube, equipped with two output channels and a retainer in the form of a thickening of the tube;

The

• Foley drainage catheter is the most commonly used type of drainage in urology. It is an excellent option for long-term use. Equipped with a special balloon (filled with sterile liquid) holding the device inside the MP. Through this catheter, the bladder is washed, drugs are administered, or urine is removed into the urinal attached to the end of the tube;

• two-channel with a common stroke for the outflow of urine and washing the MP and the channel through which balloon liquid is introduced;
• three-channel with an additional channel for the introduction of drugs, made of silicone-coated latex (cheap option), which eliminates the deposition of salts inside the catheter, or silver-coated silicone (expensive option), which inhibits bacterial replication and reduces the risk of infection;
• two-channel with a coraco-curved tip of Timman, which is the most convenient option for catheterization against the background of the prostate and its hyperplasia;
• with women’s and children’s versions (shorter in length and with a smaller diameter).

Drainage with rigid (metal) systems is rare today. In normal practice, catheterization with a soft catheter is used, which minimizes the risk of injury to the urethra.

In each case, the drainage system is selected by a doctor and installed by medical personnel. Self-drainage is fraught with serious consequences, additional infection and the development of dangerous complications, since the procedure requires special preparation and knowledge of certain rules of the installation algorithm.

Self-catheterization is performed only in emergency cases, when there is no way to call a doctor, or medical help is too late.

Preparation for drainage manipulation

The preparatory period for catheterization of patients consists of several stages, including:

• preliminary examination by a doctor to clarify the absence of contraindications;
• following a certain nutritious diet (excluding fried and spicy foods, alcohol and sweet drinks with gas) a couple of days before the procedure;
• careful preparation of the patient by a specialist (treatment of the genitals with an antiseptic, familiarization with the technique of catheterization).

At the next stage, a special kit for catheterization is selected, including:

• A set of sterile improvised materials necessary for the procedure – gauze, cotton swabs and napkins;
• Disposable medical gloves;
• Painkillers and sterile solutions to facilitate insertion of the catheter tube;
• Sterile plastic tweezers and Janet syringe cone configuration;
• Antiseptic solution and genital preparations;
• Urine tray.

Peculiarities of bladder drainage in adults

Drainage of the bladder organ in men is associated with peculiarities of the anatomical configuration of the urethra (long and curvy) and different structure of its sections – prostatic, membranous and cavernous, which makes it quite vulnerable and sensitive to various types of damage .The algorithm for performing bladder catheterization in men is determined by a certain, consistent technique for introducing a drainage device.

• drainage can be administered to men in a standing or lying position. The classic method is lying on couches with legs bent at the knees;
• the procedure begins with the treatment of the head of the penis with an antiseptic, instillation of sterile glycerin into the urethral fissure and treatment with it, the end of the catheter tube;
• The urine collection vessel is placed between the patient’s legs. If a permanent system is installed, the patient is given recommendations for its care in parallel. Sometimes a patient who has undergone surgery is offered an operation to remove the stoma;
• the next stage is the introduction of the system. With an antiseptic-treated tweezers, the doctor, at a distance of 6 centimeters from the edge, grabs the catheter tube and gradually immerses it into the urethra. To prevent uncontrolled micturition, the head of the penis is slightly squeezed.

• reaching the cavity of the urinary reservoir with a catheter is marked by the release of urine;
• after the release of urine, the tube of the system is attached to a syringe with sterile furatsilin, for subsequent rinsing of the bladder reservoir.