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Urinary catheter placement: Female Foley Catheter Insertion | Journal of Medical Insight

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Female Foley Catheter Insertion | Journal of Medical Insight

Abstract

Indwelling urethral (Foley) catheter insertion is routinely performed prior to abdominal hysterectomy procedures as well as many other gynecological operations. It is imperative to properly prepare a patient prior to the insertion of a urethral catheter to avoid catheter-associated urinary tract infection. This article demonstrates a technique to thoroughly prepare and insert an indwelling urinary catheter prior to a hysterectomy.

Case Overview
Background

Indwelling urinary catheters are placed prior to gynecological operations to decrease the size of the bladder to prevent damage, to prevent postoperative urinary retention1, and to accurately monitor urine output following surgery.2 Unfortunately, Foley catheters are known to cause catheter-associated urinary tract infection (CAUTI). Approximately 80% of urinary tract infections (UTI) are attributed to urinary catheters,3 resulting in patient discomfort, increased length of hospital stay, and higher costs associated with treatment of the infection. 4 Proper antiseptic technique when placing a urethral catheter can help prevent CAUTI.

Focused History of the Patient

A female patient undergoing an abdominal hysterectomy required urinary catheter placement prior to operation. There were no known allergies or contraindications.

Imaging

No imaging is necessary prior to urinary catheter insertion.

Natural History

CAUTI are common complications caused by Foley catheters due to the disruption of normal bodily flushing of the urethra that removes bacteria from a healthy urinary system.5 The route of transmission of bacteria is ascending, either by “hitchhiking” on the catheter from a contaminated surface to the bladder, by ascending the catheter after placement (a time-dependent process), or both.

Options and Rationale for Treatment

Before inserting an indwelling urinary catheter, one must first consider alternatives. According to the Healthcare Infection Control Practices Advisory Committee (HICPAC), operations involving the pelvic cavity are indications for urethral catheterization. Other indications include need to accurately measure urine output, to bypass bladder obstruction, urinary retention, comfort measures at the end of life, incontinent patients with sacral wounds, and others.5 In this case, the patient was undergoing an abdominal hysterectomy, an indication for Foley catheter placement.

Special Considerations

No special considerations were indicated for this patient.

Discussion

Placement of a Foley catheter creates a high risk for CAUTI resulting in increased patient morbidity, hospital costs, length of stay, and antimicrobial use; it can also lead to selection for multidrug resistant bacteria.5 Proper aseptic technique, choosing the smallest catheter that allows for proper drainage, and early removal is essential to aid in preventing infection.6 This procedure shows an aseptic technique that may prevent UTI related to Foley insertion prior to abdominal hysterectomy.

Instructions for female urethral catheterization from the Society of Urological Nurses and Associates include the following:

  1. Place patient in supine position with legs spread in stirrup position
  2. Perform thorough hand hygiene
  3. Using sterile technique, drape urethra
  4. Clean urethral opening with antiseptic (Betadine used here) while maintaining aseptic technique
  5. Lubricate catheter
  6. Advance catheter until urine appears
  7. Inflate balloon with syringe included in kit (usually 10 ml)
  8. Secure indwelling catheter

After securing the catheter, ensure that the drainage bag is placed below the bladder. Following these guidelines can prevent trauma, erosion, and CAUTI.7

Care surrounding indwelling urethral catheters can impact the occurrence of CAUTI as well. In addition to proper preparation prior to insertion, routine cleaning of the meatus, maintaining a closed urinary circuit, and prompt removal of the catheter can prevent CAUTI.5 The body of evidence suggests that indwelling catheters should be removed within 24 hours of insertion if at all possible.8

In conclusion, proper sterile preparation of the patient before insertion of an indwelling urethral catheter is one important factor in preventing CAUTI.

Equipment

Urinary catheter insertion kit, forceps, and betadine. A Foley catheter kit typically includes a latex or nonlatex catheter of appropriately chosen size and contour, a drainage bag and connecting tube, sterile lubricant, antiseptic solution, sterile cotton balls, sterile 5-10 ml syringe filled with appropriate amount of sterile water, and sterile gloves and drapes.

Disclosures

Nothing to disclose.

Statement of Consent

The patient referred to in this video article has given their informed consent to be filmed and is aware that information and images will be published online.

10.4 Urinary Catheters – Clinical Procedures for Safer Patient Care

Urinary elimination is a basic human function that can be compromised by illness, surgery, and other conditions. Urinary catheterization may be used to support urinary elimination in patients who are unable to void naturally. Urinary catheterization may be required:

  • In cases of acute urinary retention
  • When intake and output are being monitored
  • For preoperative management
  • To enhance healing in incontinent patients with open sacral and perineal wounds
  • For patients on prolonged bedrest
  • For patients needing end-of-life care

Catheter-Associated Urinary Tract Infections

Catheter-associated urinary tract infections (CAUTI) are a common complication of indwelling urinary catheters and have been associated with increased morbidity, mortality, hospital cost, and length of stay (Gould et al. , 2009). Urinary drainage systems are often reservoirs for multidrug-resistant organisms (MDROs) and a source of the transmission of microorganisms to other patients (Gould et al., 2009). The most important risk factor for developing a CAUTI, a health care associated infection (HAI), is the prolonged use of a urinary catheter (Centers for Disease Control and Prevention [CDC], 2015). Urinary tract infections (UTIs) are the most commonly reported HAIs in acute care hospitals and account for more than 30% of all reported infections (Gould et al., 2009). Catheters in place for more than a few days place the patient at risk for a CAUTI. A health care provider must assess patients for signs and symptoms of CAUTIs and report immediately to the primary health care provider. Signs and symptoms of a CAUTI include:

  • Fever, chills
  • Lethargy
  • Lower abdominal pain
  • Back or flank pain
  • Urgency, frequency of urination
  • Painful urination
  • Hematuria
  • Change in mental status (confusion, delirium, or agitation), most commonly seen in older adults

The following are practices for preventing CAUTIs (Perry et al. , 2014):

  • Insert urinary catheters using sterile technique.
  • Only insert indwelling catheters when essential, and remove as soon as possible.
  • Use the narrowest tube size (gauge) possible.
  • Provide daily cleansing of the urethral meatus with soap and water or perineal cleanser, following agency policy.
  • Ensure a closed drainage system.
  • Ensure that no kinks or blockages occur in the tubing.
  • Secure the catheter tube to prevent urethral damage.
  • Avoid use of antiseptic solutions on the urethral meatus and/or in the urinary bag.

Urinary Catheterization

Urinary catheterization refers to the insertion of a catheter tube through the urethra and into the bladder to drain urine. Although not a particularly complex skill, urethral catheterization can be difficult to master. Both male and female catheterizations present unique challenges.

Having adequate lighting and visualization is helpful, but does not ensure entrance of the catheter into the female urethra. It is not uncommon for the catheter to enter the vagina. Leaving the catheter in the vagina can assist in the correct insertion of a new catheter into the urethra, but you must remember to remove the one in the vagina.

For some women, the supine lithotomy position can be very uncomfortable or even dangerous. For example, patients in the last trimester of pregnancy may faint with decreased blood supply to the fetus in this position. Patients with arthritis of the knees and hips may also find this position extremely uncomfortable. Catheterization may also be accomplished with the patient in the lateral to Sims position (three-quarters prone).

The male urinary sphincter may also be difficult to pass, particularly for older men with prostatic hypertrophy.

There are two types of urethral catheterization: intermittent and indwelling.

Intermittent catheterization (single-lumen catheter) is used for:

  • Immediate relief of urinary retention
  • Long-term management of incompetent bladder
  • Obtaining a sterile urine specimen
  • Assessing residual urine in the bladder after voiding (if a bladder scanner is not available)

Indwelling catheterization (double- or triple-lumen catheter) is used for:

  • Promoting urinary elimination
  • Measuring accurate urine output
  • Preventing skin breakdown
  • Facilitating wound management
  • Allowing surgical repair of urethra, bladder, or surrounding structures
  • Instilling irrigation fluids or medications
  • Assessing abdominal/pelvic pain
  • Investigating conditions of the genitourinary system

The steps for inserting an intermittent or an indwelling catheter are the same, except that the indwelling catheter requires a closed drainage system and inflation of a balloon to keep the catheter in place. Indwelling catheters may have two or three lumens (double or triple lumens). Double-lumen catheters comprise one lumen for draining the urine and a second lumen for inflating a balloon that keeps the catheter in place. Triple-lumen catheters are used for continuous bladder irrigation and for instilling medications into the bladder; the additional lumen delivers the irrigation fluid into the bladder.

Indwelling urinary catheters are made of latex or silicone. Intermittent catheters may be made of rubber or polyvinyl chloride (PVC), making them softer and more flexible than indwelling catheters (Perry et al., 2014). The size of a urinary catheter is based on the French (Fr) scale, which reflects the internal diameter of the tube. Recommended catheter size is 12 to 16 Fr for females, and 14 to 16 Fr for males. Smaller sizes are used for infants and children. The balloon size also varies with catheters: smaller for children (3 ml) and larger for continuous bladder irrigation (30 ml). The size of the catheter is usually printed on the side of the catheter port.

An indwelling catheter is attached to a drainage bag to allow for unrestricted flow of urine. Make sure that the urinary bag hangs below the level of the patient’s bladder so that urine flows out of the bladder. The bag should not touch the floor, and the patient should carry the bag below the level of the bladder when ambulating. To review how to insert an indwelling catheter, see Checklist 80.

Checklist 80: Insertion of an Intermittent or Indwelling Urinary Catheter
Disclaimer: Always review and follow your hospital policy regarding this specific skill.
Safety considerations: 
  • Perform hand hygiene.
  • Check room for additional precautions.
  • Introduce yourself to patient.
  • Confirm patient ID using two patient identifiers (e.g., name and date of birth).
  • Explain process to patient; offer analgesia, bathroom, etc.
  • Listen and attend to patient cues.
  • Ensure patient’s privacy and dignity.
  • Assess ABCCS/suction/oxygen/safety.
  • Apply principles of asepsis and safety.
  • Check vital signs.
  • Complete necessaryfocused assessments.
Steps
 Additional Information
1. Verify physician order for catheter insertion. Assess for bladder fullness and pain by palpation or by using a bladder scanner. Palpation of a full bladder will cause an urge to void and/or pain.
2. Position patient prone to semi-upright with knees raised; apply gloves; and inspect perineal region for erythema, drainage, and odour. Also assess perineal anatomy. Assessment of perineal area allows for determination of perineal condition and position of anatomical landmarks to assist with insertion.
Apply non-sterile gloves
3. Remove gloves and perform hand hygiene. This prevents transmission of microorganisms.
Remove non-sterile glovesPerform hand hygiene
4. Gather supplies:

  • Sterile gloves
  • Catheterization kit
  • Cleaning solution
  • Lubricant (if not in kit)
  • Prefilled syringe for balloon inflation as per catheter size
  • Urinary bag
  • Foley catheter
Preparation ahead of time enhances patient comfort and safety.
Prepare sterile field
5. Check for size and type of catheter, and use smallest size of catheter possible. Larger catheter size increases the risk of urethral trauma.
Choose smallest catheter size possible
6. Place waterproof pad under patient. This step prevents soiling of bed linens.
Place waterproof pad under patient
7. Positioning of patient depends on gender.

Female patient: On back with knees flexed and thighs relaxed so that hips rotate to expose perineal area. Alternatively, if patient cannot abduct leg at the hip, patient can be side-lying with upper leg flexed at knee and hip, supported by pillows.

Male patient: Supine with legs extended and slightly apart.

Patient should be comfortable, with perineum or penis exposed, for ease and safety in completing procedure.
8. Place a blanket or sheet to cover patient and expose only required anatomical areas. This step helps protect patient dignity.
9. Apply clean gloves and wash perineal area with warm water and soap or perineal cleanser according to agency policy. Cleaning removes any secretions, urine, and feces, and reduces risk of CAUTI.
10. Ensure adequate lighting. Adequate lighting helps with accuracy and speed of catheter insertion.
11. Perform hand hygiene. This reduces the transmission of microorganisms.
Perform hand hygiene
12. Add supplies and cleaning solution to catheterization kit, and according to agency policy. This step ensures preparation and organization for procedure.
Add supplies as necessary
13. If using indwelling catheter and closed drainage system, attach urinary bag to the bed and ensure that the clamp is closed. Urinary bag should be closed to prevent urine drainage leaving bag.
Urinary bag
14. Apply sterile gloves using sterile technique. This reduces the transmission of microorganisms.
Apply sterile gloves
15. Drape patient with drape found in catheterization kit, either using sterile gloves or using ungloved hands and only touching the outer edges of the drape. Ensure that any sterile supplies touch only the middle of the sterile drape (not the edges), and that sterile gloves do not touch non-sterile surfaces. Drape patient to expose perineum or penis. The outer 2.5 cm is considered non-sterile on a sterile drape.
Cover patient with sterile drape
16. Lubricate tip of catheter using sterile lubricant included in tray, or add lubricant using sterile technique. Lubrication minimizes urethral trauma and discomfort during procedure.
Lubricate tip of catheter
17. Check balloon inflation using a sterile syringe. This maintains sterility of catheter.
Check balloon inflation using a sterile syringe
18. Place sterile tray with catheter between patient’s legs. Sterile tray will collect urine once catheter tip is inserted into bladder.
19. Clean perineal area as follows.

Female patient: Separate labia with fingers of non-dominant hand (now contaminated and no longer sterile). Using sterile technique and dominant hand, clean labia and urethral meatus from clitoris to anus, and from outside labia to inner labial folds and urethral meatus. Use sterile forceps and a new cotton swab with each cleansing stroke.

Male patient: Gently grasp penis at shaft and hold it at right angle to the body throughout procedure with non-dominant hand (now contaminated and no longer sterile). Using sterile technique and dominant hand, clean urethral meatus in a circular motion working outward from meatus. Use sterile forceps and a new cotton swab with each cleansing stroke.

This reduces the transmission of microorganisms.
Cleanse perineal area
20. Pick up catheter with sterile dominant hand 7.5 to 10 cm below the tip of the catheter. Holding catheter closer to the tip will help to control and manipulate catheter during insertion.
21. Insert catheter as follows.

Female patient:

  • Ask patient to bear down gently (as if to void) to help expose urethral meatus.
  • Advance catheter 5 to 7.5 cm until urine flows from catheter, then advance an additional 5 cm.

Male patient:

  • Hold penis perpendicular to body and pull up slightly on shaft.
  • Ask patient to bear down gently (as if to void) and slowly insert catheter through urethral meatus.
  • Advance catheter 17 to 22.5 cm or until urine flows from catheter.
This process helps visualize urethral meatus and relax external urinary sphincter.
Insert catheter gently
Note: If urine does not appear in a female patient, the catheter may be in the patient’s vagina. You may leave catheter in vagina as a landmark, and insert another sterile catheter.
Note: If catheter does not advance in a male patient, do not use force. Ask patient to take deep breaths and try again. If catheter still does not advance, stop procedure and inform physician. Patient may have an enlarged prostate or urethral obstruction.
22. Place catheter in sterile tray and collect urine specimen if required. Urine specimen may be required for analysis. Collect as per agency policy.
23. Slowly inflate balloon for indwelling catheters according to catheter size, using prefilled syringe. The size of balloon is marked on the catheter port.
Slowly inflate balloon
Note: If patient experiences pain on balloon inflation, deflate balloon, allow urine to drain, advance catheter slightly, and reinflate balloon.
24. After balloon is inflated, pull gently on catheter until resistance is felt and then advance the catheter again. Moving catheter back into bladder will avoid placing pressure on bladder neck.
25. Connect urinary bag to catheter using sterile technique. Keep urinary bag below level of patient’s bladder.
Connect urinary bag to catheter using sterile technique
26. Secure catheter to patient’s leg using securement device at tubing just above catheter bifurcation.

Female patient: Secure catheter to inner thigh, allowing enough slack to prevent tension.

Male patient: Secure catheter to upper thigh (with penis directed downward) or abdomen (with penis directed toward chest), allowing enough slack to prevent tension. Ensure foreskin is not retracted.

Securing catheter reduces risk of CAUTI, urethral erosion, and accidental catheter removal.
Secure catheter to patient’s leg

For male patients, leaving the foreskin retracted can cause pain and edema.

27. Dispose of supplies following agency policy. This reduces the transmission of microorganisms.
28. Remove gloves and <a href=”/clinicalskills/chapter/1-6-hand-hygiene/”>perform hand hygiene. This reduces the transmission of microorganisms.
Hand hygiene with ABHR
29. Document procedure according to agency policy, including patient tolerance of procedure, any unexpected outcomes, and urine output. Timely and accurate documentation promotes patient safety.
Data source: BCIT, 2015c; Perry et al., 2014

Video 10.2

Watch the video Urinary Catheterization (Male) by Renée Anderson and Wendy McKenzie, Thompson Rivers University.

Video 10.3

Watch the video Urinary Catheterization (Female) by Renée Anderson and Wendy McKenzie, Thompson Rivers University.

Removing a Urinary Catheter

Patients require an order to have an indwelling catheter removed. Although an order is required, it remains the responsibility of the health care provider to evaluate if the indwelling catheter is necessary for the patient’s recovery.

A urinary catheter should be removed as soon as possible when it is no longer needed. For post-operative patients who require an indwelling catheter, the catheter should be removed preferably within 24 hours. The following are appropriate uses of an indwelling catheter (Gould et al., 2009):

  • Improved comfort for end-of-life care
  • Assisting in the healing process of an open sacral or perineal pressure ulcer
  • Patients requiring prolonged immobilization (unstable thoracic or lumbar fractures, multiple traumatic injuries)
  • Select surgical procedures (prolonged procedures, urological surgeries, etc.)
  • Intra-operative monitoring of urinary output
  • Patients receiving large-volume infusions or diuretic intra-operatively

When a urinary catheter is removed, the health care provider must assess if normal bladder function has returned. The health care provider should report any hematuria, inability or difficulty voiding, or any new incontinence after catheter removal. Prior to removing a urinary catheter, the patient requires education on the process of removal, and on expected and unexpected outcomes (e.g., a mild burning sensation with the first void) (VCH Professional Practice, 2014). The health care provider should instruct patients to

  • Increase or maintain fluid intake (unless contraindicated)
  • Void when able and within six to eight hours after removal of the catheter
  • Inform the health care provider when he or she has voided, and measure the amount, colour, and any abnormal findings; ensure first void (urine output) is measured as per agency policy
  • Report any burning, pain, discomfort, or small amount of urine volume
  • Report an inability to void, bladder tenderness, or distension
  • Report any signs of a CAUTI

Review the steps in Checklist 81 on how to remove an indwelling catheter.

Checklist 81: Removing an Indwelling Catheter
Disclaimer: Always review and follow your hospital policy regarding this specific skill.
Safety considerations:
  • Perform hand hygiene.
  • Check room for additional precautions.
  • Introduce yourself to patient.
  • Confirm patient ID using two patient identifiers (e.g., name and date of birth).
  • Explain process to patient; offer analgesia, bathroom, etc.
  • Listen and attend to patient cues.
  • Ensure patient’s privacy and dignity.
  • Assess ABCCS/suction/oxygen/safety.
  • Apply principles of asepsis and safety.
  • Check vital signs.
  • Complete necessary focused assessments.
Steps
 Additional Information
1. Verify physician orders, perform hand hygiene, and gather supplies. Supplies include non-sterile gloves, sterile syringe (verify size of balloon on Foley catheter), waterproof pad, garbage bag, and cleaning supplies for perineal care.
2. Identify patient using two identifiers. Create privacy and explain procedure for catheter removal. This ensures you have the correct patient and follows agency policy on proper patient identification.
3. Educate patient on catheter removal and post-urinary catheter care. Patient must be informed of what to expect after catheter is removed and how to measure urine output, etc.
4. Perform hand hygiene and set up supplies. Perform hand hygiene

Raise bed to working height.

Organize supplies.

Position patient supine for easy access.

5. Apply non-sterile gloves. This reduces the transfer of microorganisms.
Apply non-sterile gloves
6. Measure, empty, and record contents of catheter bag. Remove gloves, perform hand hygiene, and apply new non-sterile gloves.

Remove catheter securement/anchor device.

Record drainage amount, colour, and consistency according to agency policy.

Always change gloves after handling a urinary catheter bag.

Removing catheter securement device provides easy access to catheter for cleaning and removing.

Remove catheter securement device

7. Perform catheter care with warm water and soap or according to agency protocol. This reduces the transfer of microorganisms into the urethra.
8. Insert syringe in balloon port and drain fluid from balloon. Verify balloon size on catheter to ensure all fluid is removed from balloon. A partially deflated balloon will cause trauma to the urethra wall and pain.
Insert syringe in balloon port and drain fluid from balloon
9. Pull catheter out slowly and smoothly. Catheter should slide out slowly and smoothly. If resistance is felt, stop removal and reattempt to remove the fluid from the balloon. Attempt removal again. If unable to remove the catheter, stop and notify physician.
Pull catheter out slowly and smoothly
10. Wrap used catheter in waterproof pad or gloves. Unhook catheter tube from urinary bag. Discard equipment and supplies according to agency policy. This prevents accidental spilling of urine from the catheter.
Wrap used catheter in waterproof pad or gloves
11. Provide perineal care as required and reposition patient to a comfortable position. This promotes patient comfort.
12. Review post-catheter care, fluid intake, and expected and unexpected outcomes with patient. Ensure patient has access to toilet, commode, bedpan, or urinal. Place call bell within reach. Ensure first void (urine output) is measured as per agency policy.
Encourage patient to maintain or increase fluid intake to maintain normal urine output (unless contraindicated).
13. Lower bed to safe position, remove gloves, and perform hand hygiene. Lowering the bed helps prevent falls. Hand hygiene prevents the transmission of microorganisms from patient to health care provider.
Hand hygiene with ABHR
14. Document procedure according to agency policy. Document time of catheter removal, condition of urethra, and any teaching related to post-catheter care and fluid intake.

Document time, amount, and characteristics of first void after catheter removal.

Data source: ATI, 2015d; BCIT, 2015b; Perry et al., 2014; VCH Professional Practice, 2014

If a patient is unable to void after six to eight hours of removing a urinary catheter, or has the sensation of not emptying the bladder, or is experiencing small voiding amounts with increased frequency, a bladder scan may be performed. A bladder scan can assess if excessive urine is being retained. Notify the health care provider if patient is unable to void within six to eight hours of removal of a urinary catheter. If a patient is found to have retained urine in the bladder and is unable to void, an intermittent/straight catheterization should be performed (Perry et al., 2014).

Video 10.4

Watch the video Foley Catheter Removal by Renée Anderson and Wendy McKenzie, Thompson Rivers University.
Read the To Scan or Not To Scan journal article for more information on bladder scanning.

  1. Describe the different techniques for cleansing a female and a male patient prior to catheterization.
  2. Your male patient complains of pain while you are inserting a urinary catheter. Describe your next steps.

A clever technique for placement of a urinary catheter over a wire

Urol Ann. 2015 Jul-Sep; 7(3): 367–370.

Joel E. Abbott

Department of Urology, St. John Providence, Michigan State University, Detroit, MI 48071, USA

Adam Heinemann

Department of Urology, St. John Providence, Michigan State University, Detroit, MI 48071, USA

Robert Badalament

Department of Urology, St. John Providence, Michigan State University, Detroit, MI 48071, USA

Julio G. Davalos

1Chesapeake Urology Associates, University of Maryland, Baltimore, MD 21061, USA

Department of Urology, St. John Providence, Michigan State University, Detroit, MI 48071, USA

1Chesapeake Urology Associates, University of Maryland, Baltimore, MD 21061, USA

Address for correspondence: Dr. Joel E. Abbott, 27321 Dequindre Road, Unit 32, Madison Heights, MI, USA. E-mail: [email protected]

Received 2015 Jan 20; Accepted 2015 Mar 9.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

This article has been cited by other articles in PMC.

Abstract

Objective:

The objective was to present a straightforward, step-by-step reproducible technique for placement of a guide-wire into any type of urethral catheter, thereby offering a means of access similar to that of a council-tip in a situation that may require a different type of catheter guided over a wire.

Materials and Methods:

Using a shielded intravenous catheter inserted into the eyelet of a urinary catheter and through the distal tip, a “counsel-tip” can be created in any size or type of catheter. Once transurethral bladder access has been achieved with a hydrophilic guide-wire, this technique will allow unrestricted use of catheters placed over a wire facilitating guided catheterization.

Results:

Urethral catheters of different types and sizes are easily advanced into the bladder with wire-guidance; catheterization is improved in the setting of difficult urethral catheterization (DUC). Cost analysis demonstrates benefit overuse of traditional council-tip catheter.

Conclusion:

Placing urinary catheters over a wire is standard practice for urologists, however, use of this technique gives the freedom of performing wire-guided catheterization in more situations than a council-tip allows. This technique facilitates successful transurethral catheterization over wire in the setting of DUC for all catheter types and styles aiding in urologic management of patients at a cost benefit to the health care system.

Keywords: Prostatic hyperplasia, urethral obstruction, urethral stricture, urinary bladder neck obstruction, urinary catheter, urinary retention

INTRODUCTION

Urologists frequently address difficult urethral catheterization (DUC), which may be due to obstruction, constriction, false passages, urethral stones, urethral strictures, phimosis, anasarca, bladder neck contracture, benign prostatic hyperplasia (BPH), and other more rare causes.[1,2] To facilitate successful catheterization in these situations, a wide variety of catheters differing in style, shape, size, and material have been manufactured (Coudé, council-tip, silicone, etc.). Many techniques have also been described including the use of a vaginal speculum with forceps advancement in the presence of severe anasarca,[3] the use of Peel-away® sheath placed over a resectoscope or cystoscope allowing for catheter access through the sheath once the scope is removed from the urethral lumen,[4] and hydrodistension of the urethra and lubrication of the hydrophilic Foley by attaching a 60 mL catheter tip be the standard of care.[5]

A council-tip catheter allows for wire-guided placement through an end hole drainage port (lumen) at the tip of the catheter. This provides a direct route for the wire from the drainage port through the lumen of the catheter for advancement of the catheter over the wire. There are situations in which the necessity of a guide-wire is tantamount to the need for varying styles of catheter. Many situations require bladder lavage, such as posttransurethral resection (TUR) of bladder tumor or TUR of prostate (TURP), hemorrhagic cystitis, or gross hematuria, and wire-guidance may be favorable due to the complexity of the situation. The council-tip is furthermore limited by its availability in many clinical settings as the cost of such catheters can be as much as 6–10 times the cost of the more commonly used urinary catheters. This makes it difficult for facilities with budget limitations to electively carry this additional catheter type. A less expensive urinary catheter modified into a council-tip style catheter with a routinely available angiocath, may be a preferred option due to cost, availability, and versatility. We describe a technique that allows for wire-guided catheter placement using any type, size, or style of urinary catheter.

MATERIALS AND METHODS

We present this technique utilizing a 16Fr Foley Catheter, an 18 gauge BD Insyte™ (Becton Dickinson) Autoguard shielded intravenous (IV) catheter (angiocath), and a 0.035Fr (0.89 mm) Radiofocus® Glidewire® []. Please note that any type or style of urinary catheter may be utilized depending on the clinical scenario. Any angiocath sized 18 gauge or larger may be used to accommodate the 0.035Fr glide-wire (hydrophilic guide-wire), but 16 and 18 gauge seem to be most readily available.

The technique is performed as follows:

  • First, a guide-wire must be placed into the bladder. Obtain transurethral access to the bladder using a hydrophilic guide-wire (a procedure common to the urologist), often facilitated by cystourethroscopy

  • Prepare the catheter by creating a new opening in the tip of the catheter. This is achieved by advancing the IV catheter (angiocath) through one of the lateral eyelets toward the drainage tip piercing the catheter centered at the tip. Once the angiocath is through the end of the catheter, the auto guard is deployed, and the needle is shielded, leaving the angiocath positioned in the end of the catheter tip []

    (a) This technique may be performed with any style catheter and an 18 (or larger) gauge angiocath, (b) pass the angiocath through the lateral eyelet of the catheter, (c) advance the angiocath through the center tip of the catheter, (d) ensure the angiocath shaft as well as the needle pass through the tip of the catheter, (e) use the push-button needle shield to retract the needle leaving the angiocath in place, (f) after achieving distal glidewire placement into the bladder, advance the proximal end of the glidewire through the tip of the angiocath

  • The 0.035Fr Glidewire® is then advanced through the angiocath (from the external drainage surface of the catheter) until approximately 2–3 cm of the wire is exposed from the portion of the angiocath exiting the eyelet. While stabilizing the Glidewire®, the angiocath is removed from the catheter leaving only the Glidewire® passed through the tip []

    (g) Pass the glidewire through the full extent of the angiocath, (h) remove the angiocath, (i) maintain the position of the glidewire through the tip of the catheter and out of the lateral eyelet, (j) slowly withdraw the glidewire until it enters back into the lateral eyelet of the catheter, (k) maintaining the glidewire’s position within the central tip of the catheter, redirect it to advance through the catheter lumen, (l) with the catheter successfully positioned over the glidewire, guide the catheter into the bladder over the glidewire

  • By carefully retreating the exposed portion of the Glidewire® until it is able to pass easily through the lateral eyelet into the central canal (drainage port) of the catheter. Then advance the catheter over wire until bladder access is achieved.

If the resistance is encountered as the catheter is sliding over the wire, water or saline can quickly be applied to the wire and catheter tip. Since these two contacting surfaces are hydrophilic, simply wetting the surfaces will aid in easing the advancement of the catheter.

RESULTS

When encountering a difficult catheterization and choosing to use wire-guided access, this approach is preferred due to the versatility and freedom it offers. If the circumstances warrant the use of specific catheter for a patient with additional pathology such as a false passage, BPH or post-TUR and wire-guided placement is preferred, using an IV catheter (angiocath) maintains the structural integrity of the catheter facilitating precise guidance.[4] A three-way irrigation catheter may be advanced over a wire in cases such as hemorrhagic cystitis, hemorrhagic prostatic urethra, and postinstrumentation. Since adopting this procedure, hundreds of catheters have been successfully and safely placed over wire.

A cost analysis was performed by comparing prices of the different types of catheters from different suppliers, as well as the cost of the additional materials required for the technique []. The cost of a standard catheter is significantly less than the cost of a council-tip catheter. There is a convincing cost advantage in utilizing this technique over a council-tip catheter, in addition to the clinical advantage observed.

Table 1

DISCUSSION

Other techniques of creating a “council-tip” have been described in the literature, however, limitations exist. Cutting the catheter tip transversely can result in a blunt, misshapen tip to a Foley and alter the shape of a Coudé tip causing loss of the structural integrity and sleek shape. A vertical cut is often technically difficult and still alters the integrity of the catheter’s tapered structure creating a flap at the tip of the catheter. Both cuts may also increase the likelihood of resistance and catch on a stricture or urothelial flap. In addition, if a cut is made and a catch or abrasive surface is left on the catheter, the thin layer of urothelium (3–5 cells, depending on the volume) may be traumatized during insertion, negating the effectiveness of the technique.

A new technology is now available that enables direct visualization of the urethra while passing a catheter. One such system (DirectVision System; PercuVision, Westerville, Ohio, USA) consists of a microendoscope that inserts into 1 lumen of a three-way/trilumen Foley catheter. The microendoscope is connected to a camera and light emitting diode, transporting light to the catheter tip and an image back to the liquid crystal display monitor for real-time visualization of the urethra during catheter placement. This option, while improving outcomes of a DUC, may be cost-prohibitive based on frequency of DUC seen in a given population and equipment cost. A thorough cost analysis would be advised for individual care facilities to determine the feasibility of such devices. This technology is also mainly targeted for safe placement of initial catheter placement by nursing staff or nonspecialists. A urologist would still typically handle a difficult catheterization, and these scenarios routinely require wire access and dilatation regardless.

In the clinical setting, contemporary urethral dilatation is performed with dilating instruments over a wire, although some still prefer the use of fillaforms. After dilating over a wire, use of this technique also allows for the catheter of choice to be placed over that same wire, while maintaining its position within the bladder.

This technique also offers the urologist with an additional tool when a council-tip catheter is not available. This facilitates wire-guided catheter placement with traditional catheters and readily available equipment, reducing the cost.

Proper catheter placement is critical, as failed attempts at catheterization may lead to iatrogenic injury. Forcing a catheter past the point of resistance can cause injuries ranging from a mucosal tear and bleeding to more serious false passages (perforations), which are associated with infection, urethral stricture, and subsequent surgical management.[6,7,8,9] Repeated and unsuccessful attempts may result in stress and pain for the patient, injury to the urethra, which potentiates urethral stricture formation requiring surgical reconstruction, and problematic subsequent catheterization. Improper insertion of catheters also can significantly increase healthcare costs due to added days of hospitalization, increased interventions, and increased complexity of care.[5,10]

We utilize this technique in any patient that we feel advancing a catheter over wire would be of benefit. We no longer stock council-tip catheters in our institutions since we have found this technique to be simple, easily reproducible, and materials needed are readily available. We routinely conclude TURP procedures by placing a catheter over wire in this fashion after placing a wire through the resectoscope sheath into the bladder before removing the sheath to avoid misplacement of the catheter due to the TUR defect. No adverse outcomes have been observed, and no mortality or morbidity has been attributed to catheter placement with this technique.

CONCLUSION

Complicated urinary catheterization is a commonly encountered urologic problem. The technique presented offers a step-by-step approach for improving success in catheter placement over a wire. Equipment needed is typically available on the hospital floors and in the operating room. This approach offers patients better care, with less pain and complications, while minimizing hospital resources, sparing the facility of the need to stock additional supplies.

While council-tip catheters offer a means of simple advancement over wire, they are limited by the lack of versatility for situations that call for a different style of catheter such as a Coudé, three-way or Foley catheter of different size. Furthermore, they may be cost prohibitive or simply not available to the urologist.

Coudé catheters offer greater transurethral access in the setting of BPH traversing the S-shaped bulbous urethra with rigidity to advance beyond an obstructing prostate, however, the lack of a guide makes this tool more difficult in the case of a stricture or false passage.

A three-way catheter is useful when bladder lavage is necessary, but again offers little ability to navigate obstacles in the urethra. In addition, the majority of urologists prefer large caliber three-way catheters to prevent a clot obstruction of the catheter, and this may be the cause for assistance in advancing beyond stenotic regions of the urethra.

This technique is also helpful in safely placing a drainage catheter at the conclusion of a TURP where a thorough resection thins the prostatic urethra and may undermine the bladder trigone in resection of the median lobe. The wire can be placed through the cystoscope/resectoscope followed by placement of the catheter over wire.

Footnotes

Source of Support: Nil

Conflict of Interest: None.

REFERENCES

1. Villanueva C, Hemstreet GP., 3rd Difficult male urethral catheterization: A review of different approaches. Int Braz J Urol. 2008;34:401–11. [PubMed] [Google Scholar]2. Cancio LC, Sabanegh ES, Jr, Thompson IM. Managing the foley catheter. Am Fam Physician. 1993;48:829–36. [PubMed] [Google Scholar]4. Lowe MA, Defalco AJ. New endourologic technique for catheter placement after TURP, prostatectomy, and difficult urethroscopy. Urology. 1992;40:461–3. [PubMed] [Google Scholar]5. Daneshgari F, Krugman M, Bahn A, Lee RS. Evidence-based multidisciplinary practice: Improving the safety and standards of male bladder catheterization. Medsurg Nurs. 2002;11:236–41. 246. [PubMed] [Google Scholar]6. Hadfield-Law L. Male catheterization. Accid Emerg Nurs. 2001;9:257–63. [PubMed] [Google Scholar]7. Gray M. Urinary retention. Management in the acute care setting. Part 2. Am J Nurs. 2000;100:36–43. [PubMed] [Google Scholar]8. Ramakrishnan K, Mold JW. Urinary catheters: A review. Internet J Fam Pract. 2005;3:1–29. [Google Scholar]9. Curtis LA, Dolan TS, Cespedes RD. Acute urinary retention and urinary incontinence. Emerg Med Clin North Am. 2001;19:591–619. [PubMed] [Google Scholar]10. Willette PA, Coffield S. Current trends in the management of difficult urinary catheterizations. West J Emerg Med. 2012;13:472–8. [PMC free article] [PubMed] [Google Scholar]

Inadvertent placement of a urinary catheter into the ureter: A report of 3 cases and review of the literature

Abstract

We describe three cases of inadvertent placement of the urinary catheter into the ureter. An 85-year-old gentleman on long-term indwelling catheter (IDC) for neurogenic bladder presented with fever and right flank pain. CT of abdomen and pelvis demonstrated the tip of the IDC to be located within the right vesicoureteric junction with acute right hydronephrosis and acute pyelonephritis. A 74-year-old woman, on long-term IDC for neurogenic bladder was found to have hydronephrosis on ultrasound imaging. Contrast-enhanced CT intravenous pyelography done subsequently showed the IDC was in the right distal ureter. A 47-year-old lady, on IDC for urinary retention and voiding dysfunction likely secondary to schizophrenia and anti-psychotic medications, presented with raised creatinine. A non-enhanced CT of her abdomen and pelvis was done and showed that the tip of the urethral IDC was located up to the left vesicoureteric junction. In all patients, the hydronephrosis resolved after changing the catheter and they were well on discharge. We also review the literature to identify the incidence, outcomes and possible risk factors. To our knowledge, only 20 cases have been reported thus far in the English literature. Although serious complications can occur, the incidence is very low. One risk factor that has been identified is long-term catheterization in patients with neurogenic bladder. We do not recommend routine imaging after catheterization in this group of patients. However, we should still be mindful of the possibility of this occurrence and evaluate and treat as necessary when clinical suspicion arises.

Keywords

Indwelling catheter

Ureter

Complication

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Your indwelling urinary catheter

How your catheter works

Your catheter is a hollow tube that is inserted into your bladder to drain urine.

It is inserted into the bladder through the urethra (the channel you normally urinate through) and is known as urethral catheterisation.

Your catheter will not fall out because it is held in place by a small balloon. It is inflated with sterile water after the catheter is inserted into the bladder (see figures 1 and 2).

Never try to remove your catheter without medical or nursing advice. You may cause an injury to yourself.

Most catheters can be left in place for up to 12 weeks, but this may vary under different circumstances.

The first catheter change will be done about 6 weeks after the first insertion.

A decision will be made by the nurse when the next change will be.

This will be reassessed if you have any problems.

Your catheter can be changed by your doctor or nurse:

  • at home
  • at your hostel or nursing home
  • in the hospital outpatient department.

Your doctor or nurse will advise you of the arrangements for changing your catheter.

The catheter should be comfortable to wear and should not pull.

Positioning your catheter correctly will help make it comfortable.

Sexual activity

Sexual activity may continue with an indwelling urinary catheter in place.

You may prefer to discuss with your doctor the use of a suprapubic catheter.

It is important to wash around the catheter prior to sexual intercourse.

Men should fold the catheter along the side of the erect penis and hold in place with a condom.

Women should tape the catheter up onto the stomach.

Only water based lubricants should be used to assist with sexual intercourse. Other lubricants may damage the catheter. 

Where to get help

Remember

  • Your catheter is a hollow tube that is inserted into your bladder to drain urine.
  • Your catheter will not fall out because it is held in place by a small balloon.
  • Never try to remove your catheter without medical or nursing advice.

Acknowledgements

Royal Perth Hospital


This publication is provided for education and information purposes only. It is not a substitute for professional medical care. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your healthcare professional. Readers should note that over time currency and completeness of the information may change. All users should seek advice from a qualified healthcare professional for a diagnosis and answers to their medical questions.

Urinary Catheter Placement – International Emergency Medicine Education Project

by Gul Pamukcu Gunaydin

Case Presentation

A 75-year-old male patient was admitted to the emergency department with difficulty voiding. He had this complaint for over a year, and tonight, although he felt pain and distention in his lower abdomen, he could not urinate at all. On his physical exam, the patient had a palpable mass that was thought to be the distended bladder. He was agitated and tachycardic. He was diagnosed with acute urinary retention, and initial attempt to insert urinary indwelling catheter was failed. The second attempt with a Coude catheter was successful and 2 liters of urine was drained gradually. His rectal exam revealed prostate enlargement. He was discharged with instructions, uneventfully.

Procedure: Urinary Catheter Placement

Urinary catheter insertions is a common procedure in the ED. They may be external (condom) or indwelling (urethral, suprapubic). Condom catheters are indicated in men with functional disabilities such as restricted mobility or dementia with incontinence, who can void spontaneously. Suprapubic catheters are an option if urethral catheters fail. This chapter focuses solely on urethral urinary catheterization.

Emergency Indications

Short-term catheterization
  • Diagnostic
    • Diagnostic sampling (sterile urine sampling)
    • Monitoring urinary output (trauma, critically ill, burns)
    • Filling the bladder prior to pelvic ultrasound
    • Cystogram, cystourethrogram
    • Urine collection
    • Monitoring core body temperature
  • Therapeutic
    • Draining urine in acute urinary retention, urinary obstruction, inability to void
    • Irrigation of bladder to remove gross hematuria and clots/debris
    • Palliative care for terminally ill (e.g.to assist treatment of decubitus ulcers in incontinent patients by maintaining moisture free environment)
    • To warm hypothermic patients
    • Intubated patient
    • Emergency Surgery
Long-term catheterization
  • Bladder outlet obstruction
  • To reduce changes in patients who are terminally ill or cannot care for themselves
  • Neurogenic bladder
  • Urinary incontinence

Contraindications

Absolute
  • Trauma patient presenting with the following signs (known or suspected urethral damage):
    • Blood at meatus
    • Penile deformity
    • High riding prostate
    • Perineal hematoma
  • Allergy to latex, rubber or lubricants
Relative
  • Uncooperative patient
  • Recent bladder or urethral surgery
  • Urethral Stricture

Equipment and Patient Preparation

  • Urinary catheter: Catheters are classified according to the material it is made of, number of lumens and shape of the tip.
    • Number of lumens
      • One way-non balloon also known as straight, Nelaton or Robinson catheters are used for one time or intermittent drainage.
      • Two-way catheters have a balloon inflation channel and a urine drainage channel.
      • Foley catheter, which has a self-retaining balloon, is the most commonly used.
      • The triple lumen (three-way) indwelling catheter is used for bladder irrigation.
    • Shape of Tip
      • Coude or Tieman catheter curves 45 degrees at the tip and is designed to pass urethra in patients with prostatic enlargement; it offers rigidity too.
      • The Whistle Tip (Couvelaire Tip) catheter has a terminal and a lateral drainage eye used for large blood clots.
      • The Roberts tip catheter has an eye above and below the balloon to reduce the residual urine.
    • Catheter size is described in French units. It refers to the catheter’s circumference in millimeters. Start with 12-16 F for adults. Choose the smallest size that is enough for adequate drainage. If obstruction of the catheter due to blood or debris is expected, use a larger bore catheter (e.g., 18-24 F).
    • Catheter length: Adult indwelling catheters are available in a standard (male) length (40-45cm) and a shorter female length (20-26cm). Female length catheters should not be used in male patients because of the risk of inflating the balloon in the urethra.
  • Sterile gloves and drapes
  • Sterile gauze sponge or cotton balls
  • Antiseptic solution (Povidone-iodine or chlorhexidine)
  • Sterile local anesthetic lubricant gel: (% 2 lidocaine gel) anesthetizing the urethra with topical lidocaine gel instilled through a pre-loaded syringe reduces discomfort. The catheter tip is also lubricated prior to its insertion.
  • 10 ml syringe filled with sterile saline or sterile water
  • Sterile urine bag
  • Tape to secure the urine collection system

Procedure Steps

Universal precautions should be taken in all steps. Patient consent should be obtained before starting any procedure. Ensure the privacy of the patient. Aseptic insertion technique is recommended.

Female Patients
  1. Prepare all equipment on a tray covered with a sterile drape in a sterile fashion.
  2. Place the patient in the lithotomy position.
  3. Wear your sterile gloves.
  4. Check the balloon for patency.
  5. Place a fenestrated drape over the perineum.
  6. Spread the labia with your non-dominant hand.
  7. Use the forceps/pickups to hold the sterile sponge, soak it in the antiseptic solution, and clean the area from anterior to posterior and central to peripheral.
  8. Alternatively, you may change gloves after cleansing external genitals.
  9. Lubricate the tip of the catheter with %2 lidocaine gel.
  10. Pass the catheter through the meatus and advance it until the hub meets the urethral meatus, you should be able to see urine flowing. Insert the catheter 2-3 inch or 5-7.5 cm more, preferably until the hub to avoid inflating the balloon inside the urethra.
  11. Inflate the balloon with 10 ml of sterile water or saline using the filling port.
  12. Pull the catheter back until resistance is felt.
  13. Attach the urine collection bag.
  14. Secure the catheter to the anterior thigh.
  15. Remove gloves, dispose of waste appropriately, and wash hands.

Please watch below videos (manikin and patient examples)

Male Patients
  1. Perform step 1 to 4 of female patient catheterization.
  2. Firmly hold the penis with the non-dominant hand, and position the penis 45 to 90 degrees to the coronal plane, apply gentle traction. Retract the foreskin if the patient is not circumcised.
  3. Use the forceps/pickups to hold the sterile sponge, soak it in antiseptic solution and paint the area in a sterile fashion with the antiseptic solution.
  4. Alternatively, you may change gloves after cleansing external genitals.
  5. Inject 10 mL of 2% lidocaine gel into the urethra through the meatus before insertion of the catheter.
  6. Perform step 10-15 of female catheterization.
  7. When the procedure is finished, don’t forget to reduce foreskin to prevent iatrogenic paraphimosis.

Please watch below videos (manikin and patient examples)

Hints and Pitfalls

  • Universal availability and ease of insertion of urinary catheters often lead to the inappropriate and prolonged use of these catheters. Insert catheters only for appropriate indications and leave catheters in place only as long as needed.
  • A tense patient means a tight urethral sphincter; encourage the patients to relax by taking deep breaths and relax urinary sphincter muscles as if going to void.
  • Always be gentle; never force the catheter since this may cause urethral trauma.
  • If no urine has returned, do not inflate the balloon.
  • Even when urine is flowing, it is possible for the eye of the catheter to lie within the bladder while the balloon remains within the prostatic urethra; so, always advance the catheter until the hub.
  • If there is pain during inflation of the balloon, stop immediately since the balloon may still be in the urethra.
  • Once inserted, the catheter should be secured to prevent traction and damage from movement and catheter kinks.
  • Place the urinary drainage bag below the level of the patient’s bladder, not allowing it to touch the floor.
  • For difficult urinary catheterization, change the size: 20-24 F catheter for benign prostate hyperplasia, small caliber for the urethral stricture (12-16 F).
  • If catheterization is unsuccessful, it is best to avoid multiple blind attempts since they increase the risk of infection, exacerbate the patient’s discomfort, and produce urethral congestion and edema, rendering further attempts even more challenging.
  • Patients occasionally experience hypotension and hematuria when the large volume from the bladder is drained rapidly but has little clinical significance, and gradual emptying is not necessary.

Post-Procedure Care and Recommendations

  • Patients’ follow up with urology should be arranged.
  • Discharge instructions:
    • If you develop any symptoms of a urinary tract infection, contact your doctor immediately.
    • Take enough fluids to maintain adequate urine flow.
    • Be careful not to pull the catheter accidentally, avoid twisting and kinking of the catheter.
    • Keep the bag lower than the bladder to prevent back flowing.
    • Avoid disconnecting the catheter and drain tube.
    • Empty the bag regularly. The drainage spout should not touch anything while emptying the bag.
  • Alpha blockers may be started to patients with prostate enlargement.

Complications

  • Discomfort, pain
  • Inability to pass the catheter
  • Misplacement of the catheter
    • Vagina
    • Ureter
    • Renal Pelvis
  • Traumatic complications to lower urinary tract – proper insertion technique is the single most important factor for preventing injury.
    • Passage of the catheter into a false lumen
    • Intraurethral balloon distention
    • Hematuria
    • Rupture of urethra 11 (may cause urethral stricture in the long term) 5
    • Bladder perforation
    • Hydro uterus
    • Paraphimosis
    • Vena cava air embolism
  • Infections: UTI accounts for 32% of all healthcare-associated infections. A majority of these infections are attributable to the use of an indwelling catheter. Use of best practice techniques by emergency nurses can help prevent UTIs from occurring as a result of urinary catheter insertions in the emergency department. Earlier catheter removals, use of smaller bore catheters, a closed drainage system, optimal hygienic techniques (hand-washing, sterile catheterization techniques) by health care workers, and removal of the catheter when infection is suspected are effective in minimizing the incidence of infection.
    • Urinary tract infection
      • Urethritis
      • Prostatitis
      • Epididymoorchitis
      • Cystitis
      • Pyelonephritis
      • Bacteriemia, urosepsis
  • Latex allergies
  • Obstruction or blockage of catheter results from precipitated mucus, protein, crystals, blood clots, and bacteria.

Urine leakage around the catheter

  • Fragmentation or fracture and retainment of the catheter
  • Catheter knotting
  • Balloon rupture
  • Calculi formation
  • Bladder spasms contraction
  • Accidental removal of the catheter
  • Stricture formation in long-term

Pediatric, Geriatric, Pregnant Patients and Other Considerations

  • Use 6-10 F catheters for pediatric patients, 12F for patients age >12 years, 5F for infants
  • Difficult urethral catheterization (DUC) is where the urological consult is requested to insert a urinary catheter. Many causes of DUC have been identified including anxiety, poor technique, urethral stricture, phimosis, bladder neck contracture, false passages, benign prostatic hyperplasia, unfavorable body habitus and patient positioning.
  • To prevent infections:
    • Insert catheters using aseptic technique and sterile equipment
    • Maintain a closed drainage system
    • Maintain unobstructed urine flow

References and Further Reading

  • Ramakrishnan K, Mold J. Urinary Catheters: A Review. The Internet Journal of Family Practice [serial on the Internet]. 2004; 3(2). http://ispub.com/IJFP/3/2/4596. Accessed March 1, 2016.
  • Cravens DD, Zweig S. Urinary catheter management. Am Fam Physician 2000;61:369-76.
  • Highton P, Wren H. Urethral catheterisation (male and female). The Foundation Years. 2008; 4:5.
  • Parker D, Callan L, Harwood J, Thompson DL, Wilde M, Gray M. Nursing interventions to reduce the risk of catheter-associated urinary tract infection. Part 1: Catheter selection. J Wound Ostomy Continence Nurs. 2009;36(1):23-34.
  • Willette PA, Coffield S. Current trends in the management of difficult urinary catheterizations. West J Emerg Med. 2012;13(6):472-8.
  • Manojlovich M, Saint S, Meddings J, Ratz D, Havey R, Bickmann J, Couture C, Fowler KE, Krein SL. Indwelling Urinary Catheter Insertion Practices in the Emergency Department: An Observational Study. Infect Control Hosp Epidemiol. 2016;37(1):117-9.
  • Devine AL. Female catheterisation: what nurses need to know! Accid Emerg Nurs. 2003;11(2):91-5.
  • Kashefi C, Messer K, Barden R, Sexton C, Parsons JK. Incidence and prevention of iatrogenic urethral injuries. J Urol. 2008;179(6):2254-7.
  • Dyc NG, Pena ME, Shemes SP, Rey JE, Szpunar SM, Fakih MG. The effect of resident peer-to-peer education on compliance with urinary catheter placement indications in the emergency department. Postgrad Med J. 2011;87(1034):814-8.
  • Villanueva C, Hemstreet GP 3rd. Difficult male urethral catheterization: a review of different approaches. Int Braz J Urol. 2008;34(4):401-11
  • Buddha S. Complication of urethral catheterisation. Lancet. 2005;365(9462):909.
  • Belizario SM. Preventing urinary tract infections with a two-person catheter insertion procedure. Nursing. 2015 Mar;45(3):67-9.
  • Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA; Healthcare Infection Control Practices Advisory Committee. Guideline for prevention of catheter-associated urinary tract infections 2009. Infect Control Hosp Epidemiol. 2010;31(4):319-26.
  • J Baker KS, Dane B, Edelstein Y, Malhotra A, Gould E. Ureteral rupture from aberrant Foley catheter placement: a case report. Radiol Case Rep. 2013 Jan;7(1):33-40.
  • Bradley A, Sozener C. Incidentally Discovered Foley Catheter Placement Into a Transplanted Kidney. Urology. 2015;86(3):e11-2.
  • Chavez AH, Reilly TP, Bird ET. Vena cava air embolism after traumatic Foley catheter placement. Urology. 2009;73(4):748-9.
  • Burnett KP, Erickson D, Hunt A, Beaulieu L, Bobo P, Shute P. Strategies to prevent urinary tract infection from urinary catheter insertion in the emergency department. J Emerg Nurs. 2010;36(6):546-50.
  • Lo E, Nicolle LE, Coffin SE, Gould C, Maragakis LL, Meddings J, Pegues DA, Pettis AM, Saint S, Yokoe DS. Strategies to prevent catheter-associated urinary tract infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014 May;35(5):464-79. doi: 10.1086/675718.

Links To More Information

  • Thomsen TW, Setnik GS. Videos in clinical medicine: male urethral
    catheterization. N Engl J Med. 2006;354(21):e22.
  • Manzano S, Vunda A, Schneider F, Vandertuin L, Lacroix LE. Videos in clinical medicine: catheterization of the urethra in girls. N Engl J Med 2014;371:e2-e2
  • Lacroix LE, Vunda A, Bajwa NM, Galetto-Lacour A, Gervaix A. Catheterization of the Urethra in Male Children. N Engl J Med 2010; 363:e19
  • Ortega R, Ng L, Sekhar P, Song M. Videos in clinical medicine: female urethral catheterization. NEJM. 2008;358(14):e15.
  • Shlamovitz GZ. Urethral Catheterization in Men. Available from: http://emedicine.medscape.com/article/80716-overview#a4. March 2016.
  • Shlamovitz GZ. Urethral Catheterization in Women. Available from: http://emedicine.medscape.com/article/80735-overview. Accessed March 2016.
  • How to catheterize a male. – theNursePath. https://thenursepath.blog/2016/12/15/how-to-catheterise-a-male/

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Indwelling Catheter Definition & Types

What is an Indwelling Catheter?

An indwelling urinary catheter (IUC), generally referred to as a “Foley” catheter, is a closed sterile system with a catheter and retention balloon that is inserted either through the urethra or suprapubically to allow for bladder drainage. External collecting devices (e.g. drainage tubing and bag) are connected to the catheter for urine collection 

Indwelling urinary catheters are recommended only for short-term use, defined as less than 30 days (EAUN recommends no longer than 14 days.) The catheter is inserted for continuous drainage of the bladder for two common bladder dysfunction: urinary incontinence (UI) and urinary retention.

Two Types of Indwelling Catheters

Indwelling urinary catheters are either inserted:

  1. Transurethrally
  2. Suprapubically

Suprapubic catheterization is usually used for bladder drainage following in bladder, urethral or pelvic surgery, or following genitourinary trauma. Both methods of indwelling catheterizations are associated with complications.

In practice, transurethral catheterization is the typical approach because the procedure can be organized and managed by nurses whereas suprapubic catheterization requires a more complex procedure. However, if in place long-term, defined as more than 30 days, the insertion, changing and management are done by nurses (registered nurses, licensed practical nurses). 

Transurethral Catheterization

Transurethral indwelling catheterization or urinary catheterization is defined as passage of a catheter into the urinary bladder via the urethra (urethral catheter). Transurethral indwelling catheterization is also called urethral catheterization. In this site, we only use the term urethral catheterization.

Suprapubic Catheterization

Suprapubic catheterization is the insertion of a catheter into the bladder via the anterior abdominal wall.  The catheter is inserted through an incision made above the pubic bone and below the umbilicus. The insertion of this type of catheterization is done by a urologic specialist. Long term catheterization can be associated with many serious problems including urinary tract infections, urethritis, bladder spasms with pain and urinary leakage, and other bladder complications.

Use Patterns

Short Term

Short-term uses include:

  • Management of acute urinary retention.
  • Postoperative bladder decompression following GU surgery or pelvic trauma.
  • Monitoring urinary output in acutely ill patients.

Long Term & CAUTI

Long-term use, defined as greater than 30 days, is discouraged because it provides access for bacteria from a contaminated environment into a vulnerable body organ and system. 

As a result, catheter-associated urinary tract infection (CAUTI) is the most common type of infection acquired in hospitals and  nursing homes. At least 15% to 25% of patients may have an indwelling catheter inserted sometime during their hospital stay, with most only used for the short-term (defined as < 30 days).  Prevalence is greater in high acuity patient units, with critical care and intensive care units having the highest prevalence.  CAUTIs are associated with multiple complications and side effects, can lead to increased length of stays, mortality rates, and ultimately higher hospital costs.  

Closed Drainage System

A closed catheter drainage system is an aseptic system in which the path from the tip of the catheter inserted into the bladder, to the bag which catches urine, is closed and should not be disconnected. This structure is designed to eliminate inoculation of the urinary tract with bacteria via the catheter drainage tubing and from the collection bag. The term ‘closed drainage’ is, however, not entirely accurate as there are often numerous portals of entry of pathogens and the system must be opened to allow emptying and be disconnected when the drainage bag is changed 

This resource center provides in-depth information on the indwelling Foley catheter from the indication through the complications and prevention strategies. It also has resources that offer tools and on-demand education webinars on appropriate use of the catheters to understanding CAUTI.

Written by: Diane K. Newman, DNP, Continence Nurse Specialist

References

  1. Hunter KF, Bharmal A, Moore KN. Long-term bladder drainage: Suprapubic catheter versus other methods: a scoping review. Neurourol Urodyn. 2013 Sep;32(7):944-51. doi: 10.1002/nau.22356
  2. Newman DK, Cumbee RP, Rovner ES. Indwelling (transurethral and suprapubic) catheters. In: Newman DK, Rovner ES, Wein AJ, editors. Clinical Application of Urologic Catheters and Products.  Switzerland: Springer International Publishing; 2018,  47-77.
  3. Newman DK. Devices, products, catheters, and catheter-associated urinary tract infections. In: Newman DK, Wyman JF, Welch VW, editors. Core Curriculum for Urologic Nursing. 1st ed. Pitman (NJ): Society of Urologic Nurses and Associates, Inc; 2017, 439-66.
  4. Newman DK. The indwelling urinary catheter: Principles for best practice. JWOCN. 2007;34:655-61 DOI: 10.1097/01.WON.0000299816.82983.4a
  5. Meddings, J, Rogers, MA, Macy, M, & Saint, S. Systematic review and meta-analysis: reminder systems to reduce catheter-associated urinary tract infections and urinary catheter use in hospitalized patients. Clin Infect Dis. 2010, 51(5), 550-60. doi: 10.1086/655133
  6. Weber DJ, Sickbert-Bennett EE, Brown V. & Rutala WA. Comparison of hospital wide surveillance and targeted intensive care unit surveillance of healthcare-associated infections. Infect Control Hosp Epidemiol. 2007,28(12), 1361-1366. doi: 10.1086/523868

Published Date: January 2013

 

self-insertion of a catheter (for women)

Your doctor has instructed you to self-catheterize (inserting a catheter) because it is difficult for you to urinate naturally. This problem can be caused by injury, illness, infection, or other medical condition. Many people urinate by self-catheterization (also called intermittent catheterization). Self-catheterization means placing a clean catheter (thin, flexible tube) into your bladder to empty it.Self-catheterization helps empty the bladder when it cannot empty naturally. It also allows the bladder to empty completely. In the hospital, you were shown how to self-catheterize. The steps below will help you remember how to do it correctly.

Prepare your kit

You will need the following:

  • soap, warm water or wet wipe

  • clean catheter

  • water soluble lubricating jelly (do not use petroleum jelly or other gel on petroleum jelly)

  • mirror

  • toilet bowl or wide bowl

Prepare

  • Wash your hands and genital area.Use warm water and soap or wet wipes. Washing movements should always be directed from front to back.

  • Lubricate the catheter with a water soluble lubricant gel.

    • Apply gel lubricant to the end of the catheter 2 to 4 inches from the end.

    • Place the other end of the catheter over a toilet or wide vessel.

Empty the bladder

  • Spread the labia (folds that cover the vaginal opening).Find the urethra (opening of the urethra) using a speculum or index finger.

  • Slowly insert the catheter into the urethra. If the catheter does not go through, take a deep breath and push as if trying to urinate.

  • If you experience severe pain, remove the catheter and try again.

  • Empty the bladder.

    • Insert the catheter only until urine begins to flow through the tube.

    • After the urine stops flowing, slowly withdraw the catheter.

Wash your kit

  • Flush the catheter with toilet soap and water.

  • Rinse it well.

  • Rinse the inside well with water. Allow to air dry.

  • Wash your hands. If you have used a wide bowl, wash it.

Follow-up

Make an appointment with your doctor as recommended by our staff.

When to Call a Doctor

Call a Doctor Immediately if you have any of the following symptoms:

  • Body temperature higher than 100.4 ° F

  • Chills

  • Burning in the urethra or in the pubic region

  • Nausea and vomiting

  • Sediment or mucus in the urine

  • Turbid urine

  • Urine bloody (pink or red) or an unpleasant odor

    900 Installation of a bladder catheter at home in Rostov

    Installation of a urinary catheter is a procedure necessary for urological examinations or diseases of the genitourinary system.The bottom line is the installation of a special tool for urine output or drug administration. Also, a bladder catheter is placed in patients who have undergone surgery to help remove urine. Only an experienced health worker should carry out the procedure, observing the rules of hygiene, in order to avoid risks of harming health.

    How is it done?

    There are 2 types of instruments that are used for the procedure:

    1. Soft;
    2. Solid.

    When catheterizing the bladder with a soft catheter, a tubular instrument made of elastic rubber with a length of 25-30 cm is inserted.A syringe with medicines can be connected to the outer end, for this it is made with an oblique cut and has a special recess.

    Solid metal has a handle and shaft with multiple holes. The length depends on whether it will be installed for a man or a woman. Due to the structural features of the urinary system, men require a longer version. For the same reason, the process of inserting a catheter into the bladder is more difficult for men than for women.

    In order for the patient to undergo the procedure with maximum comfort, it is possible to do a bladder catheterization at home.The experienced staff of the clinic “Heratsi” will establish in compliance with all the necessary rules and regulations, excluding the possibility of problems. This service is also relevant for patients who have recently undergone surgery, or bedridden patients who are difficult to deliver to a medical facility.

    Why should only a professional perform the procedure? In the absence of proper knowledge, skills and experience, unpleasant consequences may occur, the most difficult of which are:

    • Damage to the walls of the urethra at one end;
    • Development of diseases such as urethritis, cystitis or pyelonephritis due to infections brought into the urethra with non-compliance with sanitary standards;
    • Risk of entry into the blood if the urethral canal is damaged;
    • Bleeding.

    The specialists of the Heratsi Medical Center have all the necessary skills and will install the drainage at home carefully, without causing any unpleasant sensations to the patient. It is also possible to replace the tube. You can find out prices, call a doctor or clarify information of interest on the clinic’s website and by calling the round-the-clock hotline: +7 (863) 333-20-11

    Urinary catheters

    Bladder – serves for the accumulation of urine, continuously flowing from the ureters, and performs an evacuation function – urination.The size depends on the filling of the urine, the capacity is from 250 to 700 ml. If for some reason evacuation of urine is difficult, a urinary catheter is installed – an elastic tube that is inserted into the urinary tract to drain urine.

    In cases where a urinary catheter is required for a long time, it is necessary to install a cystostomy (epicystostomy) – the creation of an artificial excretory canal from the bladder by a surgical method. The outlet of the canal is in the suprapubic region. Indications for cystostomy appear, as a rule, in case of serious pathologies of the urinary tract:

    • inability to install a catheter through the urethra if it is necessary for a long stay of the drainage in the bladder;
    • benign prostatic hyperplasia;
    • non-synchronized work of the muscles of the bladder and its sphincter, which leads to stagnation of urine;
    • pelvic injuries with urethral ruptures;
    • operations performed on the urethra, penis

    There is also intermittent catheterization with disposable catheters, you can read more about it in our blog https: // www.mc21.ru/blogs/urology/odnorazovye-mochevye-urologicheskie-katetery.php

    Types of catheters

    There are several types of catheters, but basically now in medical urological practice a Foley catheter is used. This is the most common and demanded type of catheter.

    This is a urinary catheter with an inflatable balloon for filling with sterile fluid (water or saline), which anchors the catheter in the bladder. On the other hand, the tube is connected to a special container (bag) in which urine accumulates.

    Foley catheters can be with a different number of internal channels, made of different materials. They also differ in coating. A silicone-coated latex dual-lumen catheter is an inexpensive option. The most expensive is the silver-coated silicone catheter.

    The silver coated silicone catheter has the advantage that the silver layer inhibits the growth of pathogenic microbes, reducing the likelihood of developing a urinary tract infection. Therefore, after insertion of the catheter, it can remain inside for a longer period.In this case, a higher price means a greater level of safety and a lower risk of infections during catheterization.

    An uncoated silicone catheter can be used if you are allergic to latex. The silicone itself has the property of inhibiting the deposition of salts on the inner layer of the catheter.

    Removal of urine is possible in two ways:
    1. In the mode of constant opening of the locking device, urine outflow occurs in small portions into the bag-shaped urine collection bag attached to the sleeve.
    2. When closed, when the outflow of urine is carried out at once, for a certain period of time, directly into the toilet or storage bag.

    Replacement catheter

    On average, a month after the installation of the cystostomy, it needs to be replaced. This manipulation is performed by a urologist. Depending on how much the patient’s mobility is preserved, you can either come to the medical center for an appointment, or call a doctor at home. In the future, the timing of replacing the catheter is discussed with the doctor individually for each patient and depends on the type of catheter and how it is used, whether there are any complications.On average, during normal operation of the cystostomy catheter, it will need to be changed once every 4-8 weeks.

    If you leave the catheter longer than the period recommended by the doctor, there is a risk of complications due to the deterioration of its throughput, delayed outflow of urine. The risk of developing an infection increases.

    Now doctors do not recommend rinsing catheters, it is much safer to change them, since when rinsing with antiseptic solutions, there is a high probability that the flora on the walls will acquire resistance to these agents and if inflammation occurs, it will be very difficult to cope with it.Removal and replacement of a cystostomy is also mandatory by a doctor, who additionally examines the injection site, makes appointments for the underlying disease.

    Cystostomy (epicystostomy) care

    An indwelling catheter to drain urine from the bladder requires adequate hygienic care and adherence to a drinking regime.

    The most important thing to care for is cleanliness:

    • The loose catheter tube must be kept clean, as is the catheter insertion site in the lower abdomen.If there are no special recommendations of a doctor for treatment, then the skin around the catheter should be washed with warm water and soap or wiped with a swab moistened with water 2 times a day.
    • You can take a shower, a bath is not recommended.
    • If there are no signs of inflammation around the catheter, the dressing may not be used.

    A person with a catheter in place needs to drink plenty of fluids to ensure that the volume and concentration of urine passing through the catheter is sufficient to prevent calculus, salt buildup, and inflammation.The recommended volume is from 1.5 to 2.5 liters per day, or the volume that is allowed by the attending physician, in the presence of any disease in which excess fluid is not indicated.

    How to properly handle the bag-urine bag

    • The catheter and urine bag must not bend.
    • If the patient is walking, the drainage bag is attached below the bladder, on the thigh. If the patient is lying down, the drainage bag is fixed below body level, but not on the floor. The location of the drainage bag should allow urine to drain into the bag and not flow back into the bladder.
    • Empty the bag when it is half full. Change on average once a week, if not required earlier due to damage or clogging.

    Training the accumulative function of the bladder

    When inserting and replacing the catheter, the urologist should talk about training the accumulative function of the bladder. It is done to maintain the contractility of the bladder wall. The mode of constant outflow of urine disrupts the functioning of this organ, it is important to periodically create conditions for its filling.

    Training of the accumulative function of the bladder consists in clamping the drainage of the cystostomy until the urge to urinate appears. If the urge arises, the drain must be unclenched and the bladder emptied. This method has absolute and relative contraindications. You cannot start a workout without consulting a doctor, this can lead to serious complications.

  • Acute inflammatory process of the urinary tract
  • Macrohematuria and urethrorrhagia.

Relative contraindications:

  • Bladder atony
  • Bladder stones
  • Vesicoureteral reflux.

With relative contraindications, bladder training is practically impossible at home, since hardware diagnostics are required.

Patients with cystostomy should immediately contact their doctor if:

  • There is pain in the lower abdomen
  • The amount of excreted urine decreases
  • The color of urine changes, an admixture of blood or sediment appears, turbidity, a sharp unpleasant odor
  • If the catheter is blocked or damaged, it slips out of the bladder.

Finally, I would like to say that you can get used to the catheter. Of course, this creates certain inconveniences, but when the use of a catheter is necessary, with proper care and adherence to the doctor’s recommendations, you can not lose the quality of life after its installation. 90,000 Installation and replacement of a catheter at home – prices in Moscow, call a doctor at home to replace a catheter

Patients of the multidisciplinary medical center “President-Med” have access to the service “installation of a catheter at home”.An experienced specialist will come to the call, who will quickly, painlessly, professionally carry out the procedure with maximum comfort for the patient. It is easy and simple to call a doctor at home to install a catheter: fill out an application by calling the phone number indicated on the official website of the clinic or leave a request by filling out the appropriate online form. The administrators will immediately call you back to clarify the details, address, agree on the arrival time of the doctor of the desired specialization. Our specialists are responsible, punctual, come to the call exactly at the agreed time, so you and your loved ones can plan your day in advance.

Preparing for the installation and replacement of the catheter

Foley catheter is a urological device that is inserted directly into the urethra. As a rule, preparation for bladder catheterization is directly related to the specialist who performs the manipulations. The service “replacement of a urinary catheter at home” ordered in the multidisciplinary medical center “President-Med” is provided by experienced specialists with many years of experience who work with patients of any severity.Our doctors provide the following services:

  • placement of catheters;
  • system removal;
  • Change of catheter at home.

With regard to patient preparation, before replacing the catheter it is necessary: ​​

  • Carry out a thorough hygiene of the external genital organs.
  • Remove hair from the skin in the genital area.

It is also important for the patient to calm down, relax and take the correct position before manipulation.For male patients, the system is inserted in a prone position with legs straight. For women – in a prone position with raised, bent knees and legs apart.

Indications for replacing the catheter

Replacement of the urological catheter at home is carried out on a planned basis or in the presence of certain indications. The replacement schedule is drawn up taking into account what material it is made of:

  • Latex. Change the latex catheter once a week.
  • Silicone. The silicone device is changed once a month.
  • Silicone with silver. Replacement is done 90 days after installation.

The procedure must be carried out by a specially trained medical worker – a doctor of the appropriate specialization. You can disconnect the device for its next treatment, replacement or removal of urine from the ureter.

Reasons for installing a new system:

  • pain and discomfort in the lower abdomen;
  • the appearance of blood inclusions and white flakes in the excreted urine;
  • urine flows out of the catheter;
  • the outflow of urine from the device is disturbed;
  • edema of the bladder and ducts;
  • traumatic injury to the genital organs;
  • neoplasms in the bladder or urethra;
  • for postoperative rehabilitation purposes.

Features of replacing the catheter at home

Replacing the catheter at home is carried out in several stages:

  1. The old system is carefully retrieved with the precise movement of the healthcare professional’s hand.
  2. A new one is installed in place of the remote drain. The doctor slowly, carefully inserts the tube into the urethral lumen, controlling its movement and the patient’s well-being. The insertion of the catheter stops when urine begins to flow from its opening.
  3. To fix the system, its internal balloon is filled with saline, after which it remains only to gently press down on the locking valve.
  4. Once inserted, the catheter remains in the bladder until the next bladder replacement.

Prices for installation and replacement of catheter

The cost of installing and replacing a catheter for men and women will differ. To clarify the cost of the procedure, get more detailed advice and call a doctor, fill out the online feedback form or call the number indicated on the official website of the clinic.

The advantages of our services are obvious:

  • Professionalism of medical workers.Installation and replacement of the urological drainage system is carried out by experienced specialists who are fluent in all the skills for performing manipulations.
  • Comfort, safety, painlessness, strict adherence to all rules of asepsis and antiseptics.
  • Affordable prices, the ability to order the service at any time of the day, punctuality and responsibility of the entire field team

Artist: Lavrova Nina Avenirovna

Deputy General Director for Medical

Graduated from the Yaroslavl State Medical Institute with a degree in General Medicine
Medical work experience – 25 years

Make an appointment with a doctor

90,000 Private pathology.Retention of urine in cats

Acute urinary retention (obstruction of the urethra) is the most frequent and life-threatening complication of the so-called urological syndrome of cats (FLUTD or FUS).

USC is a complex of the following symptoms:

  • frequent urination in small portions, often in unusual places;

  • soreness and difficulty urinating;

  • the appearance of salts, mucus and blood in the urine.

The causes of USC are inflammatory diseases of the urinary system, mainly its lower parts – the bladder (cystitis) and urethra (urethritis), urolithiasis (ICD, urolithiasis), much less often – tumors.

The symptoms listed above are associated with inflammation of the affected organ and soreness, the appearance of abnormal inclusions in the urine and often obstacles to the normal outflow of urine. For an animal suffering from such a disease, a tense, unnatural posture is characteristic, indicating impaired urination.

The urethra (urethra) is the lowest part of the urinary system of animals, through which urine, which is continuously generated in the kidneys and accumulates in the bladder, is regularly excreted into the external environment during urination.

Acute urinary retention occurs due to blockage of the urethra with mucus, crystals, blood clots and small stones, and occurs almost exclusively in cats, and extremely rarely in cats.

Diagnostics

To establish a diagnosis of acute urinary retention, in addition to analyzing the owner’s complaints, it is necessary to feel and assess the animal’s bladder.The bladder is located in the lower abdomen between the hind legs and slightly in front of them. As a result of the blockage, it overflows with urine and becomes large, the size of a peach, and hard to the touch. The animal will worry and resist even the slightest pressure on it. A normal bladder, partially filled with urine, feels like a soft, deflated balloon, or is difficult to find at all because there is little urine in it.

If you suspect your pet has an acute urinary retention, try assessing bladder fullness, but if you have any doubts as to whether it is full or not, see your doctor immediately.After all, if urinary retention lasts for several days, the accumulation of toxins in the blood will lead to the death of the animal.

Treatment

The most important thing is to remove the blockage and restore normal urine flow. The veterinarian will feel the bladder and try to get the animal to urinate by gently applying pressure to the bladder. Sometimes this allows you to eliminate urinary retention, but more often a more serious intervention is needed – the installation of a urinary catheter.In this case, the plug in the urethra is usually flushed into the bladder.

The procedure for inserting a urinary catheter is often painful and requires prior sedation and sometimes general anesthesia. Most cats are successfully catheterized and the catheter is left in place for a couple of days. In rare cases, catheterization cannot be performed, in which case an emergency operation is required – a perineal urethrostomy.

But blockage of the urethra and its elimination are not the only problems a doctor has to deal with.Cats with urinary retention quickly become dehydrated and toxins build up in their blood, leading to nausea, vomiting, loss of appetite and general weakness. In addition, life-threatening heart rhythm disturbances can occur due to changes in the electrolyte composition of the blood. All these complications require treatment, and in addition to examination data, a biochemical blood test and (in severe cases) a gas and electrolyte blood test help to control them. Partial urinary retention can be no less dangerous than complete, and also requires treatment.

Inpatient treatment

It is necessary to understand that urinary retention lasting more than 1-2 days is a very dangerous condition that threatens the life of an animal. After a long (more than a day) urinary retention, most cats should be left for several days in a hospital clinic with an installed catheter for infusion and antibiotic therapy, control of the general condition and urine formation.

The main work in the recovery phase is done by the kidneys of the cat itself, which, due to a blockage, stopped its production.The formation of urine is monitored immediately after the restoration of its outflow, and longer if the amount of urine produced per hour is lower or higher than normal values ​​(2-4 ml / kg / hour).

Intravenous or subcutaneous fluid is injected to eliminate dehydration, drugs are administered to eliminate pain and relax the inflamed urethra, antibacterial drugs to prevent the development of bacteria on the damaged mucous membrane of the urethra and bladder.

After two days, the catheter is removed and the cat is observed to urinate.For most cats, urination is difficult and painful at first, but most often it is a temporary problem. A cat with normal urination can be taken home.

What to do after discharge from the hospital The main task of the owner is to properly follow the doctor’s prescriptions and to closely monitor the general condition of the cat and the nature of his urination. It is important to understand that the risk of re-blockage is very high in cats in the first two weeks after obstruction. period, the volume of urine excreted by the cat and, if possible, the size of the bladder should be monitored.In case of loss of appetite, nausea and vomiting, contact your veterinarian immediately. Sometimes (quite rarely) the bladder suffers from hyperextension during obstruction, in which case special treatment is required to help it contract and empty normally.

For the treatment of diseases that cause the symptoms of USC, long courses of antibiotics are used to eliminate inflammation, a special diet that prevents the formation of stones and sand, reduces the density and increases the volume of urine.Antispasmodics, such as no-shpa, are used to relax the muscles in the urethra and facilitate urine flow. In addition, your doctor may advise you to take a urine test at regular intervals.

Surgical treatment (perineal urethrostomy)

If the blockage of the urethra in a cat is repeated several times, this is an indication for surgery, in which a urethral opening is formed, similar to that of females – shorter and wider.The operation is called a “perineal urethrostomy”, during which the penis and testes are removed and a new urethral opening is formed.

The operation is performed only to prevent blockage of the urethra, it does not prevent or cure diseases of the lower urinary system. This means that urinary salt formation, inflammation, and painful urination may continue. Cats with a urethrostomy are prone to carry infections into the bladder and develop infections associated with bladder stones.

Metabolic disorders occurring during the blockage should, if possible, be eliminated before the operation. This can be controlled by a biochemical blood test (creatinine and urea) and an analysis of blood gases and electrolytes. In a number of emergency cases, this is impossible – not all cats manage to place a urinary catheter and a new urethral opening must be formed immediately. However, the risk of anesthesia is particularly high.

Postoperative care

Within 5-7 days, and sometimes longer after the operation, it is necessary to carry out the bougienage procedure once a day – inserting a thick probe or catheter into the urethra to check its patency and eliminate obstacles to urination.In this case, the doctor checks the correctness of the formation of a new urethral opening, with the help of an antiseptic removes the accumulated discharge and processes the sutures.

The most serious complication is postoperative stricture (scarring) of the urethra. In this case, the opening of the urethra becomes very narrow and reoperation is required, however, such a complication is extremely rare.

It is necessary to protect the seams from being licked by the animals themselves; for this, the doctor will recommend the use of a protective collar and a diaper.All the time, when the animal is left to itself, and you cannot control it, these protective equipment should be worn – after all, re-altering the urethrostomy under anesthesia will not please you, nor the doctor, nor the cat itself.

After the operation, an antibiotic (in tablets or injections) must be prescribed, and only a doctor should cancel it. The doctor removes the stitches in the clinic after a thorough examination of the formed stoma, complete healing of the surgical wound and normal functioning of the new urethral opening.

Installation of a urinary catheter at home

Help with acute urinary retention. How to help if a person cannot “urinate”?

Who we help to resolve urinary disorders at home:

  • sudden onset, “accumulated during the day”, with ineffective urge to urinate
  • long-term “accumulated”, with sluggish urine deposition, but leading to overflow of the bladder
  • arising in men against the background of enlarged prostate adenoma
  • in patients with an unsaturated bladder, patients after stroke
  • in patients with a “clogged” cystostomy that has ceased to function
  • diagnostically unclear patients with acute urinary retention

Which options for assistance are provided:

  • examination and identification of the most significant reason for the delay
  • delay resolution with urethral catheter (urinary catheter insertion)
  • for complex catheterizations – performing bladder catheterization in a hospital urology department and return transportation
  • in cases of urinary retention not related to urethral patency – hospitalization for treatment and examination in a specialized hospital

To determine the causes of urination disorders, there are such diagnostic outputs as:

  • examination by an ambulance doctor, examination by a urologist at home
  • Ultrasound at home (ultrasound at home)
  • MRI examination of the pelvic organs in the diagnostic center or in the hospital

The current state of the material and technical base of most hospitals and diagnostic departments makes it possible to identify and resolve acute urinary retention in a matter of minutes.

Episodes of acute urinary retention in most cases are resolved by our service at the call site. Difficulties of catheterization of the bladder, requiring the attention of doctors of the urological department, arise more often with an enlarged prostate adenoma in men and with the peculiarities of the anatomy of the urethra and its site of exit from the bladder.

Our ambulance teams always have a means to reduce friction in the urethra when placing a catheter and urethral catheters of different diameters, to carry out the procedure in accordance with the characteristics of each person.

Catheter replacement

Urinary catheter is a system of tubes placed in the body to drain and collect urine from the bladder.

Installation of a catheter and its replacement is carried out by a urologist at the address: Kirov, Gostiny lane. 5/1, Tel. 711-100

Urinary catheters are sometimes recommended as a treatment for urinary incontinence or urinary retention in both men and women. There are several different types of catheters.They can be used for a variety of different reasons.

Urinary catheters

Urinary catheters are used to drain the bladder. Bladder catheterization is often the last resort because of the potential complications from prolonged use of the catheter. Complications associated with catheter use may include:

  • Bubble stones
  • Blood infections (sepsis)
  • Blood in urine (hematuria)
  • Skin damage
  • Urethral injury
  • Urinary tract or kidney infections

Your doctor may recommend a urinary catheter for short or long term use.Long-term catheters are called permanent catheters.

There is a wide variety of urinary catheters. Urinary catheters differ in the material they are made of (latex, silicone, Teflon) and type (Foley catheter, straight catheter, curved tip catheter). For example, a Foley catheter is a soft plastic or rubber tube that is inserted into the bladder to drain urine.

Urologists recommend using the smallest catheter size.Some people may need large catheters to prevent urine from leaking around the catheter, or if the urine is concentrated and contains blood or a large amount of sediment.

Remember that large catheters can damage the urethra. Some people may develop latex allergies or sensitivity with long-term use of latex catheters. Teflon or silicone catheters should be used in these patients.

Prolonged (permanent) urinary catheters

A catheter, which is inserted into the bladder for a long time, is connected to a urine collection bag to collect urine.There are two types of drainage bags.

The first type of drainage bag is a small bag that is attached to the leg with an elastic band. The bag can be worn throughout the day as it can be easily hidden under trousers or a skirt. The bag is easy to empty in the toilet.

Another type of urine collection bag is a large bag that is used at night. This bag is usually hung on the bed or on the floor.

How to care for your urinary catheter

If the catheter becomes clogged, painful, or infected, the catheter must be replaced immediately.

For the maintenance of the indwelling catheter, it is necessary to wash the urethra (the exit site of the catheter) daily with soap. Also cleanse the entire genital area after each bowel movement to prevent infection of the catheter. Urology doctors no longer recommend the use of antibacterial ointments to clean the catheter, as their effectiveness in preventing infection has not been proven.

Increase your fluid intake to reduce the risk of complications (if you can drink plenty of fluids for health reasons).Discuss this problem with your doctor.

The urine collection bag should always be located below the bladder so that urine does not flow back into the bladder. Empty the bag either every 8 hours or as it fills.

Ensure that the outlet valve of the drainage bag remains sterile. Wash your hands before and after handling the drainage bag. Do not let the outlet valve touch anything. If the outlet valve is dirty, wash it with soap and water.

How to handle a urine bag?

Some doctors recommend periodically emptying the drainage bag.Disconnect the urine collection bag from the catheter (connect the catheter to the second bag during treatment).

Clean and deodorize the drainage bag by filling the bag with a solution of two parts vinegar and three parts water. You can substitute chlorine bleach for the vinegar water solution. Soak the bag in this solution for 20 minutes. Hang up the drainage bag with the drain valve open to dry it.

What to do if the catheter is leaking?

Some people may experience urine leakage around the catheter.This may be due to a small catheter, an inappropriate balloon size, or bladder spasm.

If bladder spasm occurs, check that the catheter is draining urine properly. If there is no urine in the bag, the catheter may be blocked by blood or coarse sediment. Or, the catheter or drainage tube has twisted and formed a loop.

If you have been taught to flush the catheter, try flushing the catheter yourself. If you are unable to flush the catheter, see your doctor immediately.If you have not been instructed on how to flush the catheter and urine does not enter the drainage bag, then you need to urgently contact your doctor.

Other causes of urine leakage around the catheter include:

  • Constipation
  • Urinary tract infections
Potential complications of urinary catheter use

Contact your doctor if you develop any of these complications:

  • Bleeding in or around the catheter
  • The catheter drains a small amount of urine, or there is no urine despite sufficient fluid intake
  • Fever, chills
  • Leakage of large amounts of urine around the catheter
  • Urine with a strong odor or urine becomes cloudy or thick
  • Edema of the urethra around the catheter

Suprapubic urinary catheters

The suprapubic urinary catheter is an indwelling catheter that is inserted directly into the bladder through the abdomen above the pubic bone.This catheter is inserted by a urologist in a clinic or hospital setting. The exit site of the catheter (located on the abdomen) and the catheter should be cleaned daily with soap and water and covered with dry gauze.

Suprapubic catheters are replaced by qualified medical personnel. The suprapubic catheter can be connected to the standard drainage bags described above. Suprapubic catheter recommend:

  • After some gynecological operations
  • For patients requiring long-term catheterization
  • For patients with trauma or urethral blockade

Complications from suprapubic catheter use may include:

  • Bladder stones
  • Blood infections (sepsis)
  • Blood in urine (hematuria)
  • Skin damage
  • Leakage of urine around the catheter
  • Urinary tract or kidney infections.

Bladder cancer may develop after prolonged use of the catheter.

How to put a urinary catheter in a man?
  1. Gather all equipment: catheter, moisturizing gel, sterile gloves, clean wipes, syringe with water to inflate the balloon, urine bag.
  2. Wash your hands. Use betadine or a similar antiseptic (unless specifically instructed) to clean the outer opening of the urethra.
  3. Put on sterile gloves.Make sure not to touch the outside of the gloves with your hands.
  4. Lubricate the catheter.
  5. Take a member and hold it perpendicular to the body. Pull your penis slightly towards your navel.
  6. Begin to gently insert and advance the catheter.
  7. You will encounter resistance when you reach the external sphincter. Ask the patient to take a few deep breaths to relax the muscles blocking the opening of the urethra and continue to advance the catheter.
  8. If urine appears, continue to advance the catheter to the “Y” connector level. Keep the catheter in one position while you inflate the balloon. Inflating the balloon of a catheter in the urethra causes severe pain and can lead to injury. Check if the catheter is in the bladder. You can try flushing the catheter with a few milliliters of sterile water. If solution does not come back easily, the catheter may not be inserted far enough into the bladder.
  9. Lock the catheter and attach the urine bag to it.

How to put a urinary catheter in a woman?

  1. Gather all equipment: catheter, moisturizing gel, sterile gloves, clean wipes, syringe with water to inflate the balloon, urine bag.
  2. Wash your hands. Use betadine or another antiseptic to clean the outer opening of the urethra. In women, it is necessary to treat the labia and urethral opening with gentle movements from top to bottom. Avoid the anal area.
  3. Put on sterile gloves.Make sure not to touch the outside of the gloves with your hands.
  4. Lubricate the catheter.
  5. Part the labia and locate the urethral opening, which is located below the clitoris and above the vagina.
  6. Slowly insert the catheter into the urethral opening.
  7. Advance the catheter gently.
  8. If urine appears, advance the catheter an additional 2 inches. Hold the catheter in one position while inflating the balloon.Check if the catheter is in the bladder. If the patient feels pain when the balloon is inflated, it is necessary to stop. Deflate the balloon and advance the catheter another 2 inches, and try to inflate the balloon again.
  9. Lock the catheter and attach the urine bag.

How to remove a urinary catheter?

Indwelling catheters can be removed in two ways. The first method is to attach a small syringe to the opening of the catheter. Remove all liquid.Pull the catheter out slowly.

Warning: Never remove your indwelling catheter unless your doctor has trained you. Remove the catheter only with your doctor’s approval.

Some urologists instruct their patients to cut the balloon filling tube above the main tube. After all the water has drained out, slowly pull out the catheter. Be careful not to cut the catheter elsewhere.

If you are unable to remove the urinary catheter with little force, inform your doctor immediately.

Tell your doctor if you have no urine within 8 hours after removing the catheter, or if your stomach is swollen and painful.

Short-term (intermittent) catheters

Some patients require intermittent bladder catheterization. These people need to be taught how to insert a catheter on their own to drain the bladder when needed. They do not need to wear a urine bag all the time.

People who can use intermittent catheterization include:

  • Any patient who is unable to properly empty the bladder
  • Men with large prostates
  • People with damage to the nervous system (neurological diseases)
  • Women after certain gynecological operations

The process is similar to the procedures described above.However, the balloon does not need to be inflated and the catheter is removed as soon as the flow of urine has ceased.

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