CATHETERIZATIONCATHETERIZATION
DR AFZAL JUNEJODR AFZAL JUNEJO ASSOCIATE PROFESSORASSOCIATE PROFESSOR SURGERY , LUMHS .SURGERY , LUMHS .
Urethral Catheterization - Urethral Catheterization - A Simple Plan A Simple Plan
CatheterisationCatheterisation
Drainage… Drainage…
Indications Indications Management of acute urinary Management of acute urinary
retention retention or bladder outlet or bladder outlet obstruction. obstruction.
Urine output measurement Urine output measurement in in critically ill patients.critically ill patients.
During surgery to assess fluid statusDuring surgery to assess fluid status.. During and following specific During and following specific
surgeries of the genitourinary tract surgeries of the genitourinary tract or adjacent structures (ie, urologic, or adjacent structures (ie, urologic, gynecologic, colorectal surgery).gynecologic, colorectal surgery).
Reference: Schaeffer AJ. Placement and management of urinary bladder catheters. UpToDate ® (2010)
Indications – Copied from Indications – Copied from UTDUTD
Management of hematuria associated Management of hematuria associated with clots. with clots.
Management of immobilized patients (eg, Management of immobilized patients (eg, stroke, pelvic fracture).stroke, pelvic fracture).
Management of patients with neurogenic Management of patients with neurogenic bladder. bladder.
Management of open wounds located in Management of open wounds located in the sacral or perineal regions in patients the sacral or perineal regions in patients who are incontinent. who are incontinent.
. .
Reference: Schaeffer AJ. Placement and management of urinary bladder catheters. UpToDate ® (2010)
Indications – Copied from Indications – Copied from UTDUTD
Intravesical pharmacologic therapy Intravesical pharmacologic therapy (eg, bladder cancer). (eg, bladder cancer).
Improved patient comfort for end Improved patient comfort for end of life care. of life care.
Management of patients with Management of patients with urinary incontinence following urinary incontinence following failure of conservative, behavioral, failure of conservative, behavioral, pharmacologic and surgical pharmacologic and surgical therapy. therapy.
Reference: Schaeffer AJ. Placement and management of urinary bladder catheters. UpToDate ® (2010)
Urethral Catheterization - Urethral Catheterization - IndicationsIndications
Collection of uncontaminated Collection of uncontaminated specimenspecimen
Intermittent bladder Intermittent bladder decompressiondecompression
Urologic study of anatomy of Urologic study of anatomy of urinary tracturinary tract
Indications simplifiedIndications simplified
Indications for Indications for catheterisationcatheterisation
Retention of urineRetention of urine Monitor urine output / acutely ill patientMonitor urine output / acutely ill patient Pre/peri/post-operativelyPre/peri/post-operatively Assessment and investigationsAssessment and investigations Treatment (e.g. to instil chemotherapy)Treatment (e.g. to instil chemotherapy) Irrigation of bladderIrrigation of bladder Bypass an obstructionBypass an obstruction Management of incontinence (as a last Management of incontinence (as a last
resort)resort)
Urethral Catheterization – Urethral Catheterization – Absolute contraindicationsAbsolute contraindications
Known urethral trauma - Known urethral trauma -
blood at meatus, blood at meatus,
fractured penis, etc.fractured penis, etc.
Relative contraindications Relative contraindications
urethral stricture, urethral stricture, recent urinary tract surgery (ie, recent urinary tract surgery (ie,
urethra, bladder),urethra, bladder), presence of an artificial sphincter..presence of an artificial sphincter..
Reference: Schaeffer AJ. Placement and management of urinary bladder catheters. UpToDate ® (2010)
Catheter SelectionCatheter Selection Points to considerPoints to consider;;
SizeSizeBalloon size Balloon size LengthLength
MaterialMaterial (consider latex allergy)(consider latex allergy)
Drainage system Drainage system (closed / link (closed / link system)system)
Catheter sizeCatheter size
Urinary catheters are sized using French Urinary catheters are sized using French (F) units. The French number divided by 3 (F) units. The French number divided by 3 is the outer diameter of the catheter in is the outer diameter of the catheter in millimeters. millimeters.
RangesRanges: : InfantInfant: 8F: 8FChild/adolescentChild/adolescent: 10-12: 10-12Adult and large adolescentAdult and large adolescent: 14-18F : 14-18F
(female/male)(female/male) Most common: Most common: 14F to 16F14F to 16F used in large, older used in large, older
adolescents and adultsadolescents and adults
5 – 10 ml balloon usually with fluid 5 – 10 ml balloon usually with fluid to inflate (15-30cc balloons may be to inflate (15-30cc balloons may be used in patients with prostate used in patients with prostate surgery)surgery)
Balloon sizeBalloon size
Catheter MaterialsCatheter Materials
Short-term Short-term materialsmaterials
May stay in up to 3/52May stay in up to 3/52
LatexLatexPTFE coated PTFE coated
latexlatexSiliconised latexSiliconised latexPVCPVC
Long-term materialsLong-term materials May stay in up to 3/12May stay in up to 3/12
Silicone elastomer Silicone elastomer (silastic)(silastic)
Hydrogel coated Hydrogel coated latexlatex
Silver coated latexSilver coated latex100% silicone100% silicone100% silicone + 100% silicone +
hydrogel coatinghydrogel coating
Types of CathetersTypes of Catheters
Manystylesand
colorsfromwhich
tochoose
Straight CatheterStraight Catheter
Courtesy of http://www.vetmed.wsu.edu/courses_samDX/urinary.htm
The rounded tip of this intermittent catheter reduces urethral trauma as the catheter is passed. Urine enters the lumen of the catheter through two "eye" holes.
intermittent or straightintermittent or straight
intermittent or straight intermittent or straight cathetercatheter
Foley catheter or Foley catheter or retention or indwelling retention or indwelling
cathetercatheter
Foley Catheter (Foley Catheter (indwellingindwelling))
Silicone CatheterSilicone Catheter
Other CathetersOther Catheters
Coudeis a intermittent catheter with
a tapered curved tip that is designed to be easier to insert
when enlargement of the prostate is suspected.
Mushroom (Pezzer)The mushroom-shaped tip this
continuous catheter secures it in the patient's bladder after percutaneous
placement. It may be sutured to your patient's abdomen or flank, or you may
need to tape it in place.
Other Urinary EquipmentOther Urinary Equipment
Catheter Clamp
Three-way Foley for
Continuous Bladder Irrigation
Continuous
Bladder
Irrigation
External Urinary DeviceExternal Urinary Device
Condom or Texas Condom or Texas CatheterCatheter
Female external Female external Urinary Urinary Collection Collection systemsystem ((In infants/young In infants/young children; referred children; referred to as urine to as urine collection bagcollection bag))
Drainage System: closed Drainage System: closed systemsystem
Overnight drainage Overnight drainage bag / 2 litre bed bag / 2 litre bed bag bag
The bag attaches The bag attaches directly to the directly to the catheter and stays catheter and stays there for 7 daysthere for 7 days
Don’t break/open Don’t break/open the systemthe system!!
Link drainage systemLink drainage system
Urethral Catheterization - Urethral Catheterization - procedureprocedure
ProcedureProcedurePatient preparationPatient preparation
- information- information
- consent- consent
Aseptic techniqueAseptic technique- to prevent the transmission of - to prevent the transmission of
micro-micro- organisms , thus reducing organisms , thus reducing risk of infectionrisk of infection
Insertion procedureInsertion procedure
EquipmentEquipment Catheter packCatheter pack Two pairs sterile glovesTwo pairs sterile gloves Sachet of normasol (to clean round Sachet of normasol (to clean round
urethral meatus)urethral meatus) 10ml syringe10ml syringe Ampoule of sterile water for injections (if Ampoule of sterile water for injections (if
not in pack with catheter)not in pack with catheter) Lubricant e.g. instillagel Lubricant e.g. instillagel
6ml for females and 11ml for males6ml for females and 11ml for males An appropriate catheterAn appropriate catheter Drainage systemDrainage system
Catheter kitCatheter kit
Insertion procedureInsertion procedure
Insertion procedureInsertion procedure
Insertion procedureInsertion procedure
Urethral Catheterization - Urethral Catheterization - procedureprocedure
Normal male urethra - 20 cm from tip Normal male urethra - 20 cm from tip of external meatus to internal of external meatus to internal meatusmeatus
Best to “insert full hilt”Best to “insert full hilt”
before inflating balloonbefore inflating balloon Sometimes helped bySometimes helped by
straightening urethrastraightening urethra
and pulling upand pulling up
Urethral Catheterization - Urethral Catheterization - procedureprocedure
Female urethra short, straight, andFemale urethra short, straight, and
usually wide caliber BUT meatus is usually wide caliber BUT meatus is not always obviousnot always obvious
Urethra = 4 cm + tip & Urethra = 4 cm + tip &
balloon = 4 cm balloon = 4 cm about about
1/2 the catheter inserted 1/2 the catheter inserted
before inflating balloonbefore inflating balloon
DocumentationDocumentation Date inserted & Date inserted &
date due to be date due to be changedchanged
Rationale for Rationale for catheterisationcatheterisation
Any problems Any problems encounteredencountered
Size insertedSize inserted
Batch / lot numberBatch / lot number Expiry dateExpiry date Fluid used in Fluid used in
balloonballoon Type & volumeType & volume
Volume of urine Volume of urine draineddrained
Drainage system Drainage system usedused
Acute Urinary Retention -Acute Urinary Retention -difficultiesdifficulties
Acute Urinary Retention -Acute Urinary Retention -difficultiesdifficulties
Coude catheters
Complications of long-Complications of long-term catheterizationterm catheterization
::
UTI, UTI, septicemia, septicemia, urethral injury, urethral injury, hematuriahematuria BacteriuriaBacteriuria Chronic renal inflammation Chronic renal inflammation Pyelonephritis Pyelonephritis Nephrolithiasis Nephrolithiasis Cystolithiasis Cystolithiasis Bladder cancer Bladder cancer
Indwelling foley catheters are a major Indwelling foley catheters are a major source of UTI’S.source of UTI’S.
Direct relationship between duration a f/c Direct relationship between duration a f/c is in the patient and incidence of infection.is in the patient and incidence of infection.
Risk factorsRisk factors:: FemaleFemale Advanced ageAdvanced age DurationDuration DiabetesDiabetes Renal insufficiencyRenal insufficiency
Bacteria is a function of time with a Bacteria is a function of time with a f/c:f/c:
Single event – risk < 1%Single event – risk < 1% 4 days – risk increases to 30%4 days – risk increases to 30% 30 days – risk 95-100%30 days – risk 95-100%
Monitor for ComplicationsMonitor for Complications
Foul smelling urine Foul smelling urine Thick, cloudy urine with or without Thick, cloudy urine with or without
sediment sediment Painful urination (dysuria)Painful urination (dysuria) Fever, chillsFever, chills Urethral swelling around the catheterUrethral swelling around the catheter Bleeding into or around the catheterBleeding into or around the catheter Catheter draining little or no urine despite Catheter draining little or no urine despite
adequate fluid intakeadequate fluid intake Leakage of large amounts of urine around Leakage of large amounts of urine around
the catheterthe catheter
CareCare
Meatal hygieneMeatal hygiene Minimise handlingMinimise handling Maintain asepsisMaintain asepsis Do not allow bag to become too Do not allow bag to become too
fullfull Keep drainage bag below level of Keep drainage bag below level of
bladderbladder
Suprapubic Catheterization
Suprapubic catheterization allows
bladder drainage by inserting a catheter or tube into the bladder through a suprapubic (above the pubis) incision or puncture.
04/18/23 Miss Iman Shaweesh 50
Suprapubic Catheterization
It may be a temporary measure to divert the flow of urine from the urethra when the urethral route is impassable (because of
injuries, strictures, prostatic obstruction, after gynecologic or other abdominal surgery after pelvic fractures.
Suprapubic Catheterization
may also be used on a long-term basis
for women with urethral destruction secondary to long-term indwelling urethral catheters