CATHETERIZATION è DR AFZAL JUNEJO è ASSOCIATE PROFESSOR è SURGERY, LUMHS

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.

. .


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.


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..


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





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


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


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.


may also be used on a long-term basis

for women with urethral destruction secondary to long-term indwelling urethral catheters

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CATHETERIZATION è DR AFZAL JUNEJO è ASSOCIATE PROFESSOR è SURGERY, LUMHS