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

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Presentation on theme: "CATHETERIZATION è DR AFZAL JUNEJO è ASSOCIATE PROFESSOR è SURGERY, LUMHS."— Presentation transcript:

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

2 Urethral Catheterization - A Simple Plan

3 Catheterisation

4 Drainage…

5 Indications è Management of acute urinary retention or bladder outlet obstruction. è Urine output measurement in critically ill patients. è During surgery to assess fluid status. è During and following specific surgeries of the genitourinary tract or adjacent structures (ie, urologic, gynecologic, colorectal surgery). Reference: Schaeffer AJ. Placement and management of urinary bladder catheters. UpToDate ® (2010)

6 Indications – Copied from UTD è Management of hematuria associated with clots. è Management of immobilized patients (eg, stroke, pelvic fracture). è Management of patients with neurogenic bladder. è Management of open wounds located in the sacral or perineal regions in patients who are incontinent. è. Reference: Schaeffer AJ. Placement and management of urinary bladder catheters. UpToDate ® (2010)

7 Indications – Copied from UTD è Intravesical pharmacologic therapy (eg, bladder cancer). è Improved patient comfort for end of life care. è Management of patients with urinary incontinence following failure of conservative, behavioral, pharmacologic and surgical therapy. Reference: Schaeffer AJ. Placement and management of urinary bladder catheters. UpToDate ® (2010)

8 Urethral Catheterization - Indications è Collection of uncontaminated specimen è Intermittent bladder decompression è Urologic study of anatomy of urinary tract

9 Indications simplified

10 Indications for catheterisation è Retention of urine è Monitor urine output / acutely ill patient è Pre/peri/post-operatively è Assessment and investigations è Treatment (e.g. to instil chemotherapy) è Irrigation of bladder è Bypass an obstruction è Management of incontinence (as a last resort)

11 Urethral Catheterization – Absolute contraindications è Known urethral trauma - blood at meatus, blood at meatus, fractured penis, etc. fractured penis, etc.

12 Relative contraindications è urethral stricture, è recent urinary tract surgery (ie, urethra, bladder), è presence of an artificial sphincter.. Reference: Schaeffer AJ. Placement and management of urinary bladder catheters. UpToDate ® (2010)

13 Catheter Selection è Points to consider ; ÕSize ï Balloon size ï Length ÕMaterial (consider latex allergy) ÕDrainage system (closed / link system)

14 Catheter size è Urinary catheters are sized using French (F) units. The French number divided by 3 is the outer diameter of the catheter in millimeters. è Ranges: ÕInfant: 8F ÕChild/adolescent: ÕAdult and large adolescent: 14-18F (female/male) è Most common: 14F to 16F used in large, older adolescents and adults

15 5 – 10 ml balloon usually with fluid to inflate (15-30cc balloons may be used in patients with prostate surgery) 5 – 10 ml balloon usually with fluid to inflate (15-30cc balloons may be used in patients with prostate surgery) Balloon size

16 Catheter Materials è Short-term materials è May stay in up to 3/52 ÕLatex ÕPTFE coated latex ÕSiliconised latex ÕPVC è Long-term materials è May stay in up to 3/12 ÕSilicone elastomer (silastic) ÕHydrogel coated latex ÕSilver coated latex Õ100% silicone Õ100% silicone + hydrogel coating

17 Types of Catheters

18 Many styles and colors from which to choose

19 Straight Catheter Courtesy of 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.

20 intermittent or straight

21 intermittent or straight catheter

22 Foley catheter or retention or indwelling catheter Foley catheter or retention or indwelling catheterFoley catheter Foley catheter

23

24 Foley Catheter ( indwelling )

25 Silicone Catheter

26 Other Catheters Coude is 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.

27 Other Urinary Equipment Catheter Clamp Three-way Foley for Continuous Bladder Irrigation Continuous Bladder Irrigation

28 External Urinary Device è Condom or Texas Catheter Condom or Texas Catheter Condom or Texas Catheter è Female external Urinary Collection system (In infants/young children; referred to as urine collection bag )

29 Drainage System: closed system è Overnight drainage bag / 2 litre bed bag è The bag attaches directly to the catheter and stays there for 7 days è Don’t break/open the system !

30 Link drainage system

31 Urethral Catheterization - procedure

32 Procedure Patient preparation - information - consent Aseptic technique - to prevent the transmission of micro- organisms, thus reducing risk of infection

33 Insertion procedure Gather supplies Catheter kit Uro-Jet ® Fr latex catheter Drainage bag, sterilization solution & sterile gloves.

34 Equipment è Catheter pack è Two pairs sterile gloves è Sachet of normasol (to clean round urethral meatus) è 10ml syringe è Ampoule of sterile water for injections (if not in pack with catheter) è Lubricant e.g. instillagel Õ6ml for females and 11ml for males è An appropriate catheter è Drainage system

35 Catheter kit

36 Insertion procedure Unpack supplies Unpack kit Place catheter and Uro- Jet® on sterile field Pour sterilization solution in cup

37 Insertion procedure Prep & Drape Don sterile gloves. Place syringe onto Foley. Sterilize the external urethral orifice. Drape the field and transfer equipment

38 Insertion procedure Insert Foley With non-dominant hand stretch penis or open labia. With dominant hand, insert Foley. Insert to hilt and ensure that there is urine flow prior to balloon inflation. Replace forekin, attach drainage bag.

39 Urethral Catheterization - procedure è Normal male urethra - 20 cm from tip of external meatus to internal meatus è Best to “insert full hilt” before inflating balloon before inflating balloon è Sometimes helped by straightening urethra straightening urethra and pulling up and pulling up

40 Urethral Catheterization - procedure è Female urethra short, straight, and usually wide caliber BUT meatus is not always obvious usually wide caliber BUT meatus is not always obvious è Urethra = 4 cm + tip & balloon = 4 cm  about balloon = 4 cm  about 1/2 the catheter inserted 1/2 the catheter inserted before inflating balloon before inflating balloon

41 Documentation è Date inserted & date due to be changed è Rationale for catheterisation è Any problems encountered è Size inserted è Batch / lot number è Expiry date è Fluid used in balloon ÕType & volume è Volume of urine drained è Drainage system used

42 Acute Urinary Retention - difficulties

43 Coude catheters

44 Complications of long-term catheterization : è UTI, è septicemia, è urethral injury, è hematuria è Bacteriuria Bacteriuria è Chronic renal inflammation Chronic renal inflammation Chronic renal inflammation è Pyelonephritis Pyelonephritis è Nephrolithiasis è Cystolithiasis è Bladder cancer

45 è Indwelling foley catheters are a major source of UTI’S. è Direct relationship between duration a f/c is in the patient and incidence of infection. è Risk factors:  Female  Advanced age  Duration  Diabetes  Renal insufficiency

46 Bacteria is a function of time with a 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 % 30 days – risk %

47 Monitor for Complications Monitor for Complications è Foul smelling urine è Thick, cloudy urine with or without sediment è Painful urination (dysuria) è Fever, chills è Urethral swelling around the catheter è Bleeding into or around the catheter è Catheter draining little or no urine despite adequate fluid intake è Leakage of large amounts of urine around the catheter

48 Care è Meatal hygiene è Minimise handling è Maintain asepsis è Do not allow bag to become too full è Keep drainage bag below level of bladder

49 Suprapubic Catheterization è è Suprapubic catheterization allows è è bladder drainage by inserting a catheter or tube into the bladder through a suprapubic (above the pubis) incision or puncture.

50 5/5/2015Miss Iman Shaweesh50

51 Suprapubic Catheterization è è It may be a temporary measure to divert the flow of urine from the urethra when the urethral route is impassable (because of è è injuries, è è strictures, è è prostatic obstruction, è è after gynecologic or other abdominal surgery è è after pelvic fractures.

52 Suprapubic Catheterization è è may also be used on a long-term basis è è for women with urethral destruction secondary to long-term indwelling urethral catheters


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