5 IndicationsManagement of acute urinary retention or bladder outlet obstruction.Urine output measurement in critically ill patients.During surgery to assess fluid status.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 Management of hematuria associated with clots.Management of immobilized patients (eg, stroke, pelvic fracture).Management of patients with neurogenic bladder.Management of open wounds located in the sacral or perineal regions in patients who are incontinent..Reference: Schaeffer AJ. Placement and management of urinary bladder catheters. UpToDate ® (2010)
7 Indications – Copied from UTD Intravesical pharmacologic therapy (eg, bladder cancer).Improved patient comfort for end of life care.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 Collection of uncontaminated specimenIntermittent bladder decompressionUrologic study of anatomy of urinary tract
10 Indications for catheterisation Retention of urineMonitor urine output / acutely ill patientPre/peri/post-operativelyAssessment and investigationsTreatment (e.g. to instil chemotherapy)Irrigation of bladderBypass an obstructionManagement of incontinence (as a last resort)
11 Urethral Catheterization – Absolute contraindications Known urethral trauma -blood at meatus,fractured penis, etc.
12 Relative contraindications urethral stricture,recent urinary tract surgery (ie, urethra, bladder),presence of an artificial sphincter..Reference: Schaeffer AJ. Placement and management of urinary bladder catheters. UpToDate ® (2010)
13 Catheter Selection Drainage system (closed / link system) Points to consider;SizeBalloon sizeLengthMaterial (consider latex allergy)Drainage system (closed / link system)
14 Catheter size Ranges: Infant: 8F Child/adolescent: 10-12 Urinary catheters are sized using French (F) units. The French number divided by 3 is the outer diameter of the catheter in millimeters.Ranges:Infant: 8FChild/adolescent: 10-12Adult and large adolescent: 14-18F (female/male)Most common: 14F to 16F used in large, older adolescents and adults
15 Balloon size5 – 10 ml balloon usually with fluid to inflate (15-30cc balloons may be used in patients with prostate surgery)
16 Catheter Materials Short-term materials Long-term materials May stay in up to 3/52LatexPTFE coated latexSiliconised latexPVCLong-term materialsMay stay in up to 3/12Silicone elastomer (silastic)Hydrogel coated latexSilver coated latex100% silicone100% silicone + hydrogel coating
26 Other Catheters Coude Mushroom (Pezzer) 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 Three-way Foley forContinuous Bladder IrrigationContinuousBladderIrrigationCatheter Clamp
28 External Urinary Device Condom or Texas CatheterFemale external Urinary Collection system (In infants/young children; referred to as urine collection bag)
29 Drainage System: closed system Overnight drainage bag / 2 litre bed bagThe bag attaches directly to the catheter and stays there for 7 daysDon’t break/open the system!
34 Equipment Catheter pack Two pairs sterile gloves Sachet of normasol (to clean round urethral meatus)10ml syringeAmpoule of sterile water for injections (if not in pack with catheter)Lubricant e.g. instillagel6ml for females and 11ml for malesAn appropriate catheterDrainage system
36 Unpack supplies Insertion procedure Unpack kit Place catheter and Uro-Jet® on sterile fieldPour sterilization solution in cup
37 Prep & Drape Insertion procedure 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 Normal male urethra - 20 cm from tip of external meatus to internal meatusBest to “insert full hilt”before inflating balloonSometimes helped bystraightening urethraand pulling up
40 Urethral Catheterization - procedure Female urethra short, straight, andusually wide caliber BUT meatus is not always obviousUrethra = 4 cm + tip &balloon = 4 cm about1/2 the catheter insertedbefore inflating balloon
41 Documentation Date inserted & date due to be changed Rationale for catheterisationAny problems encounteredSize insertedBatch / lot numberExpiry dateFluid used in balloonType & volumeVolume of urine drainedDrainage system used
44 Complications of long-term catheterization :UTI,septicemia,urethral injury,hematuriaBacteriuriaChronic renal inflammationPyelonephritisNephrolithiasisCystolithiasisBladder cancer
45 Indwelling foley catheters are a major source of UTI’S. Direct relationship between duration a f/c is in the patient and incidence of infection.Risk factors:FemaleAdvanced ageDurationDiabetesRenal insufficiency
46 Bacteria is a function of time with a f/c: Single event – risk < 1%4 days – risk increases to 30%30 days – risk %
47 Monitor for Complications Foul smelling urineThick, cloudy urine with or without sedimentPainful urination (dysuria)Fever, chillsUrethral swelling around the catheterBleeding into or around the catheterCatheter draining little or no urine despite adequate fluid intakeLeakage of large amounts of urine around the catheter
48 Care Meatal hygiene Minimise handling Maintain asepsis Do not allow bag to become too fullKeep drainage bag below level of bladder
49 Suprapubic Catheterization Suprapubic catheterization allowsbladder drainage by inserting a catheter or tube into the bladder through a suprapubic (above the pubis) incision or puncture.
51 Suprapubic Catheterization It may be a temporary measure to divert the flow of urine from the urethra when the urethral route is impassable (because ofinjuries,strictures,prostatic obstruction,after gynecologic or other abdominal surgeryafter pelvic fractures.
52 Suprapubic Catheterization may also be used on a long-term basisfor women with urethral destruction secondary to long-term indwelling urethral catheters