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

2. Urethral Catheterization - A Simple Plan

3. Catheterisation

4. Drainage…

5. Indications
Management 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 specimen
Intermittent bladder decompression
Urologic study of anatomy of urinary tract

9. Indications simplified

10. Indications for catheterisation
Retention of urine
Monitor urine output / acutely ill patient
Pre/peri/post-operatively
Assessment and investigations
Treatment (e.g. to instil chemotherapy)
Irrigation of bladder
Bypass an obstruction
Management 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;
Size
Balloon size
Length
Material (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: 8F
Child/adolescent: 10-12
Adult and large adolescent: 14-18F (female/male)
Most common: 14F to 16F used in large, older adolescents and adults

15. Balloon size
5 – 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 3/52
Latex
PTFE coated latex
Siliconised latex
PVC
Long-term materials
May stay in up to 3/12
Silicone elastomer (silastic)
Hydrogel coated latex
Silver coated latex
100% silicone
100% silicone + hydrogel coating

17. Types of Catheters

18. Many
styles
and
colors
from
which to
choose

19. Straight Catheter
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.
Courtesy of

20. intermittent or straight

21. intermittent or straight catheter

22. Foley catheter or retention or indwelling catheter

24. Foley Catheter (indwelling)

25. Silicone Catheter

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 for
Continuous Bladder Irrigation
Continuous
Bladder
Irrigation
Catheter Clamp

28. External Urinary Device
Condom or Texas Catheter
Female 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 bag
The bag attaches directly to the catheter and stays there for 7 days
Don’t break/open the system!

30. Link drainage system

31. Urethral Catheterization - procedure

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

33. Gather supplies Insertion procedure Catheter kit Uro-Jet ®
14-16 Fr latex catheter
Drainage bag, sterilization solution & sterile gloves.

34. Equipment Catheter pack Two pairs sterile gloves
Sachet of normasol (to clean round urethral meatus)
10ml syringe
Ampoule of sterile water for injections (if not in pack with catheter)
Lubricant e.g. instillagel
6ml for females and 11ml for males
An appropriate catheter
Drainage system

35. Catheter kit

36. Unpack supplies Insertion procedure Unpack kit
Place catheter and Uro-Jet® on sterile field
Pour 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 meatus
Best to “insert full hilt”
before inflating balloon
Sometimes helped by
straightening urethra
and pulling up

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

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

42. Acute Urinary Retention - difficulties

43. Acute Urinary Retention - difficulties
Coude catheters

44. Complications of long-term catheterization:
UTI,
septicemia,
urethral injury,
hematuria
Bacteriuria
Chronic renal inflammation
Pyelonephritis
Nephrolithiasis
Cystolithiasis
Bladder 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:
Female
Advanced age
Duration
Diabetes
Renal 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 urine
Thick, cloudy urine with or without sediment
Painful urination (dysuria)
Fever, chills
Urethral swelling around the catheter
Bleeding into or around the catheter
Catheter draining little or no urine despite adequate fluid intake
Leakage of large amounts of urine around the catheter

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

49. 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.

50. 4/14/2017
Miss Iman Shaweesh

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 of
injuries,
strictures,
prostatic obstruction,
after gynecologic or other abdominal surgery
after pelvic fractures.

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