Urethral Catheterization

1. Urethral CatheterizationUrethral Catheterization
.UAK

2. OutlineOutline
catheterization
– contra/indications
– Complications
– Catheters
– procedures

3. Indications for CatheterizationIndications for Catheterization
 Drain bladder
– Unconsious - OR/Intubated
– Retention - Neurogenic bladder, Obstruction, Clots
 Monitor output
– Trauma
– Medical (CHF, RF, sepsis)
 Urine specimen
 Diagnostic studies
– Residual
– Radiographic contrast studies
– Renal function (24 h)
– Urodynamics

4. ContraindicationsContraindications
Traumatic urethral injury
– Mechanism (90% will have pelvic injury)
– Blood at meatus
– High riding prostate
– perineal hematoma
When any of these findings are present in the setting
of possible trauma, a retrograde urethrogram should
be performed to rule out a urethral tear prior to
placing a catheter into the bladder.

5. Retrograde UrethrogramRetrograde Urethrogram

6. DurationDuration
Intermittent / In & Out
– CIC- usually colonized
Indwelling
– 4% colonization / day

7. Complications of CatheterizationComplications of Catheterization
Short Term
 Trauma
 False passage
 Hematuria
 UTI
Long Term
 colonization
 urethral sloughing
 malignancy
 stones
 hematuria
 obstruction
 stricture

8. CathetersCatheters
Size
– French size = circumference in millimeters
– French: 10 Fr circumference = 3.14 mm diameter
Material
– Latex
– Silicone (silastic)
– Teflon

9. CathetersCatheters
Types
 Way
– 1 vs 2 vs 3 way
 Design
– Foley
– Coude (Tieman)
– Malecot
– Council
- Couvaliere
 Holes:
– hematuria
– 6 eyed

10. EquipmentEquipment
 Foley trays/a catheterisation pack
– Drapes
– Gauze
– lubricant
– a 12 – 14 Fr male Foley catheter
– antiseptic solution
– sterile gloves
– a 10ml sterile water -filled syringe
 Collection bag/a catheter bag
 2% xylocaine / lignocaine gel
 + extra set of hands

11. ProcedureProcedure

12. ProcedureProcedure
A chaperone is required for this procedure.
Begin by introducing yourself to the patient
and clarify his identity. Explaining what
you are going to do and obtain his consent.
Prepare your equipment for this procedure
Position the patient on his back with legs
slightly apart, and lying as flat as possible.

13.  Using an aseptic technique open the catheter pack
and pour antiseptic solution into the receiver.
Open the rest of your equipment onto the sterile
field.
 Wash and dry your hands, then put on the sterile
gloves
 Drape the patient and place a collecting vessel
between the patients legs . Hold the penis with a
sterile swab and clean the penis thoroughly.
Remember to retract the foreskin and clean around
the urethral meatus.

14.  Insert the lignocaine gel and hold the meatus closed with
pressure from the swab. Indicate that the anaesthetic needs
5 minutes to work.
 “Penis up to the sky” Hold the penis vertically with one
hand and with the other hold the catheter by its sleeve.
Advance the catheter tip from its sleeve and insert into the
urethra.
 Progressively insert the catheter, ensuring that neither your
hand nor the sleeve touch the penis until the end arm
reaches the meatus. At this point urine should start to flow
into the collecting vessel.

15.  Inflate the balloon using 10ml of sterile water, ensuring that it
does not cause any pain. NB the volume used to fill the balloon
may vary depending upon the size of the catheter used, check
the packaging for the exact volume to use.
 Attach the catheter bag.
 Gently pull on the catheter until resistance is felt. This is
when the balloon will be resting on the urethral opening of
the bladder. Then reposition the foreskin.
 Dispose of your gloves and equipment in the clinical waste
bin. Wash your hands.
 Record the volume of urine collected in the catheter bag
and ensure that the patient is comfortable and covered.
Remember to complete the sticker on the outside of the
catheter pack and put it into the patients notes.

16. ProcedureProcedure

17. cont.cont.
How do you know when you are in the bladder?
1. Urine
2. Hub of catheter at tip of penis
3. Balloon inflates easily
4. Patient should not have pain when inflating
balloon
5. When catheter pulled back (after balloon inflated)
an end-point is felt.
6. Catheter can slide in and out
7. Catheter can irrigate easily (in = out)

18. Important Misc.Important Misc.
Lubricant is your friend
Pull the penis up
Antibiotics
– Infected: short course
– SBE prophylaxis (not indicated unless infected)
– traumatic
Latex allergy
Water (not saline)
Reduce foreskin (paraphimosis)

19. Catheter
(14-16 Fr (for women)
12 Fr for young girls
Female: dorsal recumbent (supine with
knees flexed) or Sims position (side-lying
with upper leg flexed at knee and hip)
Male: supine position

20. Difficult catheterizationDifficult catheterization

21. Difficult catheterizationDifficult catheterization
History – attempts, PMHx, surgery, LUTS
P/E- abdomen, genitals
Instrumentation
1.Why?
2.Where?
3.Options?

22. WHYWHY Difficult catheterization?Difficult catheterization?
Females
Exposure
– lots of hands
Female hypospadius
– Tieman run along finger
Urethral stenosis
– Introital mass

23. WHEREWHERE Difficult catheterizationDifficult catheterization
Males
meatus
urethral stricture
sphincter
prostate (BPH/Cancer)
bladder neck

24. Difficult CatheterizationDifficult Catheterization
Lubricant and proper technique
Catheter
– Size (go larger not smaller)
– Type eg. Coude (Tieman)
Filiforms and Followers
Stylet
Flexible Cystoscope and Guide Wire
Suprapubic Tube

25. WHEREWHERE is Difficulty ?is Difficulty ?
Males
Meatus- dilatation ( sounds, snap), lubricant
urethral stricture
Sphincter-
 lubricant,
 relaxation
prostate (BPH/Cancer)
bladder neck

26. ThanksThanks