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Monday, May 9, 2011

Safe Urinary Catheterization of a Patient

Posted by Prahallad Panda on 6:32 PM Comments

My professor once said; "Urethra is just like a glass, handle with care." A little carelessness in catheterization of urethra may land the patient in a lifelong problem or may sometimes cost his/her life. Catheterization of urethra means; putting a small caliber silicon or rubber tube through the urethra into the urinary bladder to get the urine collected to an attached bag. The idea is to relieve any retained urine in the bladder or collect the urine safely to a bag without soiling the bed as in case of incontinence.
Indications could be:
(A) Bladder neck obstruction due to 1) an enlarged prostate, 2) a fibrosed prostate 3) narrowing of bladder neck.
(B) Incontinence of urine due to 1) nerve injury 2) comatose patient 3) as a pre-operative preparation for pelvic surgery 4) some cases of multiple sclerosis.
( C ) Autonomous bladder.
Requirements: 1) 5 % providone iodine lotion as antiseptic, 2) Sterile gauze and cotton, 3)Sterile gloves, 4) Sterile towel, 5 ) Sterile 5% Lignocaine jelly, 6) Foley's catheter of 14 F size and 7) Distilled water.
First of all the patient is to be placed in a comfortable bed and privacy maintained. Gentamicin in the required dose e.g. for adults 80 mgs is to be injected as a precautionary measure for probable bacterial migration upwards from urethra and spread of infection. Gloves are to be put on by the person who will catheterize the patient in an aseptic way.
The foreskin of penis is to be retracted and area surrounding the body of penis is to be cleaned; and providone iodine lotion applied. A towel is to be put around the penis, so that no equipment will become unsterile during the procedure. A full tube of lignocaine jelly is to be put into the urethra and urethra held tightly, at least for 5 minutes so that no jelly could escape out. The urethra will get anaesthetized in the meanwhile. The catheter will be taken out of the container and gradually introduced into the urethral opening; and progressed with very gentle push till it reaches the bifurcation. Now, if the catheter is in the urinary bladder, urine will be seen coming out. At this point 20 ml of distilled water is to be put into the channel with the valve by a 20 ml syringe. The water will distend the balloon present in the tip of the catheter which is inside the bladder now and the catheter will be seen retained.
The collecting bag will now be connected to the channel of catheter. Urine will be seen passing to the bag. A little providone iodine ointment is to be put around the catheter where it enters the urethra. The prepuce if present will be returned to original position. That will conclude the procedure.
Tips & Warnings
  • Precautionary Injection of gentamicin will prevent infection that is likely to enter the urinary bladder along with the passage of catheter in urethra.
  • Rubber catheters need not be used, instead silicone should be preferred in fear of subsequent urethral infection.
  • Fully aseptic method is to be followed or else an urinary tract infection may be the outcome.
  • Full tube of lignocaine jelly is to be put or else the urethra will not be fully lubricated and anaesthetized.
  • The catheter will not be introduced with force against resistance is felt that may injure the urethra; which may be the cause of a future stricture formation in urethra.
  • Catheter should be introduced up to the end till its bifurcation, so that there will be no chance of balloon present in the tip of urethra remaining in the urethra and the inadvertent inflation of it in the urethra itself; which will rapture the urethra and bleeding from urethra.
  • Before putting distilled water make sure to see urine coming out that will ensure the tip of catheter is inside the urinary bladder, and balloon is inflated in the right place.
  • Always distilled water is to be used, if, instead saline or dextrose solution is used, that may precipitate inside the narrow channel, so that while removing the catheter the water cannot be drained out resulting in non-deflation of and a retained catheter.
  • Risks;
  1. Spread of infection,
  2. Rapture of urethra,
  3. False passage creation,
  4. Injury to urethra and
  5. Bleeding from urethra.
  • When to abandon the procedure;
  1. At any time, if blood is seen coming out signifying injury to urethra.
  2. If good deal of resistance to introduction of catheter is encountered signifying impassable obstruction in urethra.
At last, I once again repeat, "Urethra is just like a glass, handle with care".
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