Bladder catheterization is the insertion of a tube into the ureter to empty it. The urological procedure is performed with urinary retention and for instillation of the bladder with drugs. To perform it, rigid and bendable catheters are used. They are introduced into the bladder through the urethral canal or punctures in the skin in the suprapubic zone. The duration of catheterization depends on the type of pathology. In case of temporary urination disorders, the catheter is placed in an outpatient or inpatient setting for a short time.
Indications for bladder catheterization
Ureter catheterization - the introduction of a device to divert urine or supply medication. The procedure is performed to diagnose or treat identified urological diseases. Depending on the testimony, a catheter is inserted temporarily or permanently.
Bladder catheterization is indicated for:
- swelling of the urinary tract
- interstitial cystitis
- genital injuries
- cysts in the bladder or urethra,
- narrowing, spasms of the urethra,
- acute urinary retention,
- temporary disability
- tumors of the urinary duct,
- blockage of the outlet of the bladder with calculi,
- urinary diverticulum,
- severe spinal injuries
- postoperative rehabilitation.
The introduction of catheters into the urea is performed for:
- washing the urinary tract and bladder,
- obtaining urine for laboratory analysis,
- normalization of outflow of urine.
When the procedure is not performed
There are relative and absolute contraindications to catheterization of the urea. Most of them are associated with a risk of damage to the urinary duct and infection:
- exacerbation of urethritis,
- acute cystitis
- urethral bleeding
- urethra obstruction,
- acute inflammation of the genitourinary system,
- severe urethral spasms.
The introduction of a catheter is dangerous for strictures (scarring) of the urinary tract. An attempt to catheterize the urea in case of obstruction of the urethra is fraught with damage or perforation of the wall.
Types of Catheters
Conventionally, all catheters for the bladder are divided into male, female and children's. They differ in length, shape and diameter, which is due to the structural features of the urinary tract in patients of different groups. Depending on the properties of the materials used, catheters are:
- Soft. Hollow tubes up to 30 cm long and up to 10 mm in diameter are made of elastic materials. The end of the catheter, which is inserted into the urinary tract, is soft and rounded. The outer end has a funnel-shaped extension, which facilitates the installation of a syringe for infusion of drugs. When introduced, they do not injure the mucous membrane of the urinary ducts. In half the cases, catheterization of the bladder with a soft catheter is performed for a period of 2 weeks to 3-6 months.
- Tough. Solid drainage tubes made of non-bending materials. Consist of a beak, a handle and a rod. The urethral end is rounded with two lateral openings. The installation of rigid catheters requires special skills, which is associated with a high risk of damage to the urethra and neck of the bladder. The length of the male catheter is 30 cm, and the female is not more than 15 cm.
According to the type of design, 4 types of catheters are distinguished:
- Robinson's probe is a disposable soft catheter with a small inner diameter with a rounded end. It is used to collect urine in women or men with edema of the urinary tract, dysuric disorders.
- Stent Timann is a rigid curved tube with an elastic soft end. It is used for urine diversion in case of inflammation of the urinary ducts.
- Foley's catheter is a flexible tube consisting of two sleeves and a reservoir for collecting urine. It is used for prolonged catheterization of the urea to empty it, rinse with medicinal solutions. For the purpose of long-term drainage of the bladder in men, self-retaining catheters are used that are equipped with an expanding balloon.
- Pezzer's catheter is a large-headed latex probe that is used only when a cystostomy is installed. Sometimes used for drainage of fistulas in the suprapubic area after surgery.
The type of probes used depends on many factors — the duration of the catheterization, the gender of the patient, and the form of the disease.
Bladder Catheterization Methods
The duration of catheterization is short and long. In the first case, the probe is injected into the urinary tract for a period of up to several days, and in the second - for constant drainage of urine.
Types of catheterization of the bladder:
- Urethral - insertion of a stent catheter through the urethra. Performed after antiseptic treatment of the genitals. To relieve pain, a local anesthetic is injected into the urethra. The procedure is performed exclusively with normal patency of the urinary tract.
- Ureteric - installation of a catheter in the ureter. It is performed if necessary, separate sampling of urine from the left and right kidneys. Recommended for stones, as well as for the introduction of medicines in the upper parts of the urinary system.
Preparation for the procedure
Catheterization is preceded by a preparatory phase. Before installing the probe in the ureter, you must:
- wash with hypoallergenic soap,
- shave hair in the genital area,
- wash the genitals with a weak antiseptic solution - Furacilin, Miramistin.
Before the procedure, the nurse disinfects medical instruments. For catheterization, you will need:
- disposable surgical gloves
- glycerin or petroleum jelly,
- tool tray
- oilcloth sheet
- waste material tray
- Syringe Janet
- gauze napkins,
- antispasmodic and local anesthetic,
Manipulations are performed exclusively under sterile conditions, and during the procedure the medical staff complies with the rules of antiseptics. This reduces the risk of infection of the urinary system.
Bladder Catheterization Algorithm
The procedure for placing the probe in men and women is the same. But in men, a significant portion of the urethra is located inside the penis, which makes it difficult to insert a drainage tube. To reduce pain, patients are given an antispasmodic, and the mouth of the urethra is treated with an anesthetic.
The installation of a urinary catheter for a woman is not difficult, which is associated with the structural features of the genitourinary system. For the convenience of performing the manipulations, the nurse asks the patient to lie on the couch, bend her knees and spread her hips to the sides.
In women, the urethra is short and wide, so the procedure takes a little time.
Bladder catheterization technology in women:
- a nurse washes her hands with an antiseptic and puts on gloves,
- between the hips of the patient is a tray for waste materials,
- the genitals and the mouth of the urethra are treated with an antiseptic solution,
- the urethral end of the catheter is lubricated with petroleum jelly or glycerin,
- at a distance of 6-7 cm from the edge, the tube is grabbed with sterile forceps and inserted into the urethra,
- it is immersed to a depth of 10 cm or until the appearance of urine,
- an urinal or syringe is attached to the free end of the tube to inject an antiseptic (in case of rinsing the bladder).
At the end of the catheterization, the tube is carefully removed. With spasm of the muscles of the urethra, the procedure is stopped.
To prevent injury to the walls of the urethra, a woman is injected with a 2% Papaverine solution.
The algorithm for performing catheterization for a man is the same as in the previous case. But due to the narrowness of the urethra, the procedure takes 2 times longer. It is carried out in a supine position, a soft drainage tube is used.
The introduction of a catheter into the bladder is carried out according to this scheme:
- the patient is asked to lie on his back and spread his legs a little,
- the inguinal region is treated with an antiseptic, after which the gloves are changed to sterile,
- the penis is wrapped with a gauze napkin,
- in the area of the coronal groove it is captured by the fingers of the left hand,
- the head of the penis is squeezed with the thumb and forefinger to open the mouth of the urethra,
- the probe input area is wiped with Povidone-iodine,
- the penis is pulled up, perpendicular to the legs,
- the inserted end of the tube is treated with petroleum jelly,
- with sterile forceps, grab it at a distance of 6 cm from the edge,
- with little effort, the catheter is inserted into the penis,
- the free edge of the tube is connected to the urinal.
If a man has a permanent catheter, the balloon, which is located on the inner edge, is filled with 5 ml of sodium chloride solution.
After the procedure, the foreskin is carefully returned to its place.
If catheterization is performed once, the stent is pulled out of the urea a little earlier than all urine is removed. This is necessary to flush the urinary tract with the remaining portion of urine.
Features of catheter placement for children
Technically, bladder catheterization in children does not differ from the action algorithm for adults. Due to the narrowness of the urinary tract, drainage tubes are installed in the ureter, subject to some rules:
- the procedure is done with a filled bubble,
- catheter and instruments are sterilized with solutions of low allergenicity,
- the stent is inserted gently without pressure.
It is undesirable to make more than two unsuccessful attempts to catheterize the bladder in children.
The installation of stent catheters should be done by a pediatric urologist. If an obstruction is detected in the urinary ducts, the procedure is abandoned. Violent overcoming is dangerous by rupture of the urethra.
Risks and complications of bladder catheterization
If the nurse has practical skills, serious complications occur infrequently. To exclude them, catheterization is performed without anesthesia, which allows you to immediately identify pain, obstacles in the urethral canal. In rare cases, after catheterization there are complaints of difficulty urinating, blood in the urine.
Possible complications of catheterization of the urea:
- damage to the urethral mucosa,
- burning during urination
- infection of the bladder and ducts,
- false urge to the toilet.
The patient’s stay in the hospital depends on the goals and method of catheterization.
How to live with a permanent catheter
A permanent catheter in the bladder increases the risk of infectious complications. To prevent them, the patient must constantly drink plenty of fluids. Due to this, the concentration of nutrients in urine decreases, which prevents the growth of bacteria.
Catheter cleaning and care features:
- the patient is laid on his back, an oilcloth diaper is laid under the buttocks,
- drainage fluid is drained, after which the catheter is removed,
- the urinal is emptied, washed with water, disinfected with Dioxidine, Furacilin or Miramistin,
- a syringe with 50-100 ml of antiseptic is injected into one end of the drainage tube,
- the urinal is empty at least 5-6 times a day,
- antiseptic treatment of the tube is performed up to 2 times a day.
After hygienic measures, the probe is washed with an isotonic sodium chloride solution. During sleep, the urinal is fixed on the bed so that it is below the urea.
How to change the device yourself
Self-replacement of the drainage tube is almost impossible. If necessary, close relatives perform the catheterization after instruction.
- empty the urinal,
- wash your hands with soap and put on sterile gloves,
- the catheter and genitals are wiped with an antiseptic,
- a syringe is attached to the outer edge of the catheter to pump fluid from the balloon at the other end of the tube,
- with gentle smooth movements, the drainage tube is removed from the urinary tract,
- one end of the new catheter is treated with petroleum jelly and injected into the ureter.
Catheterization of the bladder is a urological procedure that ensures the removal of urine from the urea. It is done for diagnostic or therapeutic purposes in case of pathologies of the urinary system. If performed correctly, it prevents complications - hydronephrosis, diverticulum of the urea, pyelonephritis.
Indications for the installation of a urinary catheter
The installation of a urinary catheter is indicated in the following conditions:
- Urinary retention due to infections and surgical interventions.
- Unconscious patient with uncontrolled outflow of urine.
- Acute inflammatory diseases of the urinary organs requiring rinsing and administration of drugs into the bladder.
- Urethral injury, swelling, scarring.
- General anesthesia and postoperative period.
- Injuries to the spine, paralysis, temporary disability.
- Severe circulatory disorders of the brain.
- Tumors and cysts of the urinary organs.
In inflammatory diseases of the urinary organs, the installation of a urinary catheter is indicated
Also, catheterization is carried out if necessary, taking urine from the urinary bladder.
Types of Catheterization
According to the duration of the procedure, catheterization is divided into long and short. In the first case, the catheter is installed on a permanent basis, in the second - for several hours or days in a hospital.
Depending on the organ undergoing the procedure, these types of catheterization are distinguished:
- renal pelvis,
- urinary bladder.
Also, catheterization can be divided into male, female and children's.
Preparation for catheterization of the bladder
The procedure does not require special preparation. Before catheterization, the patient should be washed, if necessary, shave hair in the intimate area.
The nurse or attending physician must sterilize and prepare the necessary instruments for use. The catheterization kit includes the following:
- sterile instrument tray
- diaper or oilcloth,
- disposable rubber gloves,
- antiseptic for rubber processing,
- gauze napkins,
- petroleum jelly or glycerin,
- Syringe Janet
- furatsilin solution,
- 2 new catheters.
You may also need a container to collect urine for analysis.
Before the procedure, the specialist thoroughly washes his hands, puts on disposable gloves and treats them with an antiseptic drug. The tip of the selected device is lubricated with petroleum jelly or glycerin.
Catheterization in women
The installation of a urological catheter in women is as follows:
- The patient takes a horizontal position: lies on her back, bends her legs at the knees, spreads them apart. A diaper is placed under the buttocks of the patient.
- The labia is washed, treated with an antiseptic and pushed to the sides.
- The entrance to the urethra is treated with a solution of furatsilina.
- A tube moistened in petroleum jelly is inserted into the urethra with tweezers.
- When the device is inserted 7 cm deep into the tube, urine begins to flow. The second end of the catheter is fixed in the urinal.
Depending on the purpose of the procedure, it can end at this point, or continue with washing, administering medications and then removing the device.
Due to the physiological characteristics, women tolerate this procedure much more easily than men.
Technique for men
The placement of the urethral catheter for men is as follows:
- The patient lies in a horizontal position, on his back. The legs are bent at the knees and spread apart to the sides. Oilcloth is placed under the buttocks.
- The penis is wrapped with a napkin, the urethra is treated with a solution of furatsilina and wiped.
- The catheter is taken with tweezers, inserted into the urethral canal. The penis is slowly and gently pulled onto the tube until it moves to the external sphincter.
- The device is slowly lowered into the scrotum, to overcome the obstacle.
- The second end of the catheter is fixed in the urinal. The specialist is waiting for the outflow of urine from the bladder.
Further instructions depend on how long the catheter is placed. For short-term use after the outflow of urine or the introduction of drugs, the device is removed. With prolonged use, catheterization is completed after administration.
If the procedure was carried out correctly, there is no pain.
How is a catheter placed for children?
The general algorithm for installing a catheter for children does not differ from the adult instruction.
There are important features when performing the procedure in children:
- A children's urethral catheter should have a small diameter so as not to damage the urogenital organs of the baby.
- The device is placed on a full bladder. You can check the fullness of the organ using ultrasound.
- Treatment with drugs and strong antibacterial compounds is prohibited.
- Spread the labia of the girls carefully so as not to damage the bridle.
- The insertion of the tube should be soft, slow, without the application of force.
- The catheter must be removed as soon as possible so as not to provoke inflammation.
The procedure in children, especially in infants, should be done by a urologist with a pediatric education.
Urinary Catheter Care
In order to avoid infection of the genitourinary tract, a permanent urinary catheter should be carefully looked after. The algorithm for processing it looks like this:
- Put the patient on his back, place an oilcloth or a vessel under the buttocks. Drain the drain fluid and carefully remove the device.
- Drain the urine from the drainage bag, rinse it with water, treat it with an antiseptic: Chlorhexidine, Miramistin, Dioxidine, boric acid solution.
- Flush the catheter with a 50 or 100 mg syringe. Pour an antiseptic into it, and then rinse with running water.
- For inflammatory processes of the urinary tract, treat the catheter with a solution of furatsilin, diluting 1 tablet in a glass of hot water.
Miramistin - an antiseptic for the treatment of the urinal
The urinal must be emptied 5-6 times a day, and flushed with antiseptics at least 1 time per day. The catheter should be treated no more than 1-2 times a week.
In addition, it is necessary to thoroughly rinse the genitals of the patient.
How to change the catheter at home?
Performing a catheter replacement at home is a dangerous procedure that can cause serious injury to the urinary system. An independent procedure is permissible only for a soft urethral device, and in case of serious need.
To replace the device, you must remove the old catheter:
- Empty the urinal. Wash your hands with soap and gloves.
- Lie down in a horizontal position, bend and spread your legs apart.
- Flush the device’s tube and genitals with an antiseptic or saline solution.
- Locate the cylinder opening of the device. This is the second hole that is not used to drain urine and rinse the bladder.
- Empty the bottle with a 10 ml syringe. Insert it into the hole and pump out the water until the syringe is full.
- Gently pull the tube out of the urethra.
After removing the apparatus, a new one is inserted into the urethra, according to the above instructions for representatives of different sexes.
A nurse must change the ureter and renal pelvis. The attending physician is responsible for the replacement and removal of the suprapubic (urinary) device.
Possible complications after the procedure
Pathologies resulting from catheterization include:
- damage and perforation of the urethral canal,
- urethral bladder injury
- urethral fever
- urinary tract infections.
You can avoid these complications if you use a soft catheter and carry out the procedure in medical institutions, with the help of a nurse or your doctor.
Bladder catheterization is used for stagnation of urine and infections of the genitourinary system. With a correctly selected device and observing its formulation, the procedure is unable to harm the patient and cause uncomfortable sensations.
How is bladder catheterization performed in women and men?
Catheterization of the bladder is a procedure that is significant when conducting therapeutic and diagnostic measures. The main goal is to introduce a drainage device, presented in the form of a hollow tube, into the urinary bladder cavity for subsequent artificial removal of urine, organ cleansing, or the administration of topical drugs.
In accordance with medical standards, catheterization is performed by installing the system through the urethra, however, it is also possible to insert the device through the abdominal wall. The procedure is prescribed for diseases of the urinary and reproductive organs. Indications for catheterization can be both planned and emergency.
The range of application of catheters is quite wide, they are used for medical, prophylactic, hygienic, diagnostic purposes. The introduction of a catheter into the bladder is practiced with the aim of removing urine against the background of severe diseases of the excretory system that impede the natural implementation of this process.
Diagnostic catheterization is used to collect urine, which does not contain impurities of other biological fluids. The implementation of the catheter installation in this case has important functional significance - the study of virtually sterile urine allows you to make the most complete and accurate diagnosis.
Also, the bladder catheterization technique in men and women is often used for the direct administration of drugs. Most often, this procedure is performed against the background of the development of inflammatory processes that affect the mucous tissues of the bladder, including, for example, cystitis.
The technique of catheterization may vary depending on the destination. During surgical procedures, soft disposable catheters are installed to irrigate the mucous tissues of an organ or to take urine for examination. Against the backdrop of chronic diseases associated with impaired urination, permanent catheters are used.
Bladder catheters are also classified according to the properties of the materials used in the manufacturing process of these devices, for example:
- Tough. They are used only in the most severe cases when the use of other devices is not possible. The placement and removal of such a catheter requires special care, practical experience and a number of rules, otherwise there is a high risk of damage to the mucous tissues of organs.
- Soft or elastic. Soft catheters are placed especially often. Devices of this kind have a high level of flexibility, elasticity, do not injure tissue, can be used for a long period of time.
There are two main standards of catheterization: urethral and suprapubic. The first option is used mainly if it is necessary to set up a drainage device for a short time. Its prolonged use can lead to the development of inflammatory processes, damage to the mucous tissues of the bladder.
As for suprapubic or internal catheterization, this method is particularly effective and safe. In this case, it is carried out by introducing the device through the abdominal wall. An important advantage of this method is the preservation of physical and sexual activity, which is excluded if a catheter in the bladder is inserted through the urethra.
Also, bladder catheterization in women and men is classified in accordance with the design features of the devices used. There are several main types of catheters:
- Foley's catheter. Designed to remove urine, irrigate the walls of the organ with drugs, cleanse the bladder from purulent masses, blood. It can be used for a long time.
- Nelaton's catheter. It is simple and is used for single use. Catheterization of the bladder with a soft catheter is used for surgical interventions, during childbirth, for urine collection for analysis.
- Stent Timann. It is a rigid catheter and is used only if the use of a soft catheter is not possible due to any reason, for example, with severe swelling of the urethra.
The device selection criteria and the algorithm for bladder catheterization are determined individually in each clinical case.
Indications and contraindications
The attending physician without fail takes into account both indications and possible contraindications to catheterization. In the vast majority of cases, the procedure does not cause the development of side effects and complications. Indications for catheterization of the bladder are the following factors:
- Dysfunction of the organs of the excretory system, swelling of the urinary tract tissues, other reasons that impede the natural process of committing urination.
- The patient’s lack of access to the toilet. For example, a catheter is inserted in such situations during surgical procedures, within a few hours after a natural birth or cesarean section, when the patient is in an unconscious state.
- Catheterization of the patient is necessary if, for the most accurate and complete diagnosis, a fence is required regarding a sterile portion of urine that is not contaminated with biological fluids and secrets.
- The catheter can also perform a practical function and can be used to irrigate the walls of the bladder with drugs.
As for contraindications, catheterization of the bladder in men, the execution algorithm of which is described in detail below, is not recommended in the following cases:
- Infectious lesions of the urethra. A catheter in this case can play the role of a kind of breeding ground for infection and spread inflammatory processes to the mucous tissues of the bladder.
- Spasmodic muscle contractions of the walls of the urethra. Before inserting and pulling out the catheter, the specialist must make sure that there is no muscle spasm, otherwise there is a high probability of damage to the walls of the channel during catheterization.
- Mechanical damage to the tissues of the bladder or urethra, including those received during the installation of the drainage device.
A distinctive feature of the catheterization procedure is that complications and contraindications can occur suddenly, including with the introduction of a drainage device.
To prevent possible complications, catheterization is necessary in accordance with a number of rules. Not only is the catheter insertion process important, but also the preparation for the procedure.
There are a number of recommendations that must be followed, including:
- the use of quality drainage,
- carrying out the procedure under sterile conditions,
- the presence of a specialist conducting a catheterization, practical experience,
- the use of pain medications, as well as tools that facilitate the introduction of a catheter, for example, petroleum jelly.
Immediately before the procedure, the patient needs to thoroughly wash and treat the external genitalia with any antiseptic. This measure is necessary to prevent the introduction of infection into the cavity of the bladder.
It should be noted that the implementation of the catheterization procedure for men involves some difficulties due to the anatomical features of the structure of the urethra. To prevent mechanical injuries and damage to the patient, mainly soft catheters are inserted. In general, the procedure is as follows:
- First of all, additional treatment of the external genitalia with disinfectant solutions is performed. Local anesthetics are also used.
- Next, the processing of the tip of the drain with petroleum jelly is performed.
- Then the device is inserted into the urethra with neat circular motions.
- The procedure is considered complete only if the first portions of urine appear in the catheter tube.
Next, actions are performed for the implementation of which the catheter was installed.
For example, if the main goal was to treat the bladder cavity with drugs, the necessary funds are introduced through a catheter, after which the device is removed.
It is important to note that the bladder after catheterization fully retains its functional properties if the procedure was carried out correctly.
This manipulation in women and men has some differences and features. For example, rigid devices can be used to catheterize women, since the procedure is greatly simplified due to the anatomical features of the structure of the female body. There are also a number of other nuances, compliance with which is necessary:
- Catheterization of the child is allowed only in exceptional cases with strict indications. This is due to the fact that the procedure can lead to the development of serious complications and damage to the tissues of the urethra and the bladder.
- If the catheter is installed to remove urine over a long period of time, the device’s elastic tube is displayed in a soft bag that needs to be fixed on the patient’s knee.
Important! To prevent infection after the completion of the catheterization procedure, it is necessary to carry out hygienic treatment of the external genital organs.
Catheterization of the bladder in women: what is it, how is it done, when you can’t do it
In order to recognize and treat a variety of diseases and dysfunctions of the female genitourinary organs, endoscopic manipulations are often performed, one of which is catheterization of the bladder of patients. This concept means the introduction of a special instrument into the specified organ through the urethra.
Device and types of catheters
The catheter is an empty thin tube made of soft or rigid material. It consists of the front, middle and back parts, which are respectively called the beak, body and pavilion. The beak is made in the form of a cylinder or cone; it can be either curved at an angle of 20–35 °, or straight. There are one or two openings on the front of the catheter.
The instrument pavilion is slightly expanded. This is provided so that the catheter does not accidentally slip into the entire bubble and can be attached to a flexible system. Using the latter, the organ is washed or irrigated with therapeutic solutions.
The length of flexible catheters varies between 22–38 cm, of rigid 11–16 cm. For women, short instruments are usually used.
30 catheter calibres are available depending on the inner diameter. This size for each subsequent tool number is 1/3 mm larger than the previous one. Most often, for adult women, catheters of 16–20 caliber are used.
By the type of manufacturing material, the tools are rigid, or rigid, and soft. The former are made of steel and have a smooth nickel-plated surface. Metal catheters do not change the bend angle of the beak.
Soft (elastic) catheters are less traumatic for patients, their introduction is better tolerated. The material for them can be polyethylene or rubber. Elastic instruments made of polymers can change the angle of curvature of the beak when heated, taking the form of the urinary tract.
Catheters are single and reusable. The former are stored in sealed sterile bags. The second need special treatment and sterilization before each repeated use.
Goals and objectives of the procedure
The goals of performing bladder catheterization can be diagnostic, for example:
- detection of residual urine,
- calculating organ capacity
- infusion of a contrast medium into the bubble for subsequent radiological imaging (cystograms),
- monitoring urination after any trauma or surgery,
- receiving a portion of urine directly from the bladder for laboratory analysis.
The first two indications for diagnostic catheterization are advisable when the safer method for examining the bladder - ultrasonography - for some reason was not available or did not provide comprehensive information.
This procedure can be prescribed for the implementation of therapeutic measures, such as:
- the release of the bladder from urine during its acute or chronic retention,
- washing the mucous membrane of the organ from the decay products of tumors, pus, stone and sand residues,
- injection of drug solutions into the bladder for their local effect on the affected mucous membrane,
- urine excretion in paralyzed bedridden patients with impaired organs of the lower half of the body.
When you can not do catheterization
Catheterization cannot be performed under the following conditions:
- acute inflammation in the bladder or in the urethra,
- spasm of the locking mechanism of the bladder (manipulation will become possible after the use of antispasmodic drugs),
- hematoma or perineal bruise,
- mechanical damage to the urethra,
- urethral bleeding of unknown origin.
How are women catheterized?
The urethra of a woman is several times shorter than the male and much wider; it has a constant curvature. The urethra is directed from top to bottom along the front wall of the vagina to the pubic joint, ending with its external opening in anticipation of the vagina. Due to these anatomical features, it is much easier for a woman to insert an instrument into the bladder than a man.
Preparation for manipulation
Catheterization should be preceded by a detailed survey and study of the patient's history. The doctor finds out if she has cardiovascular diseases or is allergic to the medicines used, the results of laboratory tests of blood and urine are studied.
Gynecological examination of the genitals is mandatory. This helps to determine the tactics of catheterization in the presence of tumor formations in the female reproductive system or with congenital malformations of the latter.
The introduction of a catheter into the bladder is performed under antiseptic conditions. The nurse performing the manipulation processes the hands with an antiseptic before starting the procedure, puts on sterile gloves and a mask.
Catheterization of the urinary organ in women can be carried out with either a rigid or a polyethylene device. To facilitate gliding along the urethra, the beak of the prepared instrument is lubricated with sterile liquid paraffin or glycerin.
The procedure is carried out in the following order:
- The patient lies on a couch or gynecological chair with legs bent at the knees and legs apart.
- The woman's body is covered with a clean sheet, leaving the external genitals in sight.
- A vessel for urine is placed between her hips.
- The paramedic is on the right side of the lying woman.
- With the fingers of his left hand spreading the labia majora of the woman, with his right he makes the toilet of the external genitalia and the entrance to the urethra with a cotton swab dipped in a disinfecting solution.
- If a soft catheter is used, the medic grabs it with sterile forceps at a distance of 4-6 cm from the beak and introduces it into the urethra with smooth rotational movements. The outer part of the flexible tool should be sandwiched between the extreme fingers (the little finger and the ring) of the right hand, and it is better if the assistant holds it.
- If the procedure is performed by a female steel catheter, then it is taken into the right hand and carefully, without the use of force, is introduced into the urethra.
- Leakage of urine from the outside of the instrument is evidence that the catheter is located in the bladder. Biological fluid is diverted to a special tray.
- If it is necessary to rehabilitate or irrigate the bladder after emptying it, a special large syringe filled with the drug is attached to the catheter.
- After completion of the procedure, the device is carefully removed. If the patient's condition allows, she is recommended to wash the external genital organs with a weak solution of potassium permanganate or a decoction of chamomile for 2-3 days after catheterization.
Sometimes there are cases when this manipulation must be done systematically or left the device in the urinary organ for a certain time. Women, unlike men, usually easily endure the many hours of the urological tube in the urethra, they are less likely to experience complications of the procedure.
Prolonged urine diversion is carried out using a Foley balloon catheter.
After the device is in the bladder, fluid is pumped into the balloon and, if indicated, the organ is washed with an antiseptic solution (potassium permanganate 0.3: 1000 or Rivanol 1: 1000).
A flexible catheter is fixed with a band-aid on the patient's thigh and left in the bladder. After 5-6 days, it is removed and, if necessary, a new one is introduced.
Due to the simplicity of the manipulation of women, they have practically no negative consequences. Sometimes during catheter insertion, spasms or damage to the urethra may occur, accompanied by bleeding.
In this case, the procedure should be stopped immediately. As a rule, this happens with strictures (cicatricial narrowing) of the lower urinary tract, which are less common in the weaker sex than in men.
In case of insufficient sterility of the instruments and hands of a nurse, pathogens can be introduced into the urinary tract. The consequence of this is acute cystitis.
Another rare complication in female patients is the so-called urethral fever, which is expressed by chills and temperature spikes. This condition is treated with antibiotics and antipyretic drugs.
I am familiar with this procedure firsthand - I know from my own experience what catheterization of the bladder is. I did it after a complicated birth right on the delivery table. This was necessary to evaluate kidney function.
I can only say one thing: after 14 hours of contractions and prolonged suturing of tears, surviving the introduction of a metal catheter into the bladder cost me nothing. I didn’t even feel this and didn’t immediately notice that I had some kind of cold instrument in my urethra.
I lay with a catheter in the bladder for about an hour, after which the doctors safely removed it and said that the urine was excreted - which means that everything will be fine. Should this procedure happen at another time - maybe I would not like it, but right after the birth I almost did not feel it.
Insertion of a catheter into the bladder is not the most pleasant manipulation for women, but do not be afraid of it. With skillful and coordinated actions of the hands of a medical professional, she will not cause you the slightest discomfort.
The procedure is needed for the timely recognition and treatment of various diseases of the urinary system.
For women, it is painless, and the introduction of an instrument into their bladder in the vast majority of cases does not cause special difficulties for medical personnel.
Catheterization in women: about the need for the procedure and the technique for its implementation
Urologists and gynecologists very often send their patients to undergo such a procedure as catheterization.
During this manipulation, a catheter is inserted into the woman’s urethra through which urine outflows or special medications are administered.
Catheterization of the bladder in women is prescribed for a variety of indications. At the same time, only an experienced specialist should always carry out such a procedure, as if the catheter is improperly placed, the urethra and urinary tract can be easily injured.
Indications for the procedure
Most often, women are referred for catheterization in the following cases:
- for collecting urine for analysis (in contrast to the usual collection of morning urine in a container, this method of collecting urine allows you to get a more “clean” biological material for research without any impurities),
- to fill the bladder with medications in the treatment of various diseases of the urinary system,
- for washing and disinfecting the urinary tract (catheterization will help to remove pus, sand, crushed small stones, etc. from the body),
- to study the volume of residual urine filling the urinary bubble,
- for emptying or filling the pelvic organ before an x-ray (during the diagnosis, the urinous bladder should be empty or filled with a special contrast agent that, when x-rayed, will stain internal organs and tissues, so that the doctor can get a more accurate picture of the state of the urinary tract),
- to remove urine when it is impossible to empty yourself (urine retention, acute or chronic violation of normal urination, etc.)
Catheterization of the bladder with a soft catheter in women is done during surgical operations on internal organs undergoing local or general anesthesia. Also, catheters in the urinary bubble are placed in paralyzed people, patients who cannot move, are in a coma, etc.
According to medical standards, when conducting a catheterization in women, a physician should use the following tools and supplies:
- sterile soft catheters of various sizes,
- urinal bag
- a tray for used tools,
- sterile wipes and cotton balls,
- disposable syringes (for the introduction of medicinal solutions),
- medical gloves,
- furatsilin in the form of a solution,
- glycerin or liquid paraffin.
Consequences and complications of the procedure
Serious complications can occur if a catheter is improperly selected, abruptly installed, or if the rules are not followed.
Two of the most common consequences that appear after catheterization can be distinguished:
- damage to the walls of the urethra and the bladder itself (from minor injuries to tears),
- infection in the urinary tract and, as a result, the development of cystitis, urethritis and other similar diseases.
With a sharp rise in temperature, symptoms of intoxication and pain in the lower abdomen that arose after catheterization, a woman urgently needs to seek medical help.
Catheterization is an important and useful procedure that allows you to diagnose a disease or cure a particular ailment. In order for the manipulation to be successful and not cause complications, women need to trust their health only to qualified medical specialists.
Nurse action algorithm.
Explain to the patient the goal, the course of the upcoming manipulation, obtain the patient’s voluntary consent to perform the manipulation,
Fence off the patient with a screen,
Handle at a hygienic level, wear gloves,
To help the patient to take a position in bed - lying on his back with legs bent at the knees, to lay oilcloth and diaper under the patient’s basin,
Have a thorough crotch toilet,
Change gloves, treat gloves with cotton balls in 70% alcohol, discard used balls into the waste tray,
Place a tray with sterile wipes and a waste tray between the patient’s hips,
Open the catheter’s packaging with clean scissors and lay it in a sterile cuvette with sterile tweezers,
Open the stopper of the vaseline oil bottle with a sterile cloth, pour a few drops into the waste tray,
Apply liquid paraffin to the blind end of the catheter, close the bottle,
Pour the washing solution into Jean's syringe, put it in a sterile tray,
Put napkins and gauze balls in a sterile tray, pour Oktenisept r-r,
Treat gloves with cotton balls in 70% alcohol, discard used balls into the waste tray,
Dilute the labia minora and labia minora with a sterile tissue 1 and II with the fingers of the left hand,
To treat twice with tissues soaked in Octenisept, consistently large, then small labia, the opening of the urethra,
Blot this area once with a dry sterile cloth,
Grab the catheter with sterile forceps, 4-5 cm from the blind end (the rear of the hand is facing the catheter!), Lift the free end between 4-5 fingers,
Extend the labia with the fingers of the left hand through a sterile napkin, insert the catheter into the urethra,
When urine appears, lower the peripheral end of the catheter into the tray and drain the urine into the tray,
Attach the Janet syringe to the catheter and inject an antiseptic solution into the bladder (until the patient becomes uncomfortable),
Release half of the solution from the bladder, remove the catheter, place the cathete in the waste material tray,
Remove trays, urinal, diaper and oilcloth,
To correct the bed, to help the patient to take a comfortable position in bed, to cover him, to make sure that he feels comfortable,
Remove all equipment, ventilate the room,
soak the catheter in 5% r-r of chloramine - 60 min.,
fill the contents of the urinal with bleach powder (1: 5) - 60 minutes,
soak napkins in 3% r-r of chloramine - 120 min.,
soak the trays in 3% r-r of chloramine - 60 min.,
put the diapers in a bag for dirty laundry,
soak the Janet syringe in 5% r-r of chloramine - 60 min
process oilcloth 2 r. with an interval of 15 minutes 3% r-rum chloramine,
remove gloves, soak in 3% solution of chloramine - 60 min,
change the robe, put it in the bag for dirty laundry,
26. Treat hands at a hygienic level.
Catheterization of the bladder in men, execution algorithm.
1. Wash your hands. They are treated with a 0.5% chlorhexidine solution.
2. Two sterile catheters are placed on the sterile tray, the rounded ends of which are lubricated with sterile glycerin, two sterile cotton balls moistened with furatsilin, two sterile wipes, tweezers, a Janet syringe with a solution of furacilin, heated in a water bath to +37. +38 "C,
3. Wash the patient. A container for urine is placed between his legs.
4. Put on sterile gloves and stand to the right of the patient.
5. A penis is wrapped around the penis below the head.
6. Take the penis between the III and IV fingers of the left hand, slightly squeeze the head, and I and II fingers slightly push the foreskin.
7. With their right hand take a cotton ball moistened with furatsilin and process the glans penis with movements from the urethral opening to the periphery.
8. One or two drops of sterile glycerin are poured into the external opening of the urethra.
9. In the right hand take a sterile tweezers.
10. A catheter is taken with sterile forceps at a distance of 5-6 cm from the rounded end, and the free end is captured between the IV and V fingers.
11. Insert the catheter with tweezers at 4 - 5 cm, holding it with I and II fingers of the left hand, fixing the glans penis.
12. Intercept the catheter with tweezers and slowly insert another 5 cm. At the same time, the penis is pulled onto the catheter with the left hand, which contributes to its better advancement along the urethra.
13. As soon as the catheter reaches the bladder, urine appears and the free end of the catheter should be lowered into the urine container.
14. After the cessation of urine output, the catheter is connected to a Janet syringe filled with furatsilin, and 100 - 150 ml of solution is slowly injected into the bladder, and then, sending the catheter into the tray, the contents are removed.
15. The flushing is repeated until a clear fluid is released from the bladder.
16. After washing, the catheter is carefully removed from the urethra by rotational movements.
17. Once again, the external opening of the urethra is treated with a cotton ball moistened with furatsilin.
Catheterization of the bladder in men with a soft catheter
Notes. Before the intervention, it is necessary to establish a trusting relationship with the patient. The sterility of the catheter must be maintained 20 cm from the rounded end. A nurse has the right to perform catheterization only with a soft catheter and only as directed by a doctor. During catheterization, complications may occur (see catheterization in women).
The catheterization procedure involves the installation of a thin tube (the catheter that Foley developed) in the bladder of a man or woman. It is carried out only by a specialist with relevant experience and skills. At home, the introduction of a catheter is prohibited.
Catheterization is long-term and short-term:
- for a short time, a catheter is placed during operations on the organs of the genitourinary system, as well as for emergency care and diagnosis,
- for a long period, the catheter is used for pathologies when the natural defecation of the bladder is complicated or not at all possible.
The advantage of this medical manipulation is that with its help you can easily and quickly perform some diagnostic procedures. Sometimes surgical drainage of urine may be the only option for emptying the bladder in order to prevent hydronephrosis.
With a number of diseases of the urinary system, catheterization allows you to quickly deliver medications to the site of inflammation. Drainage through a bladder catheter in men is also often included in a patient care program whose motor activity is limited.
Among the disadvantages of this manipulation, one can single out an increased likelihood of complications, especially if it is performed by a medical professional with little experience.
The following types of catheterization can be used for the procedure:
- Flexible. Made from latex, silicone and rubber. In most cases, Nelaton or Timan gadgets are used.
- Tough. They are made of a special metal alloy - brass or stainless steel. Only an experienced urologist can insert such a device.
Catheters can have a different configuration, stroke count and shape. In most cases, a Foley catheter of latex is inserted into the patient. However, it should not be worn longer than 5 days. If longer catheterization is required, then devices with a silver coating or nitrofuran coating can be delivered to the hospital. Such catheters must be changed monthly.
The placement of a urinary catheter in men is performed only with their consent. In this case, the doctor must inform about all the features of the procedure. In most cases, a flexible catheter is inserted. Metal devices are rarely used, since there is a high risk of injury when using them.
To perform the manipulation using a flexible device, the nurse prepares the following materials and tools:
- disposable catheter,
- sterile gloves
- materials for dressing,
- Syringe Janet.
In addition, the doctor also prepares liquid paraffin, a disinfectant solution, a solution of chlorhexidine and furatsilina. The urethral opening is additionally treated with Povidone-Iodine. For local anesthesia, Katedzhel gel is used.
- The patient is placed on the couch with his stomach up. An oilcloth spreads under it.
- The genitals are cleaned with an antiseptic solution applied to a soft cloth.
- Then the doctor changes gloves and takes the penis in his hand, and then wraps it in a gauze napkin.
- Then it exposes the urethral opening and disinfects this area with an antiseptic.
- In the next step, the specialist processes the tip of the catheter.
- After that, he clamps the device with tweezers and begins to insert into the urethral opening.
- The tube gently moves along the urethra.
- When the tube is fully inserted, urine will appear at its tip. She merges into a tray.
- When using a permanent catheter, after leakage of urine, the retaining capacity is filled with saline. Then the catheter is connected to the urinal.
A catheter can only be removed as directed by a doctor. In this case, the time set by him must pass.
Catheter Removal and Possible Complications
If catheterization was performed for a single withdrawal of urine, after the procedure, the tube is carefully and smoothly removed, after which the urethral opening is thoroughly treated with an antiseptic, dried and returned to its normal state.
Before removal of the catheter of a constant type, all liquid is first released from the reservoir. For this, a special syringe is used. If you need to rinse the bubble, this is done with a solution of Furacilin.
Catheterization is designed to improve the patient's condition. However, if this procedure is not performed correctly and aseptic requirements are not observed, serious complications can be encountered. The most serious consequence of an incompetent catheter placement is trauma to the urinary canal, damage or rupture of the bladder neck.
In addition, after this medical manipulation, the following complications may arise:
- Reflex vasovagal. This condition is accompanied by a sharp and sudden excitation of the vagus nerve. In this case, the patient's blood pressure rapidly decreases, dryness of the oral mucosa, pallor of the skin and loss of consciousness occur. Against the background of post-obstructive diuresis, some men develop arterial hypotension.
- Macro and microhematuria. The occurrence of bloody impurities in urine in most cases appears due to careless installation of a catheter with trauma to the mucous membrane.
- Paraphimosis is iatrogenic. This condition involves compression of the glans penis with the foreskin. The main reason for this phenomenon is inaccurate exposure of the head and prolonged discharge of the foreskin during catheterization.
- Ascending infection. This is one of the most common complications after catheterization. The main reason is poor sanitation. The penetration of pathogens into the urinary tract is the main cause of the development of cystitis, urethritis and pyelonephritis. If these pathologies are not treated, they can cause the development of urosepsis.
Due to the increased risk of complications, catheterization is performed only for direct indications. Despite the expressed uncomfortable sensations arising in the patient during the installation of the catheter device, sometimes this medical manipulation is of great benefit and becomes a very important stage in the treatment.