Catheters: indications and methods of catheterization of the bladder * Diana Clinic

What is catheterization

The content of the article

Catheterization is the process of inserting a urological catheter, a thin flexible tube connected to a reservoir. The tube allows urine to drain from the urinary tract. Most often, the device is inserted through the urethra into the bladder.

Catheter

It happens that the catheter needs to be inserted deeper into the ureters to cleanse the kidneys. In these cases, the device may not always be installed as described above. It is injected through the skin directly into the kidney or bladder (via the pubic symphysis).

Types of catheters

Conventionally, all bladder catheters are divided into men's, women's 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 makes it easier to install the syringe for infusion of medications. When administered, the mucous membrane of the urinary ducts is not damaged. In half of 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 inflexible materials. They consist of a beak, a handle and a rod. The urethral end is rounded with two lateral openings. Insertion of rigid catheters requires special skills and is associated with a high risk of damage to the urethra and bladder neck. The length of a male catheter is 30 cm, and a female catheter is no more than 15 cm.

Depending on the method of installation, the tubes are urethral, external or internal.
Based on the type of design, there are 4 types of catheters:

The Robinson probe is a disposable soft catheter with a small internal diameter and a rounded end. Used to collect urine from women or men with swelling of the urinary tract, dysuric disorders.
The Thiemann stent is a rigid, curved tube with an elastic soft end. It is used to divert urine in case of inflammation of the urinary ducts.
A Foley catheter is a flexible tube consisting of two sleeves and a reservoir for collecting urine. It is used for long-term catheterization of the bladder to empty it and rinse it with medicinal solutions. For long-term bladder drainage in men, self-retaining catheters are used, which are equipped with an expanding balloon.
Pezzera catheter is a large-headed latex probe that is used only in the case of a cystostomy. Sometimes used to drain fistulas in the suprapubic area after surgery.

The type of probes used depends on many factors - the duration of catheterization, the gender of the patient, and the form of the disease.

Catheterization: indications

The catheter should be placed first when urine is standing still, which can happen with benign prostatic hyperplasia or kidney stones.
The device is used for perineal trauma, which leads to damage to the urethra. Before the organ heals, drainage is inserted through the abdominal wall directly into the bladder.
Catheterization is also necessary after some operations on the genitourinary and gastrointestinal systems.
The catheter is inserted into patients in a pharmacological coma.
The device helps laboring women if they are unable to empty their bladder.

Bedridden patient with a catheter
In all these cases, the catheter is not inserted for long, since its presence contributes to urinary tract infections. But some patients need catheters permanently. For example, urine diversion is needed for people with a neurogenic bladder and neurological diseases.

Indications for bladder catheterization

Urinary catheterization is the insertion of a device to drain urine or administer medications. The procedure is performed to diagnose or treat identified urological diseases. Depending on the indications, a catheter is placed 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 incapacity;
tumors of the urinary ducts;
blockage of the bladder outlet with stones;
urethral diverticulum;
severe spinal injuries;
postoperative rehabilitation.

Insertion of catheters into the bladder is performed for:

washing the urinary tract and bladder;
obtaining urine for laboratory analysis;
normalization of urine outflow.

The catheter is installed on an emergency or planned basis in the urology department or on an outpatient basis.

Catheterization procedure

For most people, catheterization involves inserting a drain through the urethra into the bladder. If the procedure is carried out correctly, everything will be done without injury.

The catheter is coated with a gel with gliding and anesthetic properties. This substance also has a bactericidal effect, which prevents urinary tract infections. The tube itself is sterile, but may allow bacteria to migrate (such as E. coli that accumulate around the anus).

Catheterization is easier in women because they have a short urethra. In men, the urethra is long and naturally narrowed in three places, therefore, in order not to damage it, this procedure should be performed only in a good clinic with a urologist.

Removal of the catheter is also painless. But the first urination can be quite unpleasant (may be accompanied by a burning sensation, mild pain). Incompetent, too aggressive procedure causes pain and can even damage the urethra.

Painful urination

The cause of discomfort and inflammation of this sensitive part of the urinary tract can also be a drainage diameter that is too large.

When the procedure is not performed

There are relative and absolute contraindications to urinary catheterization. Most of them are associated with the risk of damage to the urinary ducts and infection:

anuria;
exacerbation of urethritis;
acute cystitis;
bleeding from the urethra;
obstruction of the urethra;
acute inflammation of the genitourinary system;
severe spasms of the urethra.

Insertion of a catheter is dangerous in case of strictures (scarring) of the urinary tract. An attempt to catheterize the urethra in case of obstruction of the urethra is fraught with damage or perforation of the wall.

Catheterization: how to behave at home?

Most of us have seen patients in the hospital walking around with a bag of urine hanging on a stand. But in most cases they leave the hospital without it. However, sometimes the healing process after surgery or injury takes a long time, so patients are discharged home with a catheter. How do they live with it every day?

In principle, patients with a catheter can lead a normal life, that is, do light exercise, walk around the house, go for a walk or even go to work (the urine bag can be attached using special Velcro straps to the inner thigh).

Fixation of the catheter

However, if you have such a device, you need to get plenty of rest and remember to follow a few rules:

First of all, you need to be careful with hygiene. Wash your hands thoroughly with soap and water before emptying the bladder or replacing it with a new one. It is also important to take care of intimate hygiene by washing the perineum and the outside of the catheter at least once a day with soap and water to prevent the migration of microorganisms into the urinary tract.
For the same reason, you should not unnecessarily disconnect the bag from the drain hole.
It is necessary to empty the urine bag regularly because urine is a good breeding ground for microorganisms.
People with a catheter should drink more, preferably disinfectant herbal infusions, drinks rich in vitamin C, such as blackcurrant juice, cranberry juice. Low urine pH limits the growth of microbes.

Preparation for the procedure

Catheterization is preceded by a preparatory stage. Before installing the probe into the bladder, 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;
scissors;
catheter;
tool tray;
oilcloth sheet;
diaper;
antiseptic;
tweezers;
tray for waste material;
Janet syringe;
gauze napkins;
antispasmodic and local anesthetic;
urinal.

Based on the results of laboratory and instrumental tests, the doctor determines the optimal method of catheterization of the bladder.
Manipulations are performed exclusively under sterile conditions, and during the procedure the medical staff follows antiseptic rules. This reduces the risk of infection of the urinary system.

Installation and replacement of a urinary catheter

Carrying out the procedure for placing a urinary catheter requires certain knowledge and skills, which are possessed by the medical specialists of Paramedic Help. Do not insert a catheter yourself, so as not to damage the genitourinary organs and introduce an infection into the body.

Placement of the catheter begins with hygiene procedures. It is important to thoroughly clean and disinfect the patient’s external genitalia. The doctor or nurse himself also thoroughly washes and disinfects his hands, and uses sterile gloves. The patient is advised to relax and trust the specialist, then the process of installing a urinary catheter will be quick and painless.

How the catheter is placed:

The patient lies on his back with his knees bent. The patient's position is slightly different depending on whether the catheter is being inserted into a man, a woman, or a child. Don’t worry, the doctor or nurse will tell you how to position your legs correctly to make the procedure as comfortable as possible.
The specialist slowly inserts the catheter into the urethra until urine begins to flow into the device. This indicates that the catheter is installed correctly.
Next, a urinal is installed, which is fixed on the patient’s thigh or bed.

Usually the catheter is used for no more than a week, after which it needs to be replaced. Silicone catheters can be used a little longer. Catheter replacement should be entrusted to specialists with medical education. It is not recommended to try to remove the urinary catheter yourself to avoid pain and unpleasant consequences. Contact Paramedic Help for catheter replacement services. Specialists will professionally carry out the necessary procedures with comfort for the patient.

Bladder catheterization algorithm

The procedure for inserting the probe is the same for men and women. But in men, a large part of the urethra is inside the penis, which makes inserting a drainage tube difficult. To reduce pain, patients are given an antispasmodic drug, and the mouth of the urethra is treated with an anesthetic.

Among women

Installing a urinary catheter in a woman is not difficult, due to the structural features of the genitourinary system. To make the manipulations easier, 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 little time.

Technology of bladder catheterization in women:

the nurse washes her hands with antiseptic and puts on gloves;
a tray for waste materials is installed between the patient’s thighs;
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 tweezers and inserted into the urethra;
it is immersed to a depth of 10 cm or until urine appears;
a urinal or syringe is attached to the free end of the tube to inject an antiseptic (in case of washing the bladder).

At the end of catheterization, the tube is carefully removed. If the urethral muscles spasm, the procedure is stopped.

In men

The algorithm for performing catheterization on 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 performed in the supine position and a soft drainage tube is used.

The catheter is inserted into the bladder according to the following scheme:

the patient is asked to lie on his back and spread his legs slightly;
the groin area is treated with an antiseptic, after which the gloves are changed to sterile ones;
the penis is wrapped in gauze;
in the area of the coronary sulcus it is grasped with the fingers of the left hand;
the head of the penis is squeezed with the thumb and forefinger to open the urethral opening;
the probe insertion area is wiped with Povidone-iodine;
the penis is pulled up, perpendicular to the legs;
the inserted end of the tube is treated with Vaseline;
Use sterile tweezers to 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 a urinal.

If a permanent catheter is installed in a man, 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 bladder a little earlier than all the urine has been 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 algorithm of actions for adults. Due to the narrowness of the urinary tract, drainage tubes are installed in the bladder, taking into account certain rules:

the procedure is performed with a full bladder;
the catheter and instruments are sterilized with low allergenic solutions;
The stent is inserted carefully 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 performed by a pediatric urologist. If an obstruction is detected in the urinary ducts, the procedure is abandoned. Forcibly overcoming obstacles is dangerous by rupturing the urethra.