Transcript URINARY CATHETERS

URINARY CATHETERS
DEPARTMENT OF UROLOGY
2006
DIAN L KIRSTEIN
CATHETERS
• Size
• Shape
• Material
• Retaining mechanism
• Lumens
SIZES
• Different size systems
(External catheter diameter)
• Most common: French (F) (Charriere)
• 0.33mm = 1F
• 3F = 1mm, 30F = 10 mm
CATHETER TYPES
• Non self-retaining
(Jaques, Robinson, Nelaton)
• Self-retaining
(Pezzer, Malecot)
• Self-retaining 2/3 way balloon
Foley Catheter
• Postoperative haematuria catheter (rigid)
CONDOM CATHETERS
• Men without outflow obstruction and
intact voiding reflex pathways
• Restricted to selected patients where
other measures are unsuccessful
TYPES OF MATERIAL
• Latex
• Plastic
• Silicone coated latex
• Silicone
• Hydromers (biocath)
• Silver-inpregnated
• Antibiotic coated
INDICATIONS FOR USE OF URINARY
CATHETERS
• Diagnostic
• Therapeutic
• Short-term
• Long-term
SHORT-TERM CATHETERIZATION
•
Acute urinary retention
•
Urine collection (U mcs, residual volume)
•
Urologic surgery
•
Surgery on contiguous structures
•
Urine output (medical, surgical)
•
Urodynamic studies
•
Radiology ( cystogram)
•
Installation of antibiotics, immunotherapy etc
LONG-TERM CATHETERIZATION
• Refractory urine retention
– not correctable medically or surgically
• Neurogenic bladder
– some
• Incontinence
– non-responders to specific treatment
– terminally ill, severely impaired
– intractable skin breakdown
TECHNIQUE
• Inform patient -
explain procedure
• NB aseptic
• Prepare
• Indication
• Size:
“narrowest, softest tube that will serve the purpose”
PREPARATION
•
Position patient
•
Expose
•
Open set using sterile technique
•
Wash hands and don sterile gloves
•
Test catheter balloon
•
Attach drainage bag to catheter
•
Lubricate catheter (local anesthetic lubricant)
•
Clean
CATHETERIZATION
• Aseptic
• Place catheter (urine?)
• Inflate balloon (5ml)
• Gently pull back on catheter
• Tape tubing to thigh
• Position bag to facilitate drainage by gravity
• NB: retract foreskin
CLOSED DRAINAGE SYSTEM
• “Open drainage system”:
– 95% bacteriuria prevalence in 4 days
• “Closed”:
– 5% per day risk, 40% by day 10
• Risk increases:
– changing the catheter bags
– taking urine samples
– bladder washout regimes
SUPRAPUBIC CATHETER
INDICATIONS
• Failed urethral catheterization
• Urethral disruption
• Long-term bladder drainage
SUPRAPUBIC CATHETER
CONTRA-INDICATIONS
• Non-palpable bladder
• Previous lower abdominal surgery
• Coagulopathy
• Known bladder tumour
• Clot retention
SUPRAPUBIC CATHETER
TECHNIQUE
• Informed consent
• Supine position
• Confirm full bladder
• Prepare suprapubic area
• Anesthetize: skin, sub-cutaneous tissue to the anterior
bladder wall
• Confirm distance to full bladder by aspiration
TECHNIQUE
• Plan angle and depth of puncture
• Stab wound
• Cystostomy trocar
• Fixate catheter
Area to be shaved,
prepared and draped prior
to trochar placement
Position of the Stamey
trochar in the bladder.
The angle, distance
from the pubis and
position of the catheter
in relation to the bladder
wall are demonstrated