Catheterisation

1. Catheterisation Thiru Gunendran 5th Year Medical Student Urology Revision Day Nov 2010

2. Outline WHAT YOU NEED TO KNOW • Indications • Types • Procedure • Complications • Contraindications

3. Indications for catheter Urinary retention Post operative e.g. after spinal Monitor fluid balance e.g. shock, post-op Indications Quality of life e.g. terminally ill Decompression e.g. perforation, fistula Irrigation post TURP or TURBT Severe incontinence Instillation of chemicals

4. Types • Short term vs long term (PTFE / silicone) • Permanent vs intermittent • Male vs female • Urethral vs suprapubic • Number of channels - 1, 2 or 3 The indication will determine the type of catheter used

5. Types of catheters

6. Urinary retention Mass arising centrally from the pelvis May be painful or painless Dull to percussion Unable to get below the mass

7. Suprapubic catheters

8. Practical

9. Flight of the catheter

10. Pre catheterisation Need for catheterisation  Explain and obtain permission from patient.  Select the correct type of catheter  Select the appropriate drainage system (hourly bag) • Prepare catheter trolley (pack, cleansing solution, catheter, water for balloon, lidocaine gel, gloves, catheter bag, CSU pot) • Wash hands, wear gloves

11. Catheter trolley

12. Procedure • Drape patient. • Cleanse penis with appropriate solution. • Instil lidocaine gel into the urethra. (Apply gentle pressure to clamp the urethra so gel will pass down the urethra to facilitate lubrication) • Insert catheter and advance to near bifurcation until urine starts to flow. • Inflate the balloon with 10mls of sterile water (not saline!) • Gently withdraw the catheter until resistance is felt. • Connect sterile drainage system. • Reposition foreskin if uncircumcised!

13. Documentation The following information should be recorded: • Date & time of insertion • Indication • Catheter size + type • Balloon inflation volume • Any difficulty encountered • Residual volume • Catheter pack sticker

14. Example of entry in notes 5th Nov 2010, 1530 hours Catheterisation for retention. 1% lidocaine jelly. 16Ch, 2 way hydrogel coated latex. Easy passage. Clear urine drained. 10ml in balloon. Foreskin replaced. 800ml residual. Place sticker FY1

15. Common problems Can’t get it in - stricture or enlarged prostate Can’t get it out - non deflating balloon No drainage - the catheter or tubing may be kinked/blocked - the drainage bag is too full or above the level of the bladder By-passing - catheter may be blocked/dislodged - secondary to detrusor overactivity

16. Complication • Urinary tract infection 5 to 10%/day • Urethral trauma from the balloon being blown up in the urethra • Bladder spasms • Haematuria • Paraphimosis in an uncircumcised male • Bladder stones • Urethral strictures

17. Haematuria

18. Paraphimosis

19. Bladder stones

20. Contraindications Signs of Urethral trauma • Blood at meatus • Scrotal haematoma • High riding prostate Do not catheterise

21. Key message • If a urethral catheter will not pass easily, then do not persist but ask for advice • Never inflate balloon unless in bladder • Always record residual volume • Pull foreskin back in uncircumcised male • If in doubt seek help

22. Do not force it!