Urethral Catheterization: Types, Indications, and Technique

1. In the name of god

2. Dr. A Jabbari (MD) Tabriz university of medical science Urology department Principle Of Urethral Catheterization

3. اهداف درس: • آشنایی با انواع کاتترها • اندیکاسیون کاتتریزاسیون • نحوه صحیح کاتتریزاسیون روش ارزیابی : • تئوری بیشتر بصورت MCQ • عملی بصورت استفاده از فرمهای Logbook

4. The word "katheter" came from "kathiemai — καθίεμαι" meaning "to sit". The ancient Greeks inserted a hollow metal tube through the urethra into the bladder to empty it and the tube came to be known as a "katheter".

5. One of the earliest descriptions of a urinary catheter can be found in the Hippocratic text On Diseases (400 BC), in which bladder drainage was considered a basic skill in the armamentarium of Greek physicians Historical Background

6. In Avicenna’s Canon of Medicine, mention is also made of urethral catheterization as a means to deliver intravesical therapy.

8. The most common indications for the use of a bladder catheter can be broadly divided into two main categories: To allow the instillation of diagnostic or therapeutic agents To obtain drainage of bladder Indications

9. To allow healing after lower urinary tract surgery/trauma To evacuate the bladder when the urine contains particulate matter, especially in combination with simultaneous irrigation (post transurethral resection, clot/purulent material evacuation) Other indications..

10. The collection of microbiologic clean urine (uncooperative patients because of age or mental status or comorbidities that prevent voluntary voiding) To provide access to the bladder for urinary tract imaging studies such as cystography To allow instillation of pharmacologic agents for local therapy of some bladder pathologies

12. The size and type of urinary catheter used depends on the indication for catheter insertion, age of the patient, and type of fluid expected to be drained Catheter Selection

13. Catheter size is measured in the French scale, whereby one Fr is equal to 0.33 mm As a general rule, catheter size should be the smallest size that can accomplish the desired drainage Catheter size

15. Modern urinary catheters are most frequently made of latex, rubber, silicone, and polyvinylchloride (PVC) Rubber and latex catheters are often chosen for short-term drainage. Silicone catheters are indicated for patients requiring a longer period of indwelling time Evidence suggests that the use of silicone catheters is associated with a lower incidence of urinary tract infections compared with those made of latex. Material

19. The most basic catheters are constructed with a single lumen to permit urinary drainage or irrigation/instillation. Additional lumens are added to permit addition of a retention balloon (two way ) and for simultaneous drainage and irrigation (three way ) Number of Channels

21. Tip Shape

22. One-time drainage, instillation or irrigation in children, females, and most males Robinson Nelaton Jaques Straight without retainig mechanism

25. Foley: continuous drainage or irrigation in children, females, and most males Madduri: used for urethrography, allows proximal and distal occlusion and contrast instillation in the intermediate section Straight with balloon

28. Malecot: continuous drainage or irrigation in children, females, and most males Straight with 2 or 4 wings

30. Pezzer: continuous drainage or irrigation in children, females, and most males Straight with umbrella

32. MalecotvsPezzer

33. Coudé: continuous drainage or irrigation Ease of insertion males with enlarged prostate midlobe or high bladder neck Curved with balloon

35. Councill: continuous drainage or irrigation in children, females, and most males (end hole permits insertion or exchange over a previously placed guidewire) End hole catheters

37. Whistle tip: has a large diameter end hole occupying half of its beveled tip ( for increased drainage/instillation capacity) End hole catheter

40. The patient should be in the supine position at a comfortable height for the physician performing catheterization In female patients a “frog-leg” position is most suitable, and the use of stirrups can be considered, especially in the obese Catheterization should be carried out in a sterile fashion with antiseptic preparation and draping of the patient’s meatal and genital area Technique of Catheter Insertion

41. If topical anesthesia is to be used,evidence suggests it requires a minimum of 10 minutes of exposure of low temperature(< 4° C) anesthetic gel(depending on the agent), sufficient volume of the agent (20 to 30 mL), and slow instillation time (>3 to 10 seconds) to have the most effect.

43. Catheterization in male Patients

44. After sterile skin preparation and draping, grasp the shaft of the penis with the nondominant hand (which is now regarded as contaminated) and hold the penis at a 90-degree angle or perpendicular to the patient. Insert the lubricated tip of the catheter into the urethral meatus and gently but firmly continue to advance the catheter for 7 to 10 cm, while simultaneously bringing the shaft of the penis to the horizontal plane or parallel to the patient

45. Once the entire length of the catheter has been introduced (up to the juncture of the connector or to the two-way bifurcation),wait for spontaneous urine passage, confirming proper placement of the catheter If spontaneous drainage of urine is not seen, gently press on the patient’s suprapubic area If despite this maneuver no drainage occurs, slowly instill 20 mL of saline using a catheter-tipped syringe into the drainage port of the catheter and then slowly aspirate the fluid instilled

46. Only when the position of the catheter has been verified should the retaining balloon be inflated Sterile water is the preferred solution for balloon inflation. Air is compressible and might leak, and electrolyte or glucose-based solutions can precipitate and occlude the tubing and valve mechanism

47. The catheter should be attached to a sterile closed bag system as soon as urine is draining The drainage bag should be placed below the level of the bladder to encourage one-way gravity flow with the tubing as straight as possible and avoiding kinks that might impair drainage.

48. In patients with acute urinary retention with significant bladder distension ,bladder drainage might precipitate decompression-induced hematuria. In these patients the catheter should be intermittently clamped and released to permit gradual bladder decompression over 30 to 60 minutes ex vacuohematuria