In
urinary catheterization, or "
cathing" for short, a plastic tube known as a urinary
catheterIn medicine a catheter is a tube that can be inserted into a body cavity, duct or vessel. Catheters thereby allow drainage, injection of fluids or access by surgical instruments. The process of inserting a catheter is catheterization. In most uses a catheter is a thin, flexible tube , although...
is inserted into a patient's
bladderIn anatomy, the urinary bladder is the organ that collects urine excreted by the kidneys prior to disposal by urination. A hollow muscular, and distensible organ, the bladder sits on the pelvic floor...
via their
urethraIn anatomy, the urethra is a tube which connects the urinary bladder to the outside of the body. The urethra has an excretory function in both sexes to pass urine to the outside, and also a reproductive function in the male, as a passage for semen.The external urethral sphincter is a striated...
. Catheterization allows the patient's
urineUrine is a liquid waste product of the body secreted by the kidneys by a process of filtration from blood called urination and excreted through the urethra. Cellular metabolism generates numerous waste compounds, many rich in nitrogen, that require elimination from the bloodstream...
to drain freely from the bladder for collection, or to inject liquids used for treatment or diagnosis of bladder conditions. The procedure of catheterization will usually be done by a clinician, often a
nurseA nurse is a healthcare professional who, in collaboration with other members of a health care team, is responsible for: treatment, safety, and recovery of acutely or chronically ill individuals; health promotion and maintenance within families, communities and populations; and, treatment of...
, although self-catheterization is possible as well.
Catheters come in several basic designs:
- A Foley catheter
Foley catheters are flexible tubes that are passed through the urethra during urinary catheterization and into the bladder to drain urine. They are retained by means of a balloon at the tip which is inflated with sterile water. The balloons typically come in two different sizes: 5 cc and 30 cc...
is retained by means of a balloon at the tip which is inflated with sterile water.
In
urinary catheterization, or "
cathing" for short, a plastic tube known as a urinary
catheterIn medicine a catheter is a tube that can be inserted into a body cavity, duct or vessel. Catheters thereby allow drainage, injection of fluids or access by surgical instruments. The process of inserting a catheter is catheterization. In most uses a catheter is a thin, flexible tube , although...
is inserted into a patient's
bladderIn anatomy, the urinary bladder is the organ that collects urine excreted by the kidneys prior to disposal by urination. A hollow muscular, and distensible organ, the bladder sits on the pelvic floor...
via their
urethraIn anatomy, the urethra is a tube which connects the urinary bladder to the outside of the body. The urethra has an excretory function in both sexes to pass urine to the outside, and also a reproductive function in the male, as a passage for semen.The external urethral sphincter is a striated...
. Catheterization allows the patient's
urineUrine is a liquid waste product of the body secreted by the kidneys by a process of filtration from blood called urination and excreted through the urethra. Cellular metabolism generates numerous waste compounds, many rich in nitrogen, that require elimination from the bloodstream...
to drain freely from the bladder for collection, or to inject liquids used for treatment or diagnosis of bladder conditions. The procedure of catheterization will usually be done by a clinician, often a
nurseA nurse is a healthcare professional who, in collaboration with other members of a health care team, is responsible for: treatment, safety, and recovery of acutely or chronically ill individuals; health promotion and maintenance within families, communities and populations; and, treatment of...
, although self-catheterization is possible as well.
Catheter types
Catheters come in several basic designs:
- A Foley catheter
Foley catheters are flexible tubes that are passed through the urethra during urinary catheterization and into the bladder to drain urine. They are retained by means of a balloon at the tip which is inflated with sterile water. The balloons typically come in two different sizes: 5 cc and 30 cc...
is retained by means of a balloon at the tip which is inflated with sterile water. The balloons typically come in two different sizes: 5 cc and 30 cc. They are commonly made in silicone rubber or natural rubber.
- A Robinson catheter is a flexible catheter used for short term drainage of urine. Unlike the Foley catheter, it has no balloon on its tip and therefore cannot stay in place unaided.
- A Coudé catheter is designed with a curved tip that makes it easier to thread the catheter past the prostate or obstructions in the urethral canal. A Coudé catheter tip may be provided with a balloon or not.
- An irrigation catheter has a separate lumen to carry irrigation fluid into the bladder. This is useful following endoscopic surgical procedures or in the case of gross hematuria.
- An external Texas or condom catheter is used for incontinent males and carries a lower risk of infection than an indwelling catheter.
Catheter diameters are sized by the
French catheter scaleThe French catheter scale is commonly used to measure the outer diameter of cylindrical medical instruments including catheters...
(F). The most common sizes are 10 F (3.3mm) to 28 F (9.3mm). The clinician selects a size large enough to allow free flow of urine, but large enough to control leakage of urine around the catheter. A larger size can become necessary when the urine is thick, bloody or contains large amounts of
sedimentSediment is any particulate matter that can be transported by fluid flow, and which eventually is deposited.Sediments are most often transported by water transported by wind and glaciers...
. Larger catheters, however, are more likely to cause damage to the urethra. Some people develop allergies or sensitivities to latex after long-term latex catheter use making it necessary to use silicone or Teflon types. Silver alloy coated urinary catheters may reduce infections.
Sex Differences
In males, the catheter tube is inserted into the urinary tract through the
penisThe penis is an external sexual organ of certain biologically male organisms, in both vertebrates and invertebrates....
. A condom or Texas catheter can also be used. In females, the catheter is inserted into the
urethral meatusThe urinary meatus is the external orifice of the urethra, from which urine is ejected during urination and semen is ejected during ejaculation....
, after a cleansing using povidone-iodine. The procedure can be complicated in females due to varying layouts of the genitalia (due to age,
obesityObesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems...
,
Female genital cuttingFemale genital mutilation , also known as female genital cutting , female circumcision or female genital mutilation/cutting , is any procedure involving the partial or total removal of the external female genitalia or other injury to the female genital organs "whether for cultural, religious or...
,
childbirthChildbirth is the culmination of a human pregnancy or gestation period with birth of one or more newborn infants from a woman's uterus...
, or other factors), but a good clinician should rely on
anatomicalAnatomy is a branch of biology and medicine that is the consideration of the structure of living things. It is a general term that includes human anatomy, animal anatomy and plant anatomy...
landmarks and patience when dealing with such a patient. In the UK it is generally accepted that cleaning the area surrounding the urethral meatus with 0.9% sodium chloride solution is sufficient for both male and female patients as there is no reliable evidence to suggest that the use of antiseptic agents reduces the risk of urinary tract infection.
Common indications to catheterize a patient include acute or chronic
urinary retentionUrinary retention also known as ischuria is a lack of ability to urinate. It is a common complication of benign prostatic hypertrophy , although anticholinergics may also play a role, and requires a catheter or prostatic stent...
- (which can damage the kidneys), orthopedic procedures that may limit a patient's movement, the need for accurate monitoring of input and output (such as in an
ICUIntensive care medicine or critical care medicine is a branch of medicine concerned with the provision of life support or organ support systems in patients who are critically ill and who usually require intensive monitoring.- Overview :...
),
benign prostatic hyperplasiaBenign prostatic hyperplasia also known as benign prostatic hypertrophy , benign enlargement of the prostate , and adenofibromyomatous hyperplasia, refers to the increase in size of the prostate in middle-age and elderly men...
, incontinence, and the effects of various surgical interventions involving the bladder and prostate.
For some patients the insertion and removal of a catheter causes excruciating pain, so a topical
anestheticAnesthesia, or anaesthesia , has traditionally meant the condition of having sensation blocked or temporarily taken away. This allows patients to undergo surgery and other procedures without the distress and pain they would otherwise experience...
is used. Catheterization should be performed as a sterile
medical procedureA medical procedure is a course of action intended to achieve a result in the care of persons with health problems.A medical procedure with the intention of determining, measuring or diagnosing a patient condition or parameter is also called a medical test...
and should only be done by trained, qualified personnel, using equipment designed for this purpose, except in the case of intermittent self catheterization where the patient has been trained to perform the procedure himself or herself. If correct technique is not used there may be trauma to the urethra or prostate (male), urinary tract infection, or a
paraphimosisParaphimosis is a medical condition where the foreskin becomes trapped behind the glans penis, and cannot be pulled back to its normal flaccid position covering the glans penis...
in the uncircumcised male.
Maintenance of a catheter
A catheter that is left in place for more than a short period of time is generally attached to a drainage bag to collect the urine. This also allows for measurement of urine volume. There are two types of drainage bags: The first is a leg bag, a smaller drainage device that attaches by
elasticAn elastomer is a polymer with the property of elasticity. The term, which is derived from elastic polymer, is often used interchangeably with the term rubber, although the latter is preferred when referring to vulcanisates. Each of the monomers which link to form the polymer is usually made of...
bands to the leg. A leg bag is usually worn during the day, as it fits discreetly under pants or skirts, and is easily emptied into a toilet. The second type of drainage bag is a larger device called a down drain that may be used overnight. This device is usually hung on the patient's bed or placed on the floor nearby.
During long-term use, the catheter may be left in place during the entire time, or a patient may be instructed on a procedure for placing a catheter just long enough to empty the bladder and then removing it (known as
intermittent self-catheterization). Patients undergoing major
surgerySurgery is a medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, to help improve bodily function or appearance, or sometimes for some other reason...
are often catheterized and may remain so for some time. The patient may require irrigation of the bladder with sterile saline injected through the catheter to flush out clots or other matter that does not drain.
Effects of long term use
The duration of cathetarization can have significance for the patient.
IncontinentUrinary incontinence is any involuntary leakage of urine. It is a common and distressing problem, which may have a profound impact on quality of life. Urinary incontinence almost always results from an underlying treatable medical condition...
patients commonly are catheterized to reduce their cost of care. However, long-term catheterization carries a significant risk of
urinary tract infectionA urinary tract infection is a bacterial infection that affects any part of the urinary tract.The main causitive agent is:Escherichia coli. Although urine contains a variety of fluids, salts, and waste products, it usually does not have bacteria in it. When bacteria get into the bladder or kidney...
. Because of this risk catheterization is a last resort for the management of incontinence where other measures have proved unsuccessful. Other long term complications may include blood infections (
sepsisSepsis is a serious medical condition that is characterized by a whole-body inflammatory state and the presence of a known or suspected infection.
), urethral injury, skin breakdown, bladder stones, and blood in the urine (hematuriaIn medicine, hematuria, or haematuria, is the presence of red blood cells in the urine. It may be idiopathic and/or benign, or it can be a sign that there is a kidney stone or a tumor in the urinary tract , ranging from trivial to lethal...
). After many years of catheter use, bladder cancerBladder cancer refers to any of several types of malignant growths of the urinary bladder. It is a disease in which abnormal cells multiply without control in the bladder. The bladder is a hollow, muscular organ that stores urine; it is located in the pelvis...
may also develop.
Combating infection
Everyday care of catheter and drainage bag is important to reduce the risk of infection. Such precautions include:
- Cleansing the urethral area (area where catheter exits body) and the catheter itself.
- Disconnecting drainage bag from catheter only with clean hands
- Disconnecting drainage bag as seldom as possible.
- Keeping drainage bag connector as clean as possible and cleansing the drainage bag periodically.
- Use of a thin catheter where possible to reduce risk of harming the urethra
In anatomy, the urethra is a tube which connects the urinary bladder to the outside of the body. The urethra has an excretory function in both sexes to pass urine to the outside, and also a reproductive function in the male, as a passage for semen.The external urethral sphincter is a striated...
during insertion.
- Drinking sufficient liquid to produce at least two liters of urine daily
- Sexual activity is very high risk for urinary infections, especially for catheterized women.
Recent developments in the field of the temporary prostatic stentA prostatic stent is used to keep open the male urethra and allow the passing of urine in cases of prostatic obstruction and lower urinary tract symptoms . Prostatic obstruction is a common condition with a variety of etiologies...
have been viewed as a possible alternative to indwelling catheterization and the infections associated with their use.
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