URETHRAL CATHETERIZATION
Category: Urology
Abstract : urethral catheterization - Indications Relief of urinary retention; prevention of urinary retention a period of post-operative catheterization is commonly employed after many operations where limited mobility makes normal voiding difficult; monitoring of urine output (e.g. post-operatively); prevention of damage to the bladder during caesarian section; bladder drainage following surgery to the
urethral catheterization - Indications
Relief of urinary retention; prevention of urinary retention a period of post-operative catheterization is commonly employed after many operations where limited mobility makes normal voiding difficult; monitoring of urine output (e.g. post-operatively); prevention of damage to the bladder during caesarian section; bladder drainage following surgery to the bladder, prostate, or urethra (e.g.
TURP, TURBT, open bladder stone removal, radical prostatectomy); bladder drainage following injuries to the bladder.
Technique
Explain the need for and method of catheterization to the patient. Use the smallest catheter in practical terms usually a 12Ch, with a 10ml balloon. For longer catheterization periods (weeks) use a silastic catheter to limit tissue reaction , thereby reducing risk of a catheter-induced urethral stricture. If clot retention, use a 3 way catheter (20Ch or greater) to allow evacuation of clots and bladder irrigation to prevent subsequent catheter blockage.
Technique is aseptic. One gloved hand is sterile, the other is dirty . Dirty hand holds penis or separates labia to allow cleansing of urethral meatus; this hand should not touch catheter. Use sterile water or sterile cleaning solution to prep skin around meatus.
Apply lubricant jelly to urethra. Traditionally this contains local anaesthetic (e.g. 2% lignocaine) which takes between 3-5 min to work. However, a randomized, placebo controlled trial showed that 2% lignocaine was no more effective for pain relief than anaesthetic-free lubricant,48 suggesting that it is lubricant action which prevents urethral pain. If using local anaesthetic lubricant, warn patient that it may sting . Local anaesthetic lubricant is contraindicated in patients with allergies to local anaesthetics and in those with urethral trauma, where there is a (theoretical) risk of complications arising from systemic absorption of lignocaine. When instilling jelly, do so gently a sudden, forceful depression of the plunger of the syringe can rupture the urethra! In male, milk gel towards posterior urethra, while squeezing meatus to prevent it from coming back out of meatus.
Insert the catheter using sterile hand, until flow of urine to confirm it is in bladder. Failure of urine flow may indicate that the catheter balloon is in the urethra. Intra-urethral inflation of balloon can rupture urethra. If no urine flows attempt aspiration of urine using a 50ml bladder syringe (lubricant gel can occlude eye-holes of catheter). Absence of urine flow indicates either catheter is not in the bladder or, if indication for catheterization is retention, that the diagnosis is wrong (there will usually be
a few ml of urine in the bladder even in cases where the absence of micturition is due to oliguria or anuria, so complete absence of urine flow usually indicates the catheter is not in the bladder). If the catheter will not pass into the bladder, and you are sure that the patient is in retention, proceed with suprapubic catheterization.
Hit: 305 times
Related Articles in Urology :
|
Advertise with Health Information Encyclopedia