URINARY CATHETERIZATION

A urinary catheter (such as a Foley catheter) is a plastic tube which

is inserted through a patient's urinary tract into their bladder. A balloon located at the end of the catheter is usually inflated with sterile water to prevent the catheter from slipping out. In this manner, the patient's urine is collected and contained for various medical purposes. The procedure of catheterization will usually be done by a doctor, often a nurse, although self-catheterization is possible as well.

 Catheters come in a large variety of sizes, materials (latex, silicone, PVC, or Teflon) and types (Foley catheter, straight catheter, or coude tip catheter).

 In the case of internal catheters, those inserted into the urethra, the smallest size is usually recommended, although a larger size is sometimes needed to control leakage of urine around the catheter. A large size can also become necessary when the urine is thick,

bloody or contains large amounts of sediment. Larger internal

catheters, however, are more likely to cause damage to the urethra. Some people have developed allergies or sensitivities to latex after long-term latex catheter use. In such cases, silicone or Teflon types should be used.

SHORTH-TERM USE OF CATHETER

In some situations, incontinent patients are catheterized to reduce their cost of care. A condom catheter, which fits on the outside of the penis using adhesive, can be used for short-term cathaterization in males. However, long-term catheterization is not recommended because chronic use carries a significant risk of urinary tract

infection.

LONG-TERM USE OF CATHETER

A catheter that is left in place for a period of time may be attached to a drainage bag to collect the urine. There are two types of drainage bags: the first is a leg bag, a smaller drainage device that attaches by elastic 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 during the night. This device is usually hung on the patient's bed or placed on the floor nearby.

TECHNIQUE OF CATHETERIZATION

 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 surgery are often catheterized and may remain so for some
time. Long-term catheterization can expose patients to an increased risk of infection. Long-term catheterization as a remedy for incontinence is not appropriate, as the risks outweigh the benefits.

INDICATIONS FOR CATHETERIZATION

Common indications to catheterize a patient include acute or chronic urinary retention, orthopedic procedures that may limit a patient's movement, the need for accurate monitoring of input and output), benign prostatic hypertrophy, incontinence, and the effects of various surgical interventions involving the bladder and prostate. For many patients the insertion and removal of a catheter can cause excruciating pain, so a topical anesthetic can be used. Catherization should be performed as a sterile medical procedure and should only

be done by trained, qualified personnel, using equipment designed

for this purpose.

TECHNIQUE OF CATHETERIZATION
Explain procedure to the patient Assist patient into supine position with legs spread and feet together Open catheterization kit and catheter Prepare sterile field, apply sterile gloves

Check balloon for patency.

Generously coat the distal portion (2-5 cm) of the catheter with lubricant Cleanse peri-urethral mucosa with cleansing solution. Cleanse anterior to posterior, inner to outer, one swipe per swab, discard swab away from sterile field. Pick up catheter with gloved (and still sterile) dominant hand. Hold end of catheter loosely coiled in palm of dominant hand.

Identify the urinary meatus and gently insert until 1 to 2 inches beyond where urine is noted

Inflate balloon, using correct amount of sterile liquid, gently pull catheter until inflation balloon is snug against bladder neck

Connect catheter to drainage system Secure catheter to abdomen or thigh, without tension on tubing Place drainage bag below level of bladder Evaluate catheter function and amount, color, odor, and quality of

urine
Document size of catheter inserted, amount of water in balloon, patient's response to procedure, and assessment of urine

COMPLICATIONS

Complications of catheter use may include: urinary tract or kidney

infections, blood infections (sepsis), urethral injury, skin breakdown,

bladder stones, and blood in the urine (hematuria). After many years

of catheter use, bladder cancer may also develop.

BLADDER STONES

HEMATURIA

BLADDER CANCER

COMPLICATIONS

After 48 hours of catheterization, most catheters are colonized with bacteria, thus leading to possible bacteruria and its complications. Catheters can also cause renal inflammation, nephro-cysto-lithiasis, and pyelonephritis if left in for prolonged periods.

The most common short term complications are inability to insert

catheter, and causation of tissue trauma during the insertion. The alternatives to urethral catheterization include suprapubic catheterization and external catheters for longer durations.

SYMPTOMS OF URINARY INFECTION

Not everyone with a UTI has symptoms, but most people get at least some symptoms. These may include a frequent urge to urinate and

a painful, burning feeling in the area of the bladder or urethra during

urination. It is not unusual to feel bad all overtired, shaky, washed outand to feel pain even when not urinating. Often women feel an uncomfortable pressure above the pubic bone, and some men experience a fullness in the rectum. It is common for a person with a urinary infection to complain that, despite the urge to urinate, only a small amount of urine is passed. The urine itself may look milky or cloudy, even reddish if blood is present. Normally, a UTI does not cause fever if it is in the bladder or urethra. A fever may mean that the infection has reached the kidneys. Other symptoms of a kidney infection include pain in the back or side below the ribs, nausea or

vomiting.

PREVENTION OF URINAL INFECTIONS

Catheterize clients only when is necessary by using aseptic

technique, sterile equipment and trained personnel

Maintain a sterile closed-drainage system Do not disconnect the catheter and drainage tubing unless absolutely necessary Remove the catheter as soon as possible Provide routine perineal hygiene

COMPLICATIONS OF CATHETERIZATION
Normally, urine is sterile. It is usually free of bacteria, viruses, and fungi but does contain fluids, salts, and waste products. An infection occurs when tiny organisms, usually bacteria from the digestive tract, cling to the opening of the urethra and begin to multiply.

The urinary system is structured in a way that helps ward off

infection. The ureters and bladder normally prevent urine from backing up toward the kidneys, and the flow of urine from the bladder helps wash bacteria out of the body. In men, the prostate gland produces secretions that slow bacterial growth. In both sexes, immune defenses also prevent infection.

ANALYSIS OF URINE

Urinalysis is a diagnostic physical, chemical, and microscopic examination of a urine sample (specimen). Specimens can be obtained by normal emptying of the bladder (voiding) or by a hospital procedure called catheterization.

ANALYSIS OF URINE

STORAGE. Urine specimens should not remain unrefrigerated for longer than two hours. A urine specimen that cannot be delivered to a laboratory within two hours should be stored in a refrigerator. The reason for this precaution is that urine samples undergo chemical changes at room temperature. Blood cells begin to dissolve and the

urine loses its acidity.

 VISUAL EXAMINATION. A doctor, nurse, or laboratory technician

will look at the specimen to see if the urine is red, cloudy, or looks

unusual in any way. He or she will also note any unusual odor.

The urine specimen is also examined under a microscope to

determine whether it contains blood cells, crystals, or small pieces of

fibrous material (casts).

 TESTING TECHNIQUES. Urine samples are tested with a variety of different instruments and techniques. Some tests use dipsticks,

which are thin strips of plastic that change color in the presence of
specific substances. Dipsticks can be used to measure the acidity of the urine (its pH) or the presence of blood, protein, sugar, or substances produced during the breakdown of fatty acids (ketones). A urinometer is used to compare the density of the urine specimen with the density of plain water. This measurement is called specific gravity.

URINALYSIS TEST
In the urinalysis test, the urine is examined for white and red blood cells and

bacteria. Then the bacteria

are grown in a culture and tested against different

antibiotics to see which drug

best destroys the bacteria. This last step is called a

sensitivity test.