Bladder catheterization in women: how it is performed and what are the features. Catheterization of peripheral veins: technique and algorithm

There are urethral, ​​ureteral devices, a bladder catheter, stents for the renal pelvis, depending on the organ that needs catheterization.

The bladder catheterization procedure is often an absolute necessity in the diagnosis, treatment, and care of seriously ill patients. A urinary catheter is used to perform the manipulation.

general information

Often in a person this procedure causes fear and denial associated with a lack of understanding of its necessity. The technique involves the introduction of a special device into the bladder for the outflow of urine. Catheterization is necessary if the patient cannot empty the bladder naturally.

A catheter is one or more hollow tubes. It is inserted through the urethra, but sometimes catheterization is performed through the abdomen. The fixture can be installed for a short time or for a long period. Manipulation is carried out for both men and women of any age.

A catheter in the bladder is necessary for drainage, administration of drugs. Proper installation of the device is usually painless. At first glance, the procedure is simple, but requires knowledge and experience, maintaining sterility.

During catheterization, trauma to the walls of the urinary tract is possible. In addition, there is a risk of introducing pathogenic microorganisms. Bladder catheterization is performed by an average medical worker according to a medical prescription.

Types of catheters

Types of catheters are distinguished depending on the material from which they are made, the duration of wearing, the number of outlet tubes and the area of ​​catheterization. A drainage tube may be inserted through the urinary canal or through a puncture in the abdominal wall (suprapubic).

Urological catheters are produced in different lengths: for men up to 40 cm, for women - from 12 to 15 cm. There are a permanent urinary catheter and drainage for a one-time procedure. Rigid (bougie) are made of metal or plastic, soft ones are made of silicone, rubber, latex. Recently, a metal catheter is rarely used.

There are urethral, ​​ureteral, bladder catheters, stents for the renal pelvis, depending on the organ that needs catheterization.

There are devices that are completely introduced into the patient's body, others have an outer end connected to a urinal. Tubes are equipped with channels - from one to three.

The quality and material of the catheters are of great importance, especially when worn for a long time. Sometimes the patient has allergies and irritation.

The following types of catheters are most commonly used in practice:

• Foley;
• Nelaton;
• Pezzera;
• Timan.

The urinary Foley catheter is indicated for long-term use. The rounded end with the reservoir is inserted into the bladder. And at the opposite end of the catheter there are two channels - for removing urine and forcing fluid into the organ cavity. A device with three channels is used for washing and administering medication. Urine is drained through the Foley catheter and through the urethra. And also this device is used for cystostomy (hole) of the bladder in men. In this case, the tube is inserted through the abdomen.

Timan catheters are characterized by the presence of an elastic curved tip, two holes, one discharge channel. Convenient for draining patients with prostate adenoma.

A Pezzer type catheter is a tube, usually made of rubber, with a thickened bowl-shaped retainer and two outlets. Such a catheter, inserted through the urethra or cystostomy, is intended for long-term use. Installation requires the use of a button probe.

The Nelaton catheter is disposable, it is used for the periodic excretion of urine. It is made of polyvinyl chloride, softens at body temperature. Nelaton's catheter has a closed rounded end and two side holes. Different sizes are marked with different colors. There are male and female Nelaton catheters. They differ only in length.

When is catheterization needed?

A urological catheter is placed for the purpose of diagnosis, for medical procedures, in case of violation of independent urination. A contrast agent is injected through the device during an x-ray examination, and urine is also taken to detect microflora. Sometimes it is necessary to know the volume of residual fluid in the bladder. In addition, a catheter is placed after surgery to control diuresis.

Pathologies, when an independent outflow of urine is disturbed, are many. The most common reasons why a catheter is needed are:

• tumors covering the urethra;
• stones in the urethra;
• narrowing of the urinary tract;
• prostatic hyperplasia;
• glomerulonephritis;
• nephrotuberculosis.

In addition, there are other diseases of an acute and chronic nature, in which urination disorders occur and a drainage device is required. And also often there is a need to irrigate the bladder and urethra with antibacterial and other drugs for disinfection and treatment. The catheter is placed in bedridden and seriously ill people who are unconscious, as well as after surgery.

Procedure technique

In order for the catheter to function for the planned amount of time without causing complications, a certain algorithm is needed. It is extremely important to maintain sterility. In order to avoid infection, hands, instruments, genitals of patients are treated with an antiseptic (disinfected). Manipulations are mainly performed with a soft catheter. Metal is rarely used, in case of poor patency through the urinary canal.

The patient should lie on his back with knees bent and legs apart. The nurse cleans her hands and puts on gloves. Place the tray between the patient's legs. The genital area is treated with a clamp with a napkin. In women, these are the labia and urethra, in men, the glans penis and the urethra.

Then the nurse changes gloves, takes a sterile tray, takes the catheter out of the package with tweezers, treats its end with a lubricant. Enter the device with tweezers with rotational movements. Initially, the penis is held vertically, then deflected downward. When the catheter reaches the bladder, urine emerges from its outer end.

Similarly, soft catheter manipulation is performed in women. The labia are parted and the tube is carefully inserted into the opening of the urethra, the appearance of urine indicates a correctly performed procedure.

It is more difficult to put the device on a man, since the male urethra is long and has physiological constrictions.

The next steps depend on the purpose and type of device. The Foley catheter can stand for a long time. To fix it, use a syringe and 10-15 ml of saline. Through one of the channels, it is introduced inside, into a special balloon, which, inflating, holds the tube in the organ cavity. A disposable catheter is removed immediately after urine diversion or sampling for analysis, as well as after medical procedures in the urethra and bladder in women.

Features of an indwelling catheter

To restore the functions of the urinary system, sometimes you need a long period during which the device will be in the bladder. In this case, proper care of the urinary catheter is especially important. Both urethral and cystostomy catheters have their advantages and disadvantages. The introduction of a catheter through the urethra is more traumatic, it clogs more often, it can be used for no longer than 5 days. Being in the genitals, the tube causes discomfort.

The suprapubic catheter has a larger diameter, the cystostomy is easier to process. The patient can use it for several years, but will require a monthly replacement of the drain. Difficulties arise only in overweight people. Daily maintenance of an indwelling urinary catheter is required. The injection site must be kept clean, the bladder should be washed by injecting a solution of furacilin.

The catheter is connected to the urinal. They can be changed after each use or processed for reuse. In the latter case, it is necessary to soak the urinal in a solution of vinegar, rinse and dry, after disconnecting from the system. To prevent the infection from ascending into the bladder, the urinal is attached to the leg, below the level of the genitals. If the device is clogged, it must be replaced.

Patients who use a catheter for a long time usually know how to care for it. At home, it is possible to remove and replace the device both independently and with the help of a trained person. The main thing in this case is to strictly observe the rules of asepsis.

Bladder catheterization in men. Target. Bladder release; drug administration; flushing of the bladder.
Indications. Acute and chronic urinary retention; obtaining urine for research; local treatment of diseases of the bladder.
Contraindications. bladder injury; acute inflammation of the bladder and urethra (urethra).
Equipment. Sterile soft catheters of different diameters - 2 pcs.; cotton balls - 2 pcs.; gauze napkins - 2 pcs.; glycerol; Janet's syringe; tray; diaper; rubber gloves; container for urine (if urine is taken for testing for sterility, then the dishes must be sterile); tweezers: 700 - 1,500 ml of a solution of furacilin 1: 5,000; 0.5% alcohol solution of chlorhexidine; washing set; water bath for heating furatsilina; a container with a 3% solution of chloramine, marked with the inscription "For disinfection of catheters."

Bladder catheterization in men, algorithm of execution.

1. Wash their hands. They are treated with a 0.5% solution of chlorhexidine.
2. Two sterile catheters are placed on a sterile tray, the rounded ends of which are lubricated with sterile glycerin, two sterile cotton balls moistened with furatsilin, two sterile wipes, tweezers, a Janet syringe with a solution of furatsilin heated in a water bath to + 37 ... + 38 " FROM,
3. Wash away the patient. A container for urine is placed between his legs.
4. Put on sterile gloves and stand to the right of the patient.
5. Wrap the penis below the glans with a sterile cloth.
6. Take the penis between the III and IV fingers of the left hand, slightly squeeze the head, and slightly push the foreskin with fingers I and II.
7. With the right hand, take a cotton ball moistened with furatsilin, and treat the head of the penis with movements from the urethral opening to the periphery.
8. One or two drops of sterile glycerin are poured into the external opening of the urethra.
9. Sterile tweezers are taken into the right hand.
10. The catheter is taken with sterile tweezers at a distance of 5-6 cm from the rounded end, and the free end is captured between the IV and V fingers.
11. Insert the catheter with tweezers for 4 - 5 cm, holding it with the I and II fingers of the left hand, fixing the glans penis.
12. Intercept the catheter with tweezers and slowly insert it another 5 cm. At the same time, the penis is pulled onto the catheter with the left hand, which contributes to its better advancement along the urethra.
13. As soon as the catheter reaches the bladder, urine appears, and the free end of the catheter should be lowered into the urine container.
14. After the cessation of urine output, the catheter is connected to Janet's syringe filled with furatsilin, and 100-150 ml of the solution is slowly injected into the bladder, and then, by directing the catheter into the tray, the contents are removed.
15. Washing is repeated until a clear liquid is discharged from the bladder.
16. Having finished washing, the catheter is carefully removed from the urethra with rotational movements.
17. Once again treat the external opening of the urethra with a cotton ball moistened with furatsilin.

Notes. Before carrying out the intervention, it is necessary to establish a trusting relationship with the patient. It is necessary to keep the catheter sterile 20 cm from the rounded end. The nurse has the right to perform catheterization only with a soft catheter and only as directed by a doctor. Complications may occur during catheterization (see).

Bladder catheterization is a necessary medical intervention for therapeutic or diagnostic purposes in certain diseases of the genitourinary system. It is necessary to understand specifically what are the indications for bladder catheterization, the types and methods of its implementation, the process of removing the catheter.

In some diseases of the genitourinary system (prostate adenoma, oncological processes, various pathologies of the kidneys), there are serious difficulties with the excretion of urine from the patient's body.

Bladder catheterization is a medical procedure in which a special hollow device is inserted into the cavity of the urethra to force the drainage of urine. This manipulation requires certain knowledge and skills from the doctor performing it. The procedure can be performed on a planned or emergency basis.

The goals of bladder catheterization are:

• medical;
• diagnostic;
• hygienic.

The diagnostic orientation of the use of a catheter allows you to accurately determine the root cause of any genitourinary pathology. Sterile urine, directly taken from the indicated organ, is considered the most reliable material for conducting a certain kind of analysis. This technique allows you to perform diagnostic measures with the introduction of a contrast agent into the bladder.

Hygienic catheterization allows for proper care of seriously ill patients who cannot empty their bladder on their own.

For therapeutic purposes, to eliminate stagnation of urine, these manipulations are performed in the following cases:

• for emergency forced excretion of urine when the process of urination is delayed for more than 12 hours, which occurs due to various diseases of the genitourinary system;
• during the rehabilitation period of postoperative intervention on the urinary organs;
• with various pathologies of the innervation of the bladder (disturbances of the urinary functions).

Timely and competent conduct of catheterization will allow the patient to avoid deterioration in health, and sometimes death.

Classification of catheters

The use of a catheter for bladder catheterization involves the installation of a curved or straight hollow tube with holes at the ends into the urethra.

Such conductors may be intended for short-term or long-term use. When performing surgery on the organs of the urinary system, disposable short-term catheters are often used. In chronic urinary retention, the installation of this long-acting device connected to the urinal is required.

Depending on the material of manufacture, probes are used in medical practice:

• hard;
• elastic.

Rigid structures are made of non-ferrous alloys, are very traumatic and are used only in severe cases of drainage. Due to physiological characteristics, metal structures have a different configuration for men and women. Their installation is carried out only by an experienced specialist.

Elastic catheters are more comfortable to install and use. They can be made of modern silicone, flexible plastic, special soft rubber.

Drainage devices can be:

• urethral (internal);
• suprapubic (external).

Each of these types of catheters has its pros and cons. The suprapubic conductor exits through the abdominal wall, bypassing the urethra. It is easier to install, less traumatic, more affordable quality care. A person remains sexually active, which is important for long-term use of a catheter.

The urethral type device can easily damage the walls of the bladder, neck during installation. When the device fails, the leaking urine infects the patient's genitals, causing severe inflammation.

According to the design features, the following types of catheters are distinguished:

• Nelaton (Robinson) disposable device;
• Tiemann stent;
• the Foley system (which some erroneously call Faley);
• Pezzer's device.

Each of these drainages should be considered in detail.

Common types of drains

The Nelaton (Robinson) device is presented in the form of a soft tube of small diameter with a rounded end and is distinguished by a simple mechanism of action. Used for rapid catheterization of the bladder in men and women during surgery or diagnostic urine sampling.

In some diseases of the genitourinary system with a complicated course, a rigid Tiemann stent with an elastic curved tip is used, with which it is possible to reach the bladder through the damaged and inflamed walls of the urethra.

In medical practice, it is most convenient to use a Foley catheter designed for long-term installation. It is a multifunctional 2-way or 3-way device, consisting of a flexible tube with several holes, a special reservoir, with which the system is held inside the body. A catheter of this type can be used to administer drugs, flush the bladder from pus and blood, and release blood clots.

Less common Pezzera catheters are used only for cystostomy drainage, most often for kidney failure. Such systems are a flexible tube with 2-3 functional holes that extends to the outside.

All of these types of drainage have a different diameter. The specialist, depending on the appointments in each case, will select a catheter for the patient on an individual basis.

Indications and contraindications for the use of bladder catheters

When prescribing a medical procedure for installing a catheter, the doctor must take into account the indications and contraindications for its implementation. Common indications for bladder drainage are:

• any emergency conditions associated with forced diversion of urine due to a violation of the natural process of urination (bladder paresis, adenocarcinoma, prostate adenoma, etc.);
• diagnostic measures, when in order to make a correct diagnosis and prescribe effective treatment, it is necessary to take a portion of bladder urine;
• specific diseases of the urethra and bladder, requiring the introduction of drugs into their cavity, washing from pus and blood.

Contraindications to bladder catheterization should be considered:

• urinary tract infections (acute and chronic urethritis);
• injuries of the urethral canal and bladder;
• spasm of the urethra;
• lack of urine in the bladder (anuria).

Signs of contraindications to bladder catheterization may occur suddenly, during the illiterate conduct of this procedure due to trauma to the urinary tract.

Preparing to install a drain

In order for the catheterization of the bladder to pass without complications, it is necessary to carefully prepare for it. The necessary conditions for the procedure are:

• attentive attitude to the patient;
• observance of sterility;
• perfect technique of bladder catheterization;
• high-quality materials for the manufacture of the catheter.

Before manipulation, the patient should be washed from front to back, so as not to bring intestinal flora into the urethral canal. To do this, you can use a weak solution of any antiseptic (Furacilin).

Bladder catheterization set includes:

• soft or hard catheter;
• container for collecting urine;
• anesthetic (Lidocaine);
• glycerin or vaseline oil to facilitate the installation of a drainage device;
• a set of consumables (cotton balls, napkins, diapers);
• tools (syringe for drug installations, tweezers, etc.).

In order to provide the most convenient access to the insertion site of the probe, the patient lies on his back, bends his knees and moves them slightly to the sides. For the successful completion of these medical actions, the patient must be in a relaxed and anesthetized state, and the doctor and nurse must have the necessary experience.

It is worth noting that the male algorithm for carrying out this procedure is the same as the female one. But due to some physiological features of the body structure, catheterization of the bladder in men is much more difficult.

Catheter Insertion Technique

The difficulty of installing a cystic catheter in men is that their urethral canal is much longer than in women and has some physiological narrowing. In most cases, a soft catheter is used for this procedure. The technique for performing this procedure requires certain skills and abilities of the doctor and nurse. After the preparatory measures, the invasion of the bladder includes the following main stages:

• the surface of the patient's penis is treated with an antiseptic, the head is especially carefully smeared with a cotton swab and anesthetized;
• a sterile lubricant is instilled into the opening of the urethra to facilitate the manipulations;
• the inserted device is lubricated with glycerin or petroleum jelly;
• elastic drainage is inserted by a doctor with tweezers into the external urethral canal;
• the catheter is gradually brought to the man far deep into the urethra, slightly turning the device around its axis;
• the patient is considered fully catheterized when urine appears in the drainage tube.

Further actions are performed depending on the doctor's prescriptions, in accordance with the technique of bladder catheterization in men. After emptying the urinary organ, it is washed with an antiseptic agent, attaching a special syringe to the catheter. Often, the tube of the installed device with a urinal is permanently fixed during long-term wear and recommendations for care are given.

Carrying out catheterization of the bladder with a metal catheter is carried out similarly, apart from some tricks of the passage of physiologically difficult areas.

Features of bladder drainage

The female urethra has a short and wide structure, thereby greatly facilitating the installation of the catheter. The stages of bladder catheterization in women include:

• high-quality preparation for the procedure with sterile processing of instruments and surfaces of the genital organs;
• the introduction of an elastic catheter is made with tweezers into the external opening of the urethra to a depth of 5–6 cm;
• the appearance of urine in the device will indicate the achievement of the goal.

After carrying out this procedure, in order to avoid infection, all necessary hygiene rules must be observed. When the catheter is worn for a long time, its outer end is connected to the urinal, which is securely fixed on the thigh.

But it is not always effective to conduct catheterization of the bladder with a soft catheter in women. In some rare cases, metal drainage is used.

Special attention is required for the catheterization of the child. This procedure is prescribed when absolutely necessary due to the difficulty of its implementation and the high risk of complications. Sizes of catheters for a child are selected according to age. Only soft elastic drainage devices are used.

The immune system in children is not sufficiently formed, so the risk of infectious inflammation is very high. Compliance with sterility when performing this invasion of the bladder is one of the main conditions for its success.

Complications during catheterization

The risk of complications during catheterization of the bladder, with its inept performance, is quite high. The procedure is always performed without general anesthesia in order to timely notice the occurrence of pain in the patient. You can list the frequent negative consequences that appeared during the installation of a drainage device. These include:

• damage or perforation of the urethra;
• infection of the urogenital organs in women and men (cystitis, urethritis, paraphimosis, pyelonephritis, etc.);
• infection of the circulatory system through damage to the urethra;
• various bleeding, fistulas, etc.

When using a catheter of a larger diameter than prescribed, the female may suffer from dilation of the urethra.

With the constant wearing of the drainage device, it is necessary to strictly follow all the recommendations of the attending physician regarding its operation. Bladder catheterization in women and men must be accompanied by careful hygiene of the perineum and catheter, otherwise serious complications may occur. If you find urine leaks, the appearance of blood in the urinal, with discomfort in the genitourinary organs, you should immediately contact a specialist.

The catheter is removed according to the doctor's instructions. Typically, this kind of manipulation is performed in a medical institution, sometimes it can be performed at home. Properly performed catheterization of the human urinary system will help in the treatment of many infectious and non-infectious diseases and significantly improve its quality of life.

Bladder catheterization is a common medical procedure that can be performed for both diagnostic and therapeutic purposes. It is not difficult to place a catheter, but you need to know all the subtleties of manipulation and have a good command of the technique, otherwise complications are possible.

What is the procedure

Catheterization involves the introduction of a thin tube (catheter) through the urethra into the internal cavity of the bladder. Manipulation can only be carried out by an experienced specialist - a urologist or a nurse with certain skills.

The procedure itself can be short-term or long-term:

• For a short time, the catheter is placed during surgical interventions on the urinary organs or after surgery, as well as for the purpose of diagnosis or as an emergency for acute urinary retention.
• For a long time, a transurethral catheter is placed for certain diseases, when urination is seriously difficult or impossible.

The advantage of the procedure is that, thanks to it, certain diagnostic measures can be carried out quite easily, for example, taking a portion of sterile urine for analysis or filling the bladder space with a special contrast agent for subsequent retrograde urography. Urgent drainage in some situations may be the only way to empty the full bladder and avoid hydronephrosis (a pathology characterized by expansion of the renal pelvis with subsequent atrophy of the parenchyma). In diseases of the bladder, transurethral catheterization is an effective way to deliver drugs directly to the site of the inflammatory process. Drainage of urine through a catheter may also be part of a care program for severely bedridden patients, especially the elderly.

The disadvantages of the procedure include a high risk of complications, especially if the catheter is placed by an inexperienced health worker.

The excretion of urine can be carried out by various devices. Catheters that are placed for a short time can be soft (flexible) and rigid:

• Flexible are made of rubber, silicone, latex, they come in different sizes. Most often, the Timan or Nelaton models are used. They can be placed by a paramedic with experience in performing such manipulations.
• Rigid catheters are made of metal - stainless steel or brass. Only a urologist can enter such a design. Rigid catheters are used only at once.

Indwelling catheters designed for long-term use can be of various shapes and configurations - have 1, 2 or 3 strokes. Most often, a latex Foley catheter is installed, which is fixed in the lumen of the bladder due to a small balloon filled with sterile saline. Due to the risk of complications (urethritis, prostatitis, pyelonephritis, orchitis), it is recommended to leave the catheter in the urethra for no longer than 5 days, even if accompanied by antibiotics or uroantiseptics. If longer use is required, nitrofuran-coated or silver-coated designs are used. Such devices can be changed once a month.

There is another method of drainage of the bladder - through a puncture in the abdominal wall. To do this, use special suprapubic devices, for example, a Pezzer catheter.

Indications and contraindications for catheter placement

Catheterization can be performed for therapeutic purposes:

• with acute or chronic urinary retention;
• if it is impossible to urinate independently, for example, if the patient is in a state of coma or shock;
• for postoperative restoration of the urethral lumen, urine diversion and accounting for diuresis;
• for intravesical administration of medicines or washing of the bladder cavity.

Through transurethral drainage of the bladder, diagnostic tasks are also achieved:

• sampling of sterile urine for microbiological analysis;
• assessment of the integrity of the excretory tract in various injuries of the pelvic region;
• filling the bladder with a contrast agent before x-ray examination;
• conducting urodynamic tests:
  • determination and removal of residual urine;
  • assessment of bladder capacity;
  • diuresis monitoring.

Transurethral catheterization is contraindicated in the following conditions:

• acute pathologies of the genitourinary organs:
  • urethritis (including gonorrheal);
  • orchitis (inflammation of the testicle) or epididymitis (inflammation of the epididymis);
  • cystitis;
  • acute prostatitis;
  • abscess or neoplasm of the prostate;
• various injuries of the urethra - ruptures, injuries.

How is the installation of a catheter in men

The procedure is carried out with the consent of the patient (if he is conscious), while the medical staff is obliged to inform about how the manipulation will be carried out and why it is needed. Most often, a flexible catheter is inserted.

Transurethral drainage with a metal catheter, due to pain and risk of injury, is rarely performed and only by an experienced urologist. Such manipulation is required for strictures (pathological narrowing) of the urethra.

For the procedure with a flexible catheter, the nurse prepares sterile instruments and consumables:

• gloves;
• disposable catheter;
• medical oilcloth;
• forceps for working with consumables;
• tweezers for placing a catheter;
• sterile dressing material;
• trays;
• Janet's syringe for washing the bladder.

They also prepare pre-sterilized vaseline oil, a disinfectant solution for treating the hands of medical staff, for example, Sterillium, a solution of furacilin or chlorhexidine for disinfecting the penis. Povidone-iodine can be used to treat the urethral outlet, and Cathejel (gel with lidocaine and chlorhexidine) can be used for local anesthesia.

With a strong spasm of the sphincter (muscle-contact) of the bladder, preparation is carried out before the procedure: a warm heating pad is applied to the suprapubic region and an antispasmodic is injected - a solution of No-shpa or Papaverine.

Sequence of carrying out:

1. The patient is laid on his back with his legs slightly apart, having previously spread an oilcloth.
2. Hygienic treatment of the genitals is carried out, wetting the napkin in an antiseptic solution, while the head of the penis is washed with disinfectant from the urethral opening down.
3. After changing gloves, the penis is taken with the left hand, wrapped with a gauze napkin and straightened perpendicular to the patient's body.
4. The foreskin is pushed down, exposing the outlet of the urethra, this place is treated with an antiseptic - Povidone-iodine or chlorhexidine, and Katejel is injected into the urethra (if available).
5. Treat the end of the tube to be inserted with Cathejel or vaseline oil.
6. Sterile tweezers, which are held in the right hand, clamp the catheter at a distance of 50-60 mm from the beginning, the end is clamped between two fingers.
7. Gently insert the end of the tube into the urethral opening.
8. The tube is slowly advanced along the channel, intercepting it with tweezers, while gently pulling the penis up with the left hand, as if “stringing” it onto the catheter. In areas of physiological narrowing, short stops are made and the tube continues to advance with slow rotational movements.
9. When entering the bladder, resistance may be felt. In this case, they pause and ask the patient to take a slow, deep breath several times.
10. After the tube is inserted into the bladder cavity, urine appears from the distal end of the catheter. It is poured into a substituted tray.
11. If a permanent catheter is inserted, with a urinal, then after urine flows out, the fixing balloon is filled with saline (5 ml). The balloon will hold the drain in the bladder cavity. After that, the catheter is connected to the urinal.
12. If you need to rinse the cavity of the bladder, this is done using Janet's syringe after the outflow of urine. Usually use a warm solution of Furacilin.

Video: bladder catheterization technique

When determining significant resistance in the path of catheter advancement through the urethra, one should not try to overcome the obstacle by force - this threatens with serious complications, up to and including rupture of the urethra. After 2 unsuccessful attempts to perform transurethral catheterization of the bladder, it must be abandoned in favor of other methods.

Even greater caution requires catheterization with a rigid instrument. The insertion technique is similar to soft tube catheterization. A sterile metal catheter after standard hygienic treatment of the genitals is inserted into the urethra with a bent end downwards. Carefully advance along the canal, pulling the penis. To overcome the obstacle in the form of muscle pulp created by the sphincter of the bladder, the penis is placed along the midline of the abdomen. The successful completion of the introduction is indicated by the leakage of urine from the tube and the absence of blood and pain in the patient.

Traditionally, a catheter is inserted into the urethra of men without anesthesia, while to facilitate the sliding of the tube, it is simply treated with sterile glycerin or liquid paraffin. When my husband was in the urology department, the first time he underwent the procedure in this way. And everything was done very quickly and rather rudely. The husband complained that there was very little pleasant in this. Severe discomfort during and after the procedure: burning, false urge to urinate, pulling pain in the lower abdomen. Going to the toilet for two more days was accompanied by palpable soreness. The next time we had to have a catheter, we asked to use a catheter and a smaller diameter catheter. The manipulation was carried out by another nurse, while acting very carefully: she advanced the catheter slowly, paused, giving her husband the opportunity to relax and breathe calmly. Anesthesia and the correct execution technique did their job - there was practically no pain, and after the catheter was removed, the discomfort went away much faster.

Removing the catheter

If the purpose of catheterization was a one-time excretion of urine, after completion of this process, the tube is slowly and carefully removed, the urethral outlet is treated with an antiseptic, dried, and returned to the site of the prepuce.

Before removing the indwelling catheter, liquid is released from the balloon using a syringe. If it is necessary to wash the cavity of the bladder, do it with a solution of Furacilin and remove the catheter.

Possible Complications

The procedure is designed to alleviate the patient's condition, however, if the execution technique or asepsis rules are not followed, it can lead to complications. The most serious consequence of failed catheterization is trauma to the urethra, its perforation (rupture) or damage to the bladder neck.

Other complications that may occur after manipulation:

• Arterial hypotension. Vasovagal reflex - a sharp excitation of the vagus nerve, in which there is a decrease in blood pressure, slowing of the pulse, pallor, dry mouth, sometimes loss of consciousness - occurs as a response to moderate pain or discomfort during the introduction of a catheter or to the rapid collapse of an overly distended bladder. Hypotension in a longer period after drainage may develop against the background of increased post-obstructive diuresis.
• Micro- or macrohematuria. The appearance of blood in the urine most often occurs due to the rough introduction of the tube with trauma (deposition) of the mucous membrane.
• Iatrogenic paraphimosis - a sharp compression of the head of the penis at its base with a dense ring of preputial tissue (foreskin). The cause of this phenomenon may be a rough exposure of the head and a long-term displacement of the foreskin during catheterization.
• Ascending infection is one of the most frequent complications caused by neglect of asepsis rules. The introduction of pathogenic microflora into the urinary tract can lead to the development of urethritis (inflammation of the urinary canal), cystitis (inflammation of the bladder), pyelonephritis (inflammation of the pelvis and parenchyma of the kidneys) and ultimately lead to urosepsis.

Due to the high risk of complications, bladder catheterization in men is resorted to only if absolutely indicated.

Despite the possible discomfort that a patient may experience when inserting a catheter, often this procedure can bring considerable benefits and become one of the stages on the road to recovery.

urinary catheter is a system of tubes placed in the body to drain and collect urine from the bladder.

Urinary catheters are used to drain the bladder. Bladder catheterization is often a last resort due to possible complications from prolonged use of the catheter. Complications associated with the use of a catheter may include:

• bubble stones
• Blood infections (sepsis)
• Blood in the urine (hematuria)
• Skin damage
• Urethral trauma
• Urinary tract or kidney infections

There is a wide variety of urinary catheters. Urinary catheters differ in material they are made of (latex, silicone, Teflon) and type (Foley catheter, straight catheter, curved tip catheter). For example, a Foley catheter is a soft plastic or rubber tube that is inserted into the bladder to drain urine.

Urologists recommend using the smallest catheter size. Some people may need large catheters to prevent urine from leaking around the catheter or if the urine is concentrated and contains blood or a lot of sediment.

It must be remembered that large catheters can damage the urethra. Some people with long-term use of latex catheters may develop an allergy or sensitivity to latex. In these patients, Teflon or silicone catheters should be used.

Long-term (permanent) urinary catheters

A catheter, which is inserted into the bladder for a long time, is connected to a urinal to collect urine. There are two types of urinals.

The first type of urinal is a small bag that is attached to the leg with an elastic band. Such a urinal can be worn during the day, as it is easy to hide under trousers or a skirt. The bag is easily emptied in the toilet.

Another type of urinal is a large bag that is used at night. This urinal is usually hung on the bed or placed on the floor.

How to care for your urinary catheter

If the catheter becomes clogged, painful, or infected, the catheter must be replaced immediately.

To care for an indwelling catheter, it is necessary to wash the urethra (the exit site of the catheter) daily with soap and water. Also clean the genital area completely after each bowel movement to prevent infection of the catheter. Urologists no longer recommend the use of antibacterial ointments for cleaning catheters, as their effectiveness in preventing infection has not been proven.

Increase your fluid intake to reduce the risk of complications (if you can drink plenty of fluids for health reasons). Discuss this issue with your doctor.

The urinal should always be located below the bladder to prevent urine from flowing back into the bladder. Empty the bag either every 8 hours or as it fills up.

Make sure that the outlet valve of the urinal remains sterile. Wash your hands before and after handling the bag. Do not let the outlet valve touch anything. If the outlet valve is dirty, wash it with soap and water.

How to handle the urinal?

Clean and deodorize the bag by filling the bag with a solution of two parts vinegar to three parts water. You can replace the aqueous solution of vinegar with chlorine bleach. Soak the urinal in this solution for 20 minutes. Hang the bag with the outlet valve open to dry.

What to do if the catheter is leaking?

Some people may experience leakage of urine around the catheter. This phenomenon may be due to a small catheter, an inappropriate balloon size, or bladder spasm.

If bladder spasm occurs, check to see if the catheter is draining urine properly. If there is no urine in the urinal, then the catheter may be blocked by blood or coarse sediment. Or, the catheter or drainage tube has tucked up and formed a loop.

If you have been taught how to flush the catheter, then try to flush the catheter yourself. If you cannot flush the catheter, contact your doctor immediately. If you have not been instructed how to flush the catheter and urine does not enter the urinal, then you need to contact your doctor urgently.

Other causes of urine leakage around the catheter include:

• Constipation
• Urinary tract infections

Potential Complications of Using Urinary Catheters

Contact your doctor if you develop any of these complications:

• Bleeding in or around the catheter
• The catheter is draining a small amount of urine, or there is no urine despite adequate fluid intake
• Fever, chills
• Large amounts of urine leaking around the catheter
• Urine with a strong odor or urine that is cloudy or thick
• Swelling of the urethra around the catheter

Suprapubic urinary catheters

Suprapubic urinary catheter is an indwelling catheter that is inserted directly into the bladder through the abdomen above the pubic bone. This catheter is inserted by a urologist in the conditions of either a clinic or a hospital. The catheter exit site (located on the abdomen) and the catheter should be cleaned daily with soap and water and covered with dry gauze.

Replacement of suprapubic catheters is carried out by qualified medical personnel. The suprapubic catheter can be connected to the standard urinals described above. The suprapubic catheter is recommended:

• After some gynecological operations
• For patients who need long-term catheterization
• For patients with trauma or blockade of the urethra

Complications caused by the use of a suprapubic catheter may include:

• Bladder stones
• Blood infections (sepsis)
• Blood in the urine (hematuria)
• Skin damage
• Urine leakage around the catheter
• Urinary tract or kidney infections.

After prolonged use of the catheter, the development of bladder cancer is possible.

How to put a urinary catheter in a man?

1. Wash your hands. Use betadine or a similar antiseptic (unless specifically instructed) to clean the urethra.
2. Put on sterile gloves. Make sure you do not touch the outer surface of the gloves with your hands.
3. Lubricate the catheter.
4. Take the penis and hold it perpendicular to the body. Slightly pull the penis towards the navel.
5. Begin gently inserting and advancing the catheter.
6. You will meet resistance when you reach the external sphincter. Ask the patient to take a few deep breaths to relax the muscles blocking the urethra and continue advancing the catheter.
7. If urine appears, continue advancing the catheter to the "Y" level of the connector. Hold the catheter in one position while you inflate the balloon. Inflating the catheter balloon in the urethra causes severe pain and can lead to injury. Check if the catheter is in the bladder. You can try flushing the catheter with a few milliliters of sterile water. If the solution does not return easily, the catheter may not have been inserted far enough into the bladder.
8. Fix the catheter and attach the urinal to it.

How to put a urinary catheter in a woman?

1. Collect all equipment: catheter, moisturizing gel, sterile gloves, clean wipes, syringe with water to inflate the balloon, urinal.
2. Wash your hands. Use betadine or another antiseptic to treat the external opening of the urethra. In women, it is necessary to treat the labia and the opening of the urethra with gentle movements from top to bottom. Avoid the anal area.
3. Put on sterile gloves. Make sure that you do not touch the outer surface of the gloves with your hands.
4. Lubricate the catheter.
5. Part the labia and locate the opening of the urethra, which is located below the clitoris and above the vagina.
6. Slowly insert the catheter into the opening of the urethra.
7. Gently advance the catheter.
8. If urine appears, advance the catheter another 2 inches. Hold the catheter in one position while you inflate the balloon. Check if the catheter is in the bladder. If the patient feels pain when the balloon is inflated, it is necessary to stop. Deflate the balloon and advance the catheter another 2 inches and try to inflate the catheter balloon again.
9. Fix the catheter and attach the urinal.

How to remove a urinary catheter?

Indwelling catheters can be removed in two ways. The first method is to attach a small syringe to the opening of the catheter. Remove all liquid. Slowly withdraw the catheter.

Caution: Never remove your indwelling catheter unless your doctor has instructed you. Remove the catheter only after the permission of the doctor.

Some urologists instruct their patients to cut the catheter balloon inflation tube above the main tube. After all the water has drained out, slowly withdraw the catheter. Be careful not to cut the catheter elsewhere.

If you cannot remove the urinary catheter with little effort, inform your doctor immediately.

Tell your doctor if you don't pass urine within 8 hours after the catheter is removed, or if your stomach is swollen and hurts.

Short term (intermittent) catheters

Some patients require intermittent bladder catheterization. These people need to be taught how to insert a catheter on their own to drain the bladder when needed. They do not need to wear a urinal all the time.

People who may use intermittent catheterization include:

• Any patient who is unable to properly empty their bladder
• men with large prostates
• People with damage to the nervous system (neurological diseases)
• Women after certain gynecological surgeries

The process is similar to the procedures described above. However, the balloon does not need to be inflated and the catheter is removed immediately after the flow of urine has stopped.

The article is informational. For any health problems - do not self-diagnose and consult a doctor!

V.A. Shaderkina - urologist, oncologist, scientific editor