Spaulding classification of the urinary catheter. Intravenous catheters: sizes, types, fixation. Peripheral intravenous catheter. Foley catheter - what is it

Intravenous catheters are special medical instruments made in the form of a tube. Their main purpose is the introduction of various types of drugs, as well as the washing of vessels and various channels, the implementation of infusions. There are several other names by which these instruments may be known - PVVC or infusion cannulas. If patients need long-term and / or immediate infusion therapy, then it is usually the peripheral type of the instrument that is used - among other advantages, it allows you to transport the patient without fear that the needle will come out of the vessel.

About the instrument

Each catheter has the form of a tube and is equipped with a needle. The needle is inserted into the cavity of the human vein, and the fluid enters the human body through the tube. To avoid problems with fixation, the catheter is usually fixed to the skin either with suture material or with a conventional patch. The catheter can be inserted, as a rule, in the area of ​​​​the arms, neck or head. But in the area of ​​\u200b\u200bthe legs, it is not recommended to use such devices, otherwise there will be negative consequences.

Indications

There are several different situations in which an intravenous catheter is necessary. Here are the main ones:

1. emergency conditions in which the fastest possible access to the human bloodstream is required;
2. the need for transfusion of certain blood components;
3. conducting parenteral nutrition;
4. hyperhydration or simply hydration of the body;
5. the need for rapid and very accurate administration of the drug in the required concentration.

Variations

There are several different classifications of catheters. The first is based on rigidity - types are soft and hard.

Soft ones are made of PVC or rubber. They are used primarily for surgical or therapeutic purposes, when it is necessary to perform any action that will be aimed at improving the health / condition of the patient. To diagnose, more often used rigid catheters that are not very suitable for surgical purposes. In addition, plastic or rubber variations are more durable because metal is rarely used in this area.

Another classification is based on the type of veins into which catheters are inserted. There are two types:

• Arterial. As the name implies, they allow you to solve various medical problems related to the arteries.
• Venous. They allow you to get into the veins and carry out various procedures there.

You can classify catheters according to the type of application. There are those that are focused on exclusively short-term use. There are central peripheral ones that can be installed, for example, in the veins of the arms.

There may also be a catheter with an additional port. Such catheters are convenient because additional drug-type solutions can be administered without re-insertion of the needle, and therefore there will be no need for unnecessary tissue damage. If the catheter is not equipped with an additional port, then each time it is necessary to insert the needle again.

Ports - advantages and disadvantages

Many people think that models with an additional port are universally optimal, that you should not choose another - but there is a double opinion here. If there are no ports, then the price goes down and the chance of pollution becomes much less, so in many situations the simple option is much better. But when a model with an additional port is really needed, it's when a dropper is set up. For a dropper, a peripheral catheter with a port is almost always placed, since it is easier to repeatedly insert the needle without irritating the patient's skin.

Dimensions

It can be a little confusing to classify catheters by size. The fact is that they are not classified by typical centimeters or inches, they are measured in special units, Geich. To make it easier to distinguish between them, different sizes make different colors. For example, the maximum size is 2.0 by 24 mm, this is size 14. The most popular, perhaps, is the 18 size, which has dimensions of 1.3 by 45 mm. Size 18 are used very often for a variety of purposes. In addition to 18, a popular size is green, 87, which allows the transfusion of red blood cells at a rate of about 80 ml per minute.

There are many other sizes that should certainly be selected by the doctor based on the specific problem of the patient.

Application

How to use catheters - any trained nurse knows this. First, the injection site is treated, a tourniquet is applied there, which helps to fill the vein with blood. Next, the peripheral catheter is taken into the hand and inserted into the vessel. Of course, it must be precisely selected depending on the requirements imposed by the patient's condition, as well as in direct proportion to the presence / absence of a dropper. The correct material is selected, such as metal or plastic, and the size, such as 18 or 14. If the catheter's imaging chamber (its special section) fills with blood during insertion, then the insertion was successful. Next, fixation is carried out with a bandage or adhesive plaster - but the insertion site into the skin is not sealed, otherwise infectious phlebitis may develop. Finally, the inserted intravenous catheters are flushed, which avoids the formation of blood clots in the vessel where it is inserted.

Some more details on this topic in the video below:

Water for injection - liquid for diluting drugs Medical syringes: sizes and other characteristics Immunization Schedule for Adults - Vaccination Schedule

A urological catheter is a device in the form of a tube designed to evacuate urine from the urinary tract when its independent discharge is impossible or very difficult due to injury or disease. The main defining requirements for a urological catheter are atraumaticity, elasticity, strength, maximum biocompatibility, and chemical stability.

Materials for the manufacture of urological catheters

Silicone is one of the most widely used and researched materials for urinary catheters and has a number of features.

• Maximum biocompatibility.
• chemical inertness.
• Low surface tension.
• Chemical and thermal stability.
• The presence of hydrophobic properties.

Silicone has been used to make permanent and temporary catheters for over sixty years. This material does not cause local reactions and does not provoke the deposition of salts in the lumen of the catheter. Silicone elastomer is a thermosetting material capable of withstanding heat treatment at temperatures up to 230°C. The disadvantage of the elastomer is the relative high cost of production.

Latex is the sap of the rubber tree, stabilized by vulcanization (natural latex) or emulsion polymerization (synthetic latex). It is a highly elastic, durable, stable material. Latex contains proteins, lipids, inorganic salts. But it is the presence of proteins in the composition of latex that provokes the development of allergies when using its materials. Modern latex catheters are coated with silicone. The use of such a combination allows to preserve the physical properties of latex and the high biocompatibility of silicone, as a result, allergies are excluded while maintaining the high practicality of catheters.

Polyvinyl chloride is a thermoplastic synthetic material with chemical stability and inertness. Obtained by polymerization of vinyl chloride monomer. Possesses high flexibility, durability, chemical resistance. PVC is radiopaque. A significant advantage lies in the relatively low cost of production. The main disadvantage of PVC is the use of plasticizers in its production, such as DEHP, which makes the initially hard and brittle PVC elastic, flexible and durable. DEHP can be toxic and cause local inflammatory responses when using it for a long time. Therefore, PVC is considered an obsolete material for urinary catheters, giving way to newer polymers.

Brass is the metal used to make metal catheters. It was used for the manufacture of one-stage emptying of the bladder before operations and during childbirth. These days they are rarely used.

In addition to the material of manufacture of the catheter, its inner and outer coating plays an important role. Latex catheters coated with silicone to reduce allergization, local inflammatory reactions and salt precipitation in the catheter lumen. For longer life, silicone catheters are coated with silver plating, which extends their service life up to three months.

Types of urological catheters and indications for their use

According to the period for which they are installed, catheters are divided into:

• permanent;
• temporary.

According to the properties of the materials of manufacture, they are divided into:

• rigid, or rigid catheters (metal);
• soft catheters (rubber);
• semi-rigid catheters (made from different types of synthetic polymers).

According to the number of channels in the catheter body, these are:

• single-channel;
• two-channel;
• triangular catheters.

Depending on the catheterized organ, catheters are:

• urethral;
• ureteral catheters;
• catheters for the renal pelvis;
• bladder catheters.

Depending on the placement in relation to the body, external and internal are distinguished.

In addition to the above classification, catheters are divided into female and male. The main difference between male rigid urethral catheters and female ones is diameter and length: women's shorter and wider in diameter. Besides, women's catheters are straight and men's are curved, which is associated with the anatomical and physiological features of the male urethra (the presence of two S-shaped bends)

What types of catheters are the most common?

Pomerantsev-Foley catheter (Foley) designed for long-term catheterization of the bladder, and various manipulations.

A common characteristic of all varieties of the Foley catheter is the presence of a blind end with two holes. There is also an additional thin channel for inflating the rubber balloon at the end of the catheter, designed to fix the device in the bladder.

This type of catheter is used to perform a number of tasks.

• Diversion of urine.
• Removal of blood clots.
• Washing the bladder.

The introduction of a large amount of liquid (30-50 ml) into the balloon allows the use of a catheter to stop urethral bleeding. When draining the kidneys, 4-6 ml of liquid is injected into the balloon for fixation.

This catheter can also be of several varieties.

• two-way Foley catheter, a classic type of catheter that has a common channel for urination and bladder lavage and a channel for introducing fluid into the balloon.
• Three-way Foley catheter, in addition to the channel for urine and filling the balloon, it is equipped with a separate channel for the introduction of medicines into the cavity of the bladder.
• Two-way Foley catheter with Timman tip characterized by the presence of a coraco-shaped blind tip for more convenient catheterization of the male prostate in the presence of it
• Female two-way Foley catheter is distinguished by a smaller length than that of the male.
• Foley catheters for children smaller diameter for staging children or patients with pathology of the urethra.

Indications for the placement of this catheter are pathological processes, accompanied by a mechanical violation of the outflow of urine.

• Neoplasms of the prostate, bladder and ureter.
• Benign prostatic hyperplasia.
• Scars after injuries of the urethra.
• Swelling of the urethra due to inflammation.

Also, patients who do not consciously control urination are subject to catheterization.

• Patients in a coma.
• Patients with acute disorders of cerebral circulation.
• With spinal injuries.
• During general anesthesia.

The timing of catheter placement depends on the materials of manufacture or coating.

• Silicone catheters can remain in the bladder for up to 30 days.
• Latex with silicone coating - up to 7 days.
• When the catheter is coated with silver, the period of use is up to 90 days.

Nelaton catheter is a straight rubber or polymer catheter with a rounded end and two draining side holes in the terminal part. It has a smaller hole diameter compared to silicone catheters. Previously installed for long-term use by stitching to the genitals. After the invention of the Foley catheter, it is no longer used as a permanent catheter.

It is used for intermittent (periodic) catheterization of the bladder when it is impossible to urinate independently.

Robinson catheter similar to Nelaton's catheter.

Nelaton's catheter Timman's end has the characteristics of the above-described catheter with a curved end for convenient catheterization of patients with prostate adenoma.

Timman catheter (Mercier) is an elastic urethral catheter with a curved end, intended for catheterization in the presence of benign prostatic hyperplasia. It has two lateral holes near the tip and one channel for drainage.

is a rubber catheter with a dish-shaped tip and two or three holes. Designed for permanent catheterization. It is used to drain urine through, if it is impossible to divert it physiologically.

What are the disadvantages of a catheter?

• The small diameter of the channel, which contributes to its blockage.
• The possibility of tearing off the cap of the catheter when it is withdrawn.
• The absence of divisions, which makes it difficult to set it up.

Malekot catheter similar in structure and purpose to the Pezzer catheter.

Pusson's catheter- This is a straight rubber tube with three holes at the curved beak. The beak itself is made of very elastic rubber, as a result of which it twists into a spiral. For insertion into the bladder, a metal probe is inserted inside to straighten the catheter. After setting the probe is removed, the beak acquires its original shape, thus fixing in the bladder. It has only historical value.

Mazhbitsa catheter- a rubber tube with a length of 60 cm. A rubber plate for external fixation is located at a distance of 8 cm from the tip. Three holes in the catheter facilitate rapid evacuation of urine(now no longer in use).

Davol catheter is a trocar catheter for evacuation of urine by cystostomy.

ureteral catheter - a long tube with side holes, made of radiopaque material (PVC), is intended for catheterization of the ureter and renal pelvis for the purpose of drainage and administration of medications. The length of the catheter is 70 cm. It is installed using a cystoscope. The kit contains two catheters with different color markings, red for the right ureter, blue for the left.

At the present time, metal catheters are used extremely rarely, more often - in case of impossibility of setting an elastic one.

When choosing a catheter for bladder drainage, one should proceed from the main parameter - how long the catheter will be in the bladder.

• If catheterization is carried out at the same time, then it will be more relevant to use Nelaton's catheter or a metal catheter.
• For short-term drainage of urine in a hospital, use silicone coated latex catheters, which can be in the lumen of the bladder up to 10 days.
• If, in addition to the evacuation of urine, there is a need to inject drugs into the bladder, then use three-channel Foley catheters.
• If you need a permanent drainage of urine, then use catheters with a special coating (silver) Foley type.

If it is impossible to divert urine in a physiological way, a cystostomy is performed with the placement of a Pezzer catheter.

Well-known manufacturers and approximate cost of urological catheters

Which firms are the most popular manufacturers of catheters in our time?

• Apexmed
• Unomedical
• Coloplast
• TROGE MEDICAL
• CERTUS
• COVIDENT

The price range is very extensive, it directly depends on the manufacturer, the type of catheter and the material of manufacture.

Foley catheter, the most common and popular type of catheters. The purchase price of this device varies from 200 rubles to 4000 rubles. It all depends on the number of internal channels, the material of manufacture and coating.

It is used to diagnose and eliminate pathologies of the urinary tract, as well as to carry out the necessary medical manipulations. This device makes it possible to catheterize the bladder for quite a long time - up to seven days. In modern medicine, the silver-plated Foley catheter is increasingly used, which significantly reduces the risk of infection due to the silver content. This tool is simply indispensable in cases where the body cannot independently excrete urine. When transporting a patient in serious condition, especially in neurosurgical and oncological diseases, as well as after serious injuries, a Foley catheter is used, the instructions for which are quite simple and contain all the necessary recommendations.

Rules for inserting a catheter

In order not to injure the patient and not cause him pain, specially trained medical personnel should perform catheterization. For the correct insertion of the instrument, the patient should be laid down, and the skin around the urethral opening should be treated with a disinfectant solution. After that, a special tube must be slowly and carefully pushed to the bladder, where it will be held with a small bottle of water. After such manipulations, it is necessary to attach the Foley catheter to the bag where the urine will drain, and attach it to the patient's bed or clothes.

When using a catheter, the following hygiene rules must be observed:

Wash your hands thoroughly;

Treat the injection site daily;

Flush the tube after each urination;

Monitor the dryness of the genitals;

Daily give the patient to drink up to one and a half liters of liquid;

Avoid kinks and fractures of the tube;

Fix the container for collecting urine below the patient's waist.

Changing the used package

The Foley catheter is convenient in that the container for urine can be used repeatedly, however, it is necessary to carefully monitor its fullness. Next, consider the algorithm for the correct change and processing of the bag for collecting liquid. After the patient has defecated, it is necessary to disconnect the catheter tube from the filled container. The bag should be washed with water, treated with an aqueous vinegar solution and dried. Before connecting a clean container to the catheter tube, the latter must be wiped with alcohol to prevent possible infection. After making sure that the tube is firmly connected to the bag, it is necessary to open a special clamp that ensures the unhindered passage of urine. It is recommended to store liquid collection containers in dry paper bags until next use. It must be remembered that only a specialist with a medical education and the appropriate skills to perform such procedures can change and remove a Foley catheter. In case of non-compliance with these rules, quite serious and dangerous complications may develop, the elimination of which will take a long time.

Venous catheters are widely used in medicine for the administration of drugs, as well as for blood sampling. This medical instrument, which delivers fluids directly into the bloodstream, avoids multiple vein punctures if long-term treatment is required. Thanks to him, you can avoid injury to blood vessels, and consequently, inflammatory processes and thrombosis.

What is a venous catheter

The instrument is a thin hollow tube (cannula) equipped with a trocar (a hard pin with a sharp end) to facilitate its introduction into the vessel. After the introduction, only the cannula is left through which the drug solution enters the bloodstream, and the trocar is removed.

Before staging, the doctor conducts an examination of the patient, which includes:

• venous ultrasound.
• Chest x-ray.
• Contrasting phlebography.

How long does the installation take? The procedure lasts on average about 40 minutes. Insertion site anesthesia may be required when inserting a tunneled catheter.

The rehabilitation of the patient after the installation of the instrument takes about one hour, the sutures are removed after seven days.

Indications

A venous catheter is necessary if intravenous administration of drugs is required for long courses. It is used in chemotherapy in cancer patients, in hemodialysis in people with renal insufficiency, in the case of long-term antibiotic treatment.

Classification

Intravenous catheters are classified in many ways.

By appointment

There are two types: central venous (CVC) and peripheral venous (PVC).

CVCs are intended for catheterization of large veins, such as subclavian, internal jugular, femoral. Medicines and nutrients are administered with this instrument, and blood is taken.

PVC is installed in peripheral vessels. As a rule, these are the veins of the extremities.

Convenient butterfly catheters for peripheral veins are equipped with soft plastic wings with which they are attached to the skin

"Butterfly" is used for short-term infusions (up to 1 hour), because the needle is constantly in the vessel and can damage the vein if left for longer. Usually they are used in pediatrics and outpatient practice when puncturing small veins.

By size

The size of venous catheters is measured in Geich and is denoted by the letter G. The thinner the instrument, the larger the Geich value. Each size has its own color, the same for all manufacturers. The size is selected depending on the application.

By models

There are ported and non-ported catheters. Ported ones differ from non-ported ones in that they are equipped with an additional port for the introduction of liquid.

By design

Single channel catheters have one channel and end with one or more holes. They are used for periodic and continuous administration of medicinal solutions. They are used both in emergency care and in long-term therapy.

Multichannel catheters have from 2 to 4 channels. It is used for the simultaneous infusion of incompatible drugs, sampling and monitoring of hemodynamics, for visualization of the structure of blood vessels and the heart. They are often used for chemotherapy and long-term administration of antibacterial drugs.

By material

This is a long tube that is inserted into a large vessel to transport medicines and nutrients. There are three access points for its installation: internal jugular, subclavian and femoral vein. Most often, the first option is used.

When a catheter is inserted into the internal jugular vein, there are fewer complications, less pneumothorax, and it is easier to stop bleeding if it occurs.

With subclavian access, the risk of pneumothorax and damage to the arteries is high.

With access through the femoral vein after catheterization, the patient will remain immobile, in addition, there is a risk of infection of the catheter. Among the advantages, one can note an easy entry into a large vein, which is important in case of emergency assistance, as well as the possibility of installing a temporary pacemaker

Kinds

There are several types of central catheters:

• peripheral central. They drive through a vein in the upper limb until it reaches a large vein near the heart.
• Tunnel. It is injected into a large cervical vein, through which blood returns to the heart, and is excreted at a distance of 12 cm from the injection site through the skin.
• Non-tunnel. It is installed in a large vein of the lower limb or neck.
• Port catheter. Injected into a vein in the neck or shoulder. The titanium port is placed under the skin. It is equipped with a membrane that is pierced with a special needle through which liquids can be injected for a week.

Indications for use

A central venous catheter is placed in the following cases:

• For the introduction of nutrition, if its intake through the gastrointestinal tract is impossible.
• With the behavior of chemotherapy.
• For the rapid administration of large volumes of solution.
• With prolonged administration of liquids or drugs.
• With hemodialysis.
• In case of inaccessibility of the veins in the arms.
• With the introduction of substances that irritate the peripheral veins.
• During blood transfusion.
• With periodic blood sampling.

Contraindications

There are several contraindications to central venous catheterization, which are relative, therefore, according to vital indications, the CVC will be installed in any case.

The main contraindications include:

• Inflammatory processes at the injection site.
• Violation of blood clotting.
• Bilateral pneumothorax.
• Collarbone injuries.

Introduction order

Places a central catheter or interventional radiologist. The nurse prepares the workplace and the patient, helps the doctor put on sterile overalls. To prevent complications, not only installation is important, but also care for it.

After installation, it can stand in a vein for several weeks and even months.

Before installation, preparatory measures are necessary:

• find out if the patient is allergic to drugs;
• conduct a blood test for clotting;
• stop taking certain drugs a week before catheterization;
• take blood-thinning medications;
• find out if you are pregnant.

The procedure is carried out in a hospital or on an outpatient basis in the following order:

1. Hand disinfection.
2. Choice of catheterization site and skin disinfection.
3. Determining the location of the vein by anatomical features or using ultrasound equipment.
4. Administration of local anesthesia and incision.
5. Reducing the catheter to the required length and rinsing it in saline.
6. Guiding the catheter into the vein with a guidewire, which is then removed.
7. Fixing the instrument on the skin with adhesive tape and placing a cap on its end.
8. Applying a dressing to the catheter and applying the insertion date.
9. When a port catheter is inserted, a cavity is formed under the skin for its placement, the incision is sutured with an absorbable thread.
10. Check the injection site (does it hurt, is there any bleeding and fluid discharge).

Care

Proper care of the central venous catheter is very important to prevent purulent infections:

• At least once every three days, it is necessary to treat the opening of the catheter and change the bandage.
• The junction of the dropper with the catheter must be wrapped with a sterile napkin.
• After the introduction of the solution with sterile material, wrap the free end of the catheter.
• Avoid touching the infusion set.
• Change infusion sets daily.
• Do not kink the catheter.

An x-ray is taken immediately after the procedure to make sure the catheter is properly placed. The puncture site should be checked for bleeding, the catheter port should be flushed. Wash your hands thoroughly before touching the catheter and before changing the dressing. The patient is monitored for infection, which is characterized by such signs as chills, swelling, induration, redness of the catheter insertion site, and fluid discharge.

• Keep the puncture site dry, clean and bandaged.
• Do not touch the catheter with unwashed and undisinfected hands.
• Do not bathe or wash with the instrument installed.
• Don't let anyone touch him.
• Do not engage in activities that could weaken the catheter.
• Check the puncture site daily for signs of infection.
• Flush the catheter with saline.

Complications after the installation of the CVC

Catheterization of the central vein can lead to complications, including:

• Puncture of the lungs with accumulation of air in the pleural cavity.
• Accumulation of blood in the pleural cavity.
• Puncture of an artery (vertebral, carotid, subclavian).
• Embolism of the pulmonary artery.
• Misplaced catheter.
• Puncture of the lymphatic vessels.
• Catheter infection, sepsis.
• Cardiac arrhythmias during catheter advancement.
• Thrombosis.
• Nerve damage.

peripheral catheter

A peripheral venous catheter is placed according to the following indications:

• Inability to take liquid orally.
• Transfusion of blood and its components.
• Parenteral nutrition (introduction of nutrients).
• The need for frequent injection of drugs into the vein.
• Anesthesia during surgery.

PVK cannot be used if it is required to inject solutions that irritate the inner surface of the vessels, a high infusion rate is required, as well as when transfusing large volumes of blood

How veins are chosen

A peripheral venous catheter can only be inserted into peripheral vessels and cannot be placed into central ones. It is usually placed on the back of the hand and on the inside of the forearm. Vessel selection rules:

• Well-visible veins.
• Vessels that are not on the dominant side, for example, for right-handed people, should be selected on the left side).
• On the other side of the surgical site.
• If there is a straight section of the vessel corresponding to the length of the cannula.
• Vessels with a large diameter.

You can not put PVC in the following vessels:

• In the veins of the legs (high risk of thrombus formation due to low blood flow velocity).
• On the places of the bends of the arms, near the joints.
• In a vein close to an artery.
• In the middle elbow.
• In poorly visible saphenous veins.
• In weakened sclerosed.
• The deep ones.
• on infected areas of the skin.

How to put

Placement of a peripheral venous catheter can be performed by a qualified nurse. There are two ways to take it in your hand: longitudinal grip and transverse. The first option is more often used, which allows you to more securely fix the needle in relation to the catheter tube and prevent it from going into the cannula. The second option is usually preferred by nurses who are accustomed to puncturing a vein with a needle.

Algorithm for placing a peripheral venous catheter:

1. The puncture site is treated with alcohol or an alcohol-chlorhexidine mixture.
2. A tourniquet is applied, after filling the vein with blood, the skin is pulled tight and the cannula is set at a slight angle.
3. A venipuncture is performed (if there is blood in the imaging chamber, then the needle is in the vein).
4. After the appearance of blood in the imaging chamber, the advancement of the needle stops, it must now be removed.
5. If, after removing the needle, the vein is lost, re-insertion of the needle into the catheter is unacceptable, you need to pull out the catheter completely, connect it to the needle and reinsert it.
6. After the needle is removed and the catheter is in the vein, you need to put a plug on the free end of the catheter, fix it on the skin with a special bandage or adhesive plaster and flush the catheter through the additional port if it is ported, and the attached system if it is not ported. Flushing is necessary after each fluid infusion.

Care for a peripheral venous catheter is carried out approximately according to the same rules as for the central one. It is important to observe asepsis, work with gloves, avoid touching the catheter, change plugs more often and flush the instrument after each infusion. It is necessary to monitor the bandage, change it every three days and do not use scissors when changing the bandage from the adhesive tape. The puncture site should be carefully monitored.

Although peripheral venous catheterization is considered less dangerous than central venous catheterization, unpleasant consequences are possible if the installation and care rules are not followed.

Complications

Today, the consequences after the catheter occur less and less, thanks to improved models of instruments and safe and low-traumatic methods for their installation.

Of the complications that can happen, the following can be distinguished:

• bruises, swelling, bleeding at the insertion site of the instrument;
• infection in the area of ​​​​the catheter;
• inflammation of the walls of the veins (phlebitis);
• thrombus formation in a vessel.

Conclusion

Intravenous catheterization can lead to various complications, such as phlebitis, hematoma, infiltration, and others, so you should strictly follow the installation technique, sanitary standards and rules for caring for the instrument.

Catheterization of the urethra is a manipulation, the essence of which is that a hollow tube is inserted into its cavity, reaching the bladder. As a result, there is an outflow of urine. This procedure is performed for various diseases of the genitourinary system, including emergency measures for the evacuation of accumulated urine. Catheterization is carried out in men and women by experienced personnel, the introduction of the catheter provides for compliance with all the regulations that exclude the occurrence of associated infections.

Indications and contraindications for the procedure

The catheter belongs to an invasive type of medical device, its use is justified in emergency conditions, characterized by the complete impossibility of evacuating urine. Sometimes the placement of a catheter is prescribed for preventive action.

Main indications for bladder catheterization:

• emergency conditions (urinary retention caused by prostate adenoma, paresis of the bladder, the formation of blood clots and pus, adenocarcinoma, the impossibility of emptying the bladder due to a nervous condition);
• diseases of the bladder and urethral canal associated with the washing procedure and the introduction of special solutions into their cavity;
• diagnostic factor (obtaining cystic urine without inclusions is required).

Typical contraindications for catheter invasion:

• acute urethritis, including gonorrheal type;
• injuries of the bladder and urethral canal;
• contracted sphincter.

Types of urethral catheters

All these devices for emergency bladder drainage are divided into two main types:

• elastic probes (made of special rubber, flexible plastic or silicone);
• rigid probes (made of non-ferrous metal alloys).

According to their design features, drainage devices are divided into the following types:

• Robinson (Nelaton) catheter- the simplest option, the direct type, is intended for short-term and uncomplicated cases of taking the patient's urine;
• Tiemann system catheter– designed for complicated invasions, as a rule, in cases of prostate adenoma or stenosis of the urethral canal, has a rigid curved tip that allows passage;
• Foley catheter- is a flexible device that has a special balloon, with which the device is held, the balloon is also used to stop bleeding from the location of prostate adenoma after its removal;
• petzer system catheter- it is used less frequently, mainly for cystostomy drainage (in the form of a separate tube that bypasses the urethral canal and goes outside).

All device options have their own dimension, usually characterizing their diameter. This allows you to choose the right drainage system and exclude traumatic cases in the urethra or eliminate blockage of the tubes with a small diameter.

In each individual case, the probe system is selected by the attending physician. So there are devices for temporary use and permanent. For example, Foley drainage devices are designed to be worn all the time. The method of invasion of the device is also taken into account. Some probes allow self-draining, others are only intended for installation by experienced personnel.

Metal catheters look like a slightly curved tube, used in very difficult cases of drainage, when it is impossible to use elastic analogues. Drainage is carried out only by an experienced specialist.

Insertion technique

Catheterization methods differ depending on the type of device and the difference in the structure of the genitourinary system of men and women. There is a certain technique for carrying out this manipulation in women and men.

Insertion procedure for a flexible specimen catheter for women includes the following activities:

• hands are thoroughly washed and treated with a disinfectant (chlorhexidine or ethyl alcohol), gloves are put on;
• sterile vaseline and glycerin are applied to the end of the catheter (sterile lubricants are allowed);
• the external genitalia and the anus are washed away;
• the woman is laid on her back, her legs are bent at the knees and parted;
• with the left hand, the outer labia are moved apart and the opening of the urethra is washed with a solution of furacilin;
• the probe is taken with the right hand and inserted into the urethra with the help of alternate rotation, the approximate insertion depth is 5 cm;
• the appearance of urine at the opposite end of the device is a signal to stop movement.

If it is required to flush the bladder, then after the end of urine output, the catheter is connected to a special syringe (according to the Janet principle). The syringe should contain furatsilin (temperature 37 C). When the drainage end is connected to the syringe, the solution is injected into the bladder. Having lowered the drainage end into the container, they wait for the complete release of the flushing liquid. The operation can be repeated. After removing the catheter, the urethra is treated with furacilin.

The technique for introducing a metal drainage tube is performed in a similar way.

Execution procedure catheterization in men is performed as follows:

• hands are washed and treated with an antiseptic preparation (chlorhexidine or others);
• the patient is washed away, lies on his back, spreads his legs at the knees;
• the penis is treated with furatsilin;
• the surface of the catheter is lubricated with a sterile lubricant (Vaseline, glycerin);
• an elastic catheter of the required diameter is inserted into the external opening of the urethra, for this, with the foreskin retracted, the penis is slightly squeezed in the region of the vein groove, and the tissues of the head are pulled down, trying to expand the urethral canal;
• the doctor starts the device further, slightly rotates the body of the elastic tube, facilitating its movement;
• the appearance of urine from the drainage end indicates the correctness of this procedure;
• after precise adjustment of the probe, they connect and fix it with the urinal (for permanent wear).

The main problems of male catheterization are that their urethra is longer than that of women, the anatomical structure has its own characteristics.

The narrowest point is the border of membranous and cavernous tissues. Sometimes the problem occurs during the overcoming of the sphincter of the bladder. The patient himself can play a decisive role in this - the ability to relax the sphincter facilitates the process of introducing drainage.

A metal catheter is inserted only by a qualified doctor, as this is a complex process that has its own characteristics. Usually, with the invasion of metal drainage, the following manipulations are performed:

Complications

A frequent complication of bladder catheterization is the introduction of infection, including nosocomial. Ascending routes of infection often lead to inflammation of the urethra. Prolonged stay of the probe in the urethral canal causes damage to the mucous membrane. To prevent the spread of microbial flora, it is necessary to periodically flush the drainage with furatsilin.

It is advisable to use an appropriate insertion tube diameter, as a large diameter may cause urethral abscess or enlargement in women.

The likelihood of complications increases dramatically if sanitary-hygienic and disinfection measures are not observed during the insertion of the probe. With existing infections of the genitourinary system, there is a risk of developing a secondary infection, against the background of a weakened immune system.

The urine receiver should always be below the level of the bladder, emptying it every 7-8 hours. The receiver valve must be washed and dried periodically. The internal cavity of the urinal should be periodically washed out and treated with chlorine bleach.

Probe removal process

The removal of the catheter takes place in consultation with the attending physician. In some cases, you can do it yourself. If the device is equipped with a fixing balloon, then for this it is necessary to pump out water with a syringe, after which the drainage system is removed. You can also empty the balloon by cutting the tube in a special place. If for some reason the patient is not morally ready to carry out such manipulations on his own, there is no need to force such attempts, as this can lead to urethral injuries or infection.

Short-term probes of the Robinson system, patients, in most cases, remove themselves, after receiving the necessary consultations.

For successful catheterization of men and women, key factors that affect the insertion and subsequent use of the probe must be observed, which are:

• sterility of the material and the necessary instruments;
• correct selection of the tube diameter on a special scale;
• ability and skills in setting up a metal probe;
• periodic sanitation of all objects in contact with the urethra.

If the above factors are observed, then the likelihood of complications or mechanical damage to the tissues of the urethra and bladder is reduced to a minimum.