Indications

1
Indications

• Empty bladder prior to surgery
• Determine residual urine
• Irrigate bladder
• Bypass obstruction
• Relieve retention
• Introduce cytotoxic drugs
• Enable bladder function tests

2
Indications -cont

• Accurate measurement of urine output
• Relieve incontinence
• Empty bladder prior to childbirth

3
Catheter Selection

• 2 way catheter-urine balloon inflation
• 3 way catheter for irrigation
• 1 channel catheter for intermittent irrigation

4
Balloon Size

• 30ml balloon catheter designed by Frederick Foley
  in 1920s to tamponade haemorrhage after
  prostatectomy.
• 30ml catheter found to leak and cause damage to
  the neck of the bladder.
• 5-10ml catheter recommended for adults and 3-5ml
  balloon for children

5
Balloon Size - cont.

• Too much fluid in the balloon may occlude eye of
  catheter or irritate and traumatise bladder.

6
Catheter Size

• Size measured in Charrieres(Ch.) named after
  French physician.
• The charrierre is the outer circumference of the
  catheter in millimetres and is equal to 3 times
  the diameter.
• Large gauge catheters may cause
• pain
• discomfort

7
Catheter size - Cont.

• Pressure ulceration and stricture
• Retraction of urethral wall
• Abcess formation
• The smallest size catheter necessary to maintain
  adequate drainage should be chosen.e.g. size 12
  for an adult female
• Larger catheters should be used if debris or
  clots are present

8
Length of catheter

• Until 1979 only one length available 41-45cm.
• A shorter catheter 20-25cm.is now available for
  women
• Shorter catheter more discreet and less likely to
  kink and become infected

9
Length of Use

• Short term 1-14 days
• Short to medium term 2-6 weeks
• Medium to long term 6 weeks to 3 months

10
Tip design

• Tieman tip- has curved tip with 2-3 drainage eyes
  to facilitate greater drainage and to negotiate
  urethra with prostatic hypertrophy
• Whistle tip catheters- has lateral eye and eye
  above balloon to provide large drainage and
  facilitate drainage of clots and debris

11
Tip Design - cont.

• Roberts Catheter- has eye above and below the
  balloon to facilitate drainage of residual urine

12
Catheter Material

• PVC -quite rigid, with wide lumen, allows rapid
  flow of urine - used mainly for intermittent
  catheterisation
• Latex- purified rubber can cause urethral
  irritation and allow crust formation- suitable
  for short term use only. Anaphylaxis a risk.
• Ask patient if allergic to latex

13
Catheter Material - cont.

• Teflon or silicone elastomer coated- latex coated
  to reduce risk of irritation.- suitable for short
  to medium term use
• All Silicone- inert material less likely to cause
  irritation- not coated so have wider lumen. Some
  have D shaped lumen which increases risk of
  encrustation - suitable for long term use.

14
Catheter Material cont.

• Hydrogel Coatings- Inner core of latex covered
  with hydrophilic polymer less risk of urethral
  irritation. Become very smooth on rehydration
  reducing friction
• Recommended for long term use

15
Anaesthetic Lubricating Gel

• Always used for male catheterisation
• In females usually applied to catheter before
  insertion

16
Drainage bags

• Single drainage
• Urimeter
• Leg bags
• Infection enters when circuit broken
• Change bag 5-7 days using clean technique and
  gloves

17
Catheter Care

• Wash urethral meatus twice a day with clean soap,
  water and clean disposable cloth
• Take specimens from rubber cuff only
• Only empty bag when full
• Empty bag wearing gloves
• Use clean or disposable container
• Ensure tap does not touch container

18
Catheter Care cont.

• Empty urine immediately after collection
• Never collect more than one patients urine in one
  container
• Cleanse tap with alcohol after draining bag
• Ensure tap never touches the floor
• Never lift urine bag higher than bladder
• Ideally use free standing bag holders

19
Male hygiene

• Retract foreskin when cleansing

20
Catheter Valves

• Eliminate need for drainage bags

21
Infection

• Faulty aseptic technique during insertion
• Faulty technique when handling catheter tubing
  and equipment
• Sened sample to Lab inform medical staff

22
No/Poor Urine drainage

• Incorrect placement
• Check placement
• Blockage - ? bladder washout
• Poor renal function- check BP fluid status

23
Patient Discomfort

• Incorrect size - try smaller
• Patient allergic to catheter - change to low
  irritant catheter
• Trauma on insertion - analgesia

24
Male Problems

• Paraphimosis - Failure to retract foreskin during
  cleansing
• Crust around urethral meatus - inadequate
  cleansing/ increased secretions

25
Leaking urine

• Incorrect size of catheter - replace with size
  2Ch smaller
• Incorrect balloon size- select 10ml balloon.
• Bladder irritablity - try roberts catheter
• Diazepam or anticholinergic drugs

26
Unable to Deflate Balloon

• Put in 3ml more water and try again
• Aspirate above valve with needle and syringe
• Inform doctor

27
Post removal

• Retention- Increase fluid intake try running
  water, warm bath - inform doctor
• Infection- drink 2-3 litres of fluid a day, send
  specimen to lab. Inform medical staff