Makindo Medical Notes.com

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• Latex are short term, more expensive silicone long term
• Avoid if pelvic trauma without specialist approval
• Often Gentamicin 80 mg IV is given prior but not evidenced
• Size 12 is smallest, size 16 large and size 20 is for irrigation
• Insert smallest catheter for shortest time usually
• Always pull back the foreskin in uncircumcised males post procedure

Indications for Short-term catheterization (latex)

• Gynaecological/Urologic surgery
• Surgery on contiguous structures
• Critically ill patients requiring an accurate measurement of urinary output
• Acute urinary retention

Indications for Long-term catheterization (Silicone)

• Bladder outlet obstruction not correctable medically or surgically
• Intractable skin breakdown caused or exacerbated by incontinence
• Some patients with neurogenic bladder and retention
• Palliative care for terminally ill or severely impaired incontinent patients for whom bed and clothing changes are uncomfortable
• Preference of a patient who has not responded to specific incontinence treatments

Alternatives to indwelling urinary catheter consider if these alternatives would be more appropriate

• Bedside commode, urinal, or continence garments: to manage incontinence.
• Bladder management through the use of a bladder scanner: to assess and confirm urinary retention, prior to placing catheter to release urine.
• Straight catheterization: for one-time, intermittent, or chronic voiding needs.
• External conveen "condom" catheter: appropriate for cooperative men without urinary retention or obstruction.

Contraindications for catheterization

• Pelvic fracture and concerns that urethra damaged - may be blood at meatus
• Acute prostatitis

Complications of long-term catheterization include

• Chronic renal inflammation, Chronic pyelonephritis
• Nephrolithiasis, Cystolithiasis
• Symptomatic urinary tract infection with pyelonephritis
• Bacteremia, sepsis and death

Intermittent Self-Catheterization

• Intermittent catheterization may be preferable to chronic indwelling catheterization in certain patients with bladder-emptying dysfunction.
• It has become the standard of care in patients with spinal cord injuries.

Steps in Performing Clean Intermittent Self-Catheterization

• 1. Wash hands and catheter with soapy water.
• 2. Rinse hands and catheter with tap water.
• 3. Self-catheterize (without gloves).
• 4. After use, wash reusable catheter with soapy water, rinse and store in ventilated container until dry.
• 5. Place in plastic zipper bag or another clean container.

Urethral VS. Suprapubic catheters

• Suprapubic catheters are recommended by some physicians for short-term use when a catheter is needed for gynecologic, urologic and other surgeries
• Theoretically, there are fewer microbes on the abdominal wall than on the perineum, creating less risk for infection. Another advantage is easier catheter changes.
• Suprapubic catheters can also be clamped to test for adequate voiding. Some patients might also prefer a suprapubic catheter to enhance self-image and sexual functioning. Other patients prefer its comfort and convenience.
• Disadvantages of suprapubic catheters include the risk of cellulitis, leakage, hematoma at the puncture site, prolapse through the urethra and the psychological barrier of insertion through the abdominal wall.

Choice of Catheter

• For urinary drainage select the smallest gauge catheter possible usually 12Ch for a female, or 12-14Ch for a male, with a 10ml balloon. Smaller gauge catheters minimise the risk of urinary trauma and residual urine volumes, which pre-dispose to UTIs. Occasionally patients with urological conditions may require a larger gauge catheter and balloon. Larger sizes may cause pain and discomfort, pressure ulceration, blockage of the para urinary ducts and abscess formation and should only be used following a recommendation by Urology.

Choice of Catheter Plan

• Drainage bags / Valves: Drainage bags may be body-worn, i.e. leg bag, or free standing. There should be effective fixation of the catheter and drainage bag to prevent trauma. Maintenance of a closed system is essential to prevent infection.
• Two-litre drainage bags should be added for overnight drainage in patients with body-worn (leg bag) systems using a no-touch Clean Technique. Body-worn (leg bag) systems should be changed weekly (or in line with the manufacturer’s instructions) (Appendix 7)
• A catheter valve may be used as an alternative to free drainage system. The valve is attached directly to the catheter using a no-touch technique and is changed weekly.
• Intermittent bladder drainage can be achieved by the use of a catheter valve or intermittent catheterisation as these allow the bladder to expand to store urine and contract to empty, therefore maintaining the muscular effect, stimulate blood supply and maintain normal bladder health (RCN 2012). A valve cannot be used if the patient has cognitive impairment or impaired renal function.

No Urine Drainage. This may be due to:

• Kinked tubing, Constipation
• Drainage bag positioned above waist level
• General condition - is patient dehydrated or in renal failure - consider fluid challenge and medical review. Check NEWS
• Catheter not in urethra
• Catheter not the correct length (obese female patients may require a standard length catheter as a female length may to too short)
• Encrustation and blockage - see below
• Perform a bladder scan if available to see if urine is present in the bladder

Catheter Bypassing

• Catheters bypass for the following reasons and it is important to ascertain what the cause of the problem is as each will be dealt with in a different way:
• Encrustation and blockage - see below
• Twisted tubing - change position of tubing. If using a leg bag, is a shorter length tube required?
• Constipation - relieve constipation, give fluid and dietary advice.
• Bladder spasm - common within the first 24 - 48 hours after catheterisation, if it persists consider if the patient still needs to be catheterised, check the size and balloon size of the catheter as reducing the size of these may help, consider anticholinergic medication if the problem persists as it may be due to bladder spasm.
• Bladder calculi - is possible in patients who have a long-term catheter. This will need to be confirmed by x-ray/cystoscopy.

Catheter Blockage

• Change catheter and inspect catheter tip for signs of debris or encrustation and document in patient records. If an in-patient was catheterised prior to admission contact the District Nurse and enquire about management.
• Maintain a record of catheter changes to see if a pattern emerges. Consider pre-emptying blockage and changing the catheter prior to blockage if a pattern of catheter life is clear.
• Causes of Blockage
  • Recurrent blockage is a common problem that occurs in 40-50% of long-term catheters. There are a number of factors that can contribute:
    • Constipation
    • Infection
    • Kinked tubing
    • The mucosa of the bladder can get drawn into the eyes of the catheter by a build-up of suction within the catheter
    • Debris
    • Bladder stones
    • Encrustation
• Management of Catheter Blockage: When a catheter blocks a full assessment of the catheter history must be carried out. This should include
  • Fluid intake
  • Suspected bladder spasms or stones
  • Constipation
  • Kinked tubing
  • Urinary tract infection
  • How often the catheters have been changed
  • Type and size of catheter, balloon size
  • Colour, smell, appearance of the urine
  • Encrustation on the outside and/or inside of the catheter tip (catheter to be cut open and examined

Problems:Bladder spasms

• Bladder spasms feel like abdominal cramp and are quite common when you have a catheter in your bladder. The pain is caused by the bladder trying to squeeze out the balloon.
• If you are unable to tolerate this sensation, your GP can prescribe a drug such as Oxybutynin, Solifenacin or Tolterodine which stops the cramps.
• Anticholinergic drugs can also affect cognition and should be used with caution

Blood or debris in the urine

• This is common with a catheter. Look for UTI symptoms and signs and treat if present. May be exacerbated by anticoagulants which can be reviewed.
• It is only of concern if you see large clots or solid pieces of debris passing down the catheter.
• If this happens, please contact your Nurse Practitioner for advice as this may cause a blockage.

Failed Trial without catheter

• Remove catheter early morning best when constipation resolved and mobility improved
• Insert long term silicone catheter
• Consider alpha blocker
• Referral to urology TWOC clinic