All You Should Know About Urinary Catheterisation

A urinary catheter is a hollow and partially flexible tube that is used to empty the urinary bladder and collect urine in a drainage bag. This procedure is known as Urinary Catheterisation. It is made up of different materials like rubber, plastic (PVC), and silicone. It is inserted either by a doctor or nurse. There are two methods by which a urinary catheter is inserted in the body It is inserted either through the tube that carries out of the bladder. It is known as a Urethral catheter. Another method is through a small opening made above the pubic region.

Why Urinary Catheterisation is used?

Catheters are used to empty the bladder. If the bladder is not empty properly urine build up and leads to pressure in the kidneys. If the pressure is built for a long time it causes kidney failure. It, later on, cause permanent damage to the kidneys.

Urinary catheters are used:

There are two purposes for which catheters are used-

When people have difficulty in urination naturally.

It is used to empty the bladder before or after surgery and it helps to perform certain tests.

Conditions for which Urinary Catheterisation is necessary

  • After pelvic surgery.
  • Blood clots in the urine.
  • Dementia (loss of memory).
  • For the severely impaired and terminally ill patients.
  • Hysterectomy.
  • If a patient has weakness either in the urinary bladder itself or in the nerve. This will affect a person’s ability or pass urine.
  • It is given at the time of childbirth when there is a need to empty the bladder. The patient is not able to pass urine because of an epidural anesthetic.
  • It is given in case of surgery.
  • It is given when the doctor wants to deliver medicines directly to the bladder in conditions like chemotherapy for bladder cancer.
  • It is said to be the last available option in untreatable cases of urinary incontinence.
  • It is used in conditions where there is obstruction and free flow of urine is restricted. E.g.- Prostate enlargement.
  • Kidney stones.
  • Medicines that impair the ability of bladder muscles to squeeze. It causes urine to remain stuck in the bladder.
  • Severe large of the prostate gland.
  • Spina bifida.
  • Spinal cord injury.
  • Surgery in the genital area as seen in hip fracture repair.
  • To monitor the urinary output of critically ill patients and it is used after surgery.
  • To take sterile urine sampling for culture.

Types of Urinary Catheter

Two main varieties are used are given below:

Intermittent catheters

They are temporary types. They are removed once the bladder is empty.

Indwelling catheters (Other names- Urethral catheter, Suprapubic catheter, Foley catheter)

These remain in place for many days or weeks. They are held in their appropriate place by means of the inflated balloon. These are more convenient and avoid repeated insertions. But indwelling catheters are more likely to cause infections.

This type of catheter resides in the bladder.  It is inserted through the urethra. When it is inserted by making a hole in the abdomen it is known as a suprapubic catheter.

It is attached to a tiny balloon present at the end of the catheter. This prevents the tube from sliding out of the body.

Type of drainage in an indwelling urethral catheter:

Continuously via a tube into a drainage bag- It is seen in a suprapubic catheter. It is used in patients with spinal cord injury.

Intermittently via a catheter valve- It can be opened when required to allow urine to drain into a toilet, then closed to allow the bladder to refill. This avoids the need for a permanently attached drainage bag and allows the bladder to fill and empty intermittently, maintaining good bladder function. The valve must be released regularly to prevent overfilling of your bladder. It is usually connected to a larger bag for drainage at night. A catheter valve is discreet and comfortable and can provide greater independence. It also reduces the possibility of trauma and infection in your bladder.

External catheters (Condom catheters)

It is placed outside the body. It is necessary for patients with serious mental disabilities like dementia. This is named so as it looks like a condom that covers the penis head. A tube leads from the condom device to a drainage bag.

It is more comfortable and has a lower risk of infection.

Short term catheters / Intermittent catheters/In-and-out catheter.

When catheters are needed for a short duration as in surgery this is used.

Indications of Urethra Catheterisation

  • Accurate measurement of urinary output in critically ill patients.
  • Acute and chronic urinary retention. It means urine is not passed properly either from short duration or from longer duration.
  • After surgery.
  • Patients having neurological disorders like paralysis or loss of sensation in the body.
  • Patients of urinary surgery.
  • To find healing of perineal wounds in incontinent patients.

Indications for suprapubic catheterization:

  • Acute and chronic urine retention that is not able to be adequately drained with a
  • Acute prostatitis.
  • Complex urethral or abdominal surgery.
  • Complications of long-term urethral catheterization.
  • Pelvic trauma.
  • urethral catheter.
  • Wheelchair user.
  • When long-term catheterization is used to manage incontinence.

Advantages of suprapubic catheterization-

  • There is less chance of urethral trauma.
  • There is less chance of catheter contamination with micro-organism commonly found in the bowel.
  • It is very useful for patients who are chair bound.

Disadvantages of suprapubic catheters-

  • It has a bleeding and visceral injury.
  • The patient may still leak urine via the urethra.
  • Patients with artificial heart valves may require antibiotic therapy prior to initial insertion or routine catheter change.

Contraindications of Urethra Catheterisation

  • Acute prostatitis- short duration inflammation of the prostate gland.
  • If there is suspicion of urethral trauma.

Contraindications for suprapubic catheterization-

  • Cancer of bladder.
  • If the patient has localized distended urinary bladder.
  • If a patient has previous lower abdominal surgery.
  • In patients of ascites.
  • If a patient has coagulopathy.

Choosing the Right Catheter

  • It depends upon the external circumference of the catheter.
  • Inside space of the catheter (it is known as lumen). The smallest size lumen is necessary to drain completely.
  • The material used like silicone, latex, or Teflon, or a combination of these. The material selected will depend on how long the catheter will be in place.
  • Length, shape, design, and structural features are important. The doctor decides the length of the tube, size of the collection bag, and means of attachment upon the patient’s ability to walk, how and where to store or wear the collection bag, and how often the bag is to be empty.
  • The type of catheter depends upon lifestyle of patient.

Removal of Catheter

  • It depends upon-
  • Type of catheter.
  • The purpose for which it is used.
  • It can be removed after a few minutes, hours, or days or it may be used for a long time.

Complications of using Catheters

  • Allergic reaction to material used in catheter
  • Bladder stones
  • Blood in the urine
  • Blood in urine
  • Burning of the urethra or genital area
  • Chills
  • Cloudy urine due to pus
  • Damage to kidneys
  • Fever
  • Foul-smelling urine
  • Headache
  • Indwelling catheters lead to urinary tract infections
  • Infection of the urinary tract and kidneys
  • Injury to urethra
  • Leakage
  • Leaking of urine out of the catheter
  • Low back pain
  • Septicemia
  • Stricture formation
  • Symptoms of urinary tract infection-
  • Urethral trauma
  • Urethritis

Precaution While Using Catheter

  • Drink plenty of water to keep urine clear or slightly. It helps to prevent infection.
  • For reusable catheters- Make sure to clean both the catheter and the areas where it enters the body with soap and water to reduce the risk of a UTI.
  • Empty the drainage bag used to collect the urine at least every 8 hours and whenever the bag is full.
  • Use a plastic squirt bottle containing a mixture of vinegar and water or bleach and water to clean the drainage bag.

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