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Catheterisation

From Mediwikis

Types

There are many different sizes of catheter available for use, both in the medical setting and in self-catheterisation that patients may use when they have chronic urinary retention (so it doesn’t get so bad that they have to come into hospital as often).

For some reason the catheters are labelled in terms of French Gauge, with 12 being small and 20 being very large. The size 10 catheters are given to patients who self catheterise.

Male and female catheters are available. "Male" are longer and can be safely used in either men or women. Female catheters are shorter and hence will not pass the whole length of the longer urethra in men. Using these in men results in severe urethral trauma when you inflate the balloon, and because of this (and the subsequent legal precedings) some trusts only have "male" catheters to be used on both males and females.

Catheters are mainly made from latex, though there are some more rigid ones with bends in which can be used in patients who are difficult to catheterise and some that contain guide wires, for example patients with BPH (benign prostatic hyperplasia). Note that if a guide wire catheter is being used then after the catheter has been inserted the guide wire is removed.

Remember to ask about latex allergies before using a latex catheter, others like silicon catheters are also available!

Specialised Catheters

There are some catheters known as 3 way catheters, these are catheters that have an extra section within them that is connected to an extra port at the end of the catheter. These 3 way catheters are useful in patients who you worry may block their catheter, for example with blood clots or renal stones. The third port can also be used in irrigation, or flushing of the bladder.

Problems

As with every medical procedure there are problems that can arise. The main one in catheterisation is the risk of infection, patients may develop a UTI secondary to the insertion of their catheter so great effort should be made to prevent this.

The catheter is seen as a foreign body and reactions against it lead to increased chances of renal calculi (stones) forming.

If the catheter is incorrectly inserted and the balloon inflated whilst it is still in the urethra, the urethra with rupture and surgery will be needed (the patient, surgeons and your seniors will not thank you for such a preventable mistake).

In women, especially post-menopausal women, the urethra atrophies and may be very difficult to see and therefore catheterise, it is quite possible to catheterise the vagina in these patients and if this happens just try again (with a new clean catheter!).

A Note on Gloves

In the procedure detailed below two pairs of gloves are used, this is how we are advised to perform the procedure in Carlisle, different trusts have different rules. Some say that one pair of gloves should be used and there should be a “clean” and “dirty” hand. Either way is acceptable though check with your trust!

Procedure

  • Introduce yourself, check the patient’s name and age (or DOB) and consent them for the procedure, wash your hands
  • Go get your equipment and put it on a clean trolley or surface near to where you will be working. This equipment may be found in a catheter kit (or might not so you should know what you need)
Sterile gloves (you’ll need 2 pairs)
A sterile field to put all the things you need on
Catheter (choose the right size and type)
Forceps
Gauze swabs
Drape (to give you a sterile working area)
Pot to put your cleaning fluid in
Cleaning fluid (note that this should not be alcohol based – it would cause pain!)
Drainage bag
Sample bottles
Catheter insertion form (there should always be a good reason for inserting a catheter, on this form should also be detailed the type and code of the catheter used)
10ml syringe of sterile water(to use to fill the balloon in the catheter)
Syringe of lidocaine infused lubricating gell
Absorptive pad for the patient to lie on (in case of spillage of urine, you don’t want it all over the bed)
  1. Explain what is going to happen to the patient
  2. Ensure the situation is as private as possible and ensure adequate exposure of the patient (need everything removed from the waist down) you will also need adequate light so you can see what you are doing
  3. You will need a chaperone (who can also be your helper!)
  4. Put your two pairs of gloves on, one on top of the other. Whilst you are doing this, get your helper to open all the packets of things you will need and put them onto your sterile area you have made, get them to put the cleaning solution in the little pot too

In Men

  1. Get them to lie on the bed with legs together on top of the absorptive mat, if they have not been circumcised then the foreskin will need to be retracted (DO NOT FORGET to replace the foreskin after you have finished inserting the catheter)
  2. Use the forceps to pick up a swab, dip it in the cleaning solution and use it to clean the penis. Work from the top down and never go back over an area you have cleaned with the same gauze. Whilst you are cleaning the penis it should be held at 90degrees to the body so that it can be cleaned all over. You should also clean a large field around the base of the penis.

In Women

  1. Get them to lie on the bed with legs apart and knees bent
  2. Use one hand to open up the labia so you can get a good look at and clean the external genitalia
  3. Use the forceps to pick up a swab, dip it in the cleaning solution and use it to clean the genitalia from top to bottom with one wipe and then throw the gauze away, do not go back up. The whole of the genitalia needs to be thoroughly cleaned.

Then In both

  1. Use at least 4 swabs to clean the area (you may need more) until you are satisfied that it is clean. Put used swabs in the clinical waste bin.
  2. Take off your first layer of gloves and put them in the clinical waste bin as these are now dirty
  3. Cover the patient in the aseptic drape with the hole over their genitalia
  4. Get the lidocaine, squirt a bit on the sterile area (to put on the catheter tip) and liberally squirt it in and around the urethral meatus (in men the penis will have to be held up so the lidocaine doesn’t pour back out again)
  5. Wait five minutes for it to take effect (chat to the patient about the weather etc. To prevent an awkward silence)
  6. Get the catheter and rub it in the lidocaine lubricant then insert the catheter tip into the urethral meatus, push it in carefully and steadily being aware of any pain the patient may experience, ask them if it is okay
  7. Keep inserting the catheter until you are up to the ports (even if you get some urine showing as it may be in the urethra still – you need to be sure it is in the bladder)
  8. Inflate the balloon with the 10ml syringe of sterile water (make sure you check that it is a 10ml capacity balloon before you insert it, it could be more or less)
  9. Gently pull down the catheter until you feel a resistance
  10. Collect a sterile sample of urine if it is needed now
  11. Connect the catheter to the collection system that is being used
  12. Fill in the appropriate forms and check the patient is okay (in men, replace the foreskin), thank them
  13. Get rid of all the other stuff you have used into the appropriate waste bins

Other Forms of Catheterisation

Suprapubic catheters are inserted directly into the bladder through the skin. It is usually considered to cause less risk of infection.