A Comprehensive Guide to Urinary Catheterization

Introduction

Urinary catheterization is a process that is carried out to drain the bladder and collect urine with the help of a pliable tube known as a catheter. Doctors in the hospital carry out the method of catheterization.

The catheter can either be inserted through the urethra, which passes urine out of the body (urethral catheter), or via a small opening in the lower abdomen (suprapubic catheter). The catheter harbors the urinary bladder, thus allowing urine to flow into a drainage bag. Depending on the type of catheter used, the catheter might be removed after some time, hours, or days.

Why Is Urinary Catheterization Done?

• Urinary catheterization is done in people having difficulty passing urine.

• Bladder emptying is to be done before and after surgery.

• Allow urine to drain out in case of an obstruction in the urethra (a tube that carries urine out of the body). The block could be caused due to scarring of any part of the urinary tract or prostate enlargement.

• To perform some tests.

• To allow one to pass urine in case of bladder weakness or nerve damage affecting the ability to pass urine.

• To drain the bladder during childbirth.

• Drain the bladder before, during, or after certain surgeries such as womb surgery, ovary surgery, or bowel surgery.

• To put medication directly into the bladder during procedures like chemotherapy in case of bladder cancer.

• It can also be used for urinary incontinence when other treatment modalities fail.

What Are the Various Types of Catheters Used?

There are two types of catchers used for urinary catheterization. They are -

Intermittent Catheters: Intermittent catheters are catheters inserted inside the bladder temporarily and withdrawn once the bladder is drained completely. These are indicated in

• To collect sterile urine samples.

• To provide relief caused due to bladder distention.

• To help in decompressing the bladder.

• To measure the amount of urine in the bladder.

• To manage patients with spinal cord injury, neuromuscular degeneration, or bladder incompetence.

Indwelling Catheters: Indwelling catheters remain inside the bladder for several days or weeks and are positioned with the help of a sterile water-filled balloon in the bladder. There are two types of indwelling catheterizations, short-term indwelling catheterization, and long-term indwelling catheterization.

Short-term indwelling catheterization is indicated in the following cases.

• To monitor the output of urine after surgery and in critically ill people.

• To prevent the obstruction of the urethra (a small tube through which the urine passes out of the body) from blood clots with the help of continuous or intermittent bladder irrigations.

• To install medicines inside the bladder.

• Repair surgeries of the bladder, urethra, and surrounding structures for the pelvic region or abdomen surgeries.

• Urinary obstruction is caused by the enlarged prostate gland and acute urinary retention.

Long-term indwelling catheterization is indicated in the following cases.

• Refracted obstruction of the bladder and in the neurogenic bladder with urine retention.

• Chronic and extended urine retention.

• To heal the perineal ulcerations where urine might cause further irritation.

• Indwelling catheters are preferred over intermittent catheters because they are convenient to use and avoid repeated catheterizations. However, urinary tract infections are likely to occur with indwelling catheters.

• Catheter insertion is uncomfortable, so anesthetic gels are used to reduce pain during catheterization. Most people with long-term catheters become used to these with time.

How Is Urinary Catheterization Performed?

Pediatric Catheterization:

• Small catheters are used depending on the size of the urethra of the child.

• In kids, intermittent catheters are used to get a sterile urine sample. Indwelling catheters are rarely used for fear of infection.

• For very young kids, assistance is needed.

Female Catheterization:

• The positioning of the female patient is vital to visualize the urethra. The patient is placed in the supine position (on the back) with the knees bent and feet flat on the bed. The legs are separated around sixty centimeters apart.

• The labia majora and labia minora (the two skin flaps around the urethra) are separated, and the urinary meatus is located. This position is maintained to avoid any kind of contamination during the procedure.

• The meatus is cleaned with the help of forceps and cotton balls soaked in chlorhexidine in a single downward stroke.

• The drainage basin containing the catheter is placed between the thighs of the patient.

• The tip of the catheter should be lubricated and inserted inside the urinary meatus.

• The catheter is slowly pushed around five centimeters until urine begins flowing. Then the catheter is advanced further, around one to two centimeters.

• Attach the syringe containing sterile water and inflate the balloon.

• The catheter is slowly pulled back until the balloon engages the neck of the bladder.

Male Catheterization:

• The male patient is placed on their back with their legs extended flat on the bed.

• The patient is draped with sterile drapes and a drape with a hole over the penis.

• A water-soluble lubricant is applied to the tip of the catheter.

• The penis is held upright.

• The foreskin is retracted.

• The tip of the penis is cleaned with chlorhexidine-soaked cotton balls in a circular motion.

• The drainage basin containing the catheter is placed next to the thighs.

• The penis is stretched and lifted to an angle of sixty to ninety degrees.

• A project is used to anesthetize the urinary tract, minimizing discomfort.

• The lubricated tip of the catheter is then inserted within the meatus.

• The catheter is advanced until urine begins to drain.

• Attach the syringe with sterile water and inflate the balloon.

• Pull back the catheter gently until the balloon engages the neck of the bladder.

• The urinary bag is attached and positioned below the bladder level.

What Are the Risks Involved With Urinary Catheterization?

• Trauma to the urethra and bleeding due to improper catheter size or forceful insertion.

• Urinary Tract Infections - Infections of the various parts of the urinary tract, like the kidneys, ureters, urinary bladder, or urethra, due to poor sterilization or long-term indwelling catheters.

• Pain and cramps of the bladder.

• Leakage around the catheters is primarily due to the indwelling catheters.

• Bladder stones.

• Hematuria: This is a condition where there is a presence of blood in the urine.

• Septicemia: This is the spread of infection in the blood.

• Kidney damage.

How To Live With a Catheter?

• The area from where the catheter leaves the body and the catheter should be cleaned with soap and water regularly.

• One should increase water consumption to prevent any infection.

• One should wash hands with soap and water after handling the drainage device.

• Prevent developing constipation by drinking water and eating high-fiber food.

• Avoid the formation of kinks in the catheter, and ensure that the drainage bag is always kept below the bladder level.

Conclusion

Urinary catheterization is draining the bladder with the help of flexible tubes known as catheters. This procedure is carried out in various conditions. Different types of catheters and catheterizing techniques are used depending on the needs of the individual. Risks attached to the process can be avoided and treated as well. Overall, the procedure is safe and effective.