Pediatric Urinary Catheterization Procedure

Introduction:

Insertion of a urinary catheter in a pediatric patient is an invasive procedure. To carry it out, the total sterilization protocol should be followed by healthcare professionals. As the procedure carries a high risk of getting an infection and causing discomfort, it should only be carried out when absolutely necessary.

What Are the Types of Urinary Catheters?

There are a total of three types of catheters:

• Indwelling Catheter: It is a type of catheter inserted with an invasive procedure. In some cases, it is inserted through the urethra or, in some cases, through a hole in the belly. There is a drainage bag outside the body attached to this catheter that collects urine.

• Condom Catheter: This type of catheter is used in male patients with involuntary and frequent urination problems. There is a condom-like device placed over the penis that collects urine through a tube to the drainage bag.

• Intermittent Catheter: Depending on the frequency and need of drainage, this type of catheter is used to collect urine infrequently. A patient is not attached to the drainage bag continuously.

How Is a Urinary Catheter Placed?

The urethra is an opening of the male or female urinary tract from where the urine passes out. The catheter is placed into the urethra, connecting the bladder, and drains the urine out. There are several steps that a doctor follows to insert the catheter, such as:

• Clean the area, the tip of the penis, or the area around the vagina.

• Gently place a catheter into the bladder.

• In some cases where the Foley catheter is used, there will be a small balloon at the end of the catheter filled with little water. This can prevent the catheter from falling out of the urethra.

• The catheter is connected through a tube to a drainage bag, where the urine is collected.

• To check the urine output, this bag is emptied into a measuring cup.

What Are the Indications of Urinary Catheterization?

The urinary catheter is a small tube placed inside the urinary tract to aid bladder voiding. In the case of low urine output, this technique is used to help babies or adults empty their bladder. There are a few reasons that this is recommended in babies by doctors, such as:

• In some conditions, a sterile sample of urine is required. As the babies cannot void their bladder on command, this is the procedure used to collect the sample.

• In the extreme condition of obstructive uropathy when urine cannot drain through the urinary tract due to its retention.

• In the cases of neurogenic bladder, where a patient cannot control the bladder due to loss of brain, spine, and nerve control.

• During the radiographic examination of the bladder or urethra, where the contrast agent is injected into the organ, it is called cystourethrography.

• If the patient is recommended bladder irrigation.

• If there is a need to install drugs or medications.

• In the cases where urine output is required to be examined.

• In the case where the bladder needs to be drained before surgery.

What Are the Contraindications of Urinary Catheterization?

Despite its myriad uses, many situations contradict the use of catheterization in pediatric patients. These are:

• If the patient has any type of urethral trauma.

• If the patient has a medical history of urethral strictures or urethral scarring.

• In cases of structural abnormality of the urinary tract.

• If the patient had prior urethral neck reconstruction.

• If the patient had a past history of difficulty during catheterization.

What Are the Complications Related to Urinary Catheterization?

Urinary catheterization is relatively difficult in pediatric patients. There are some possible complications that can occur during the catheterization of pediatric patients, such as:

• Lack of Drainage: Usually, due to movements, there are chances of twisting of the drainage tube that causes a lack of drainage. Parents should keep the child hydrated and frequently check the position of the child and the drainage bag. If there is no visible reason for this, parents should immediately seek medical attention.

• Leakage: In the case of catheter leakage, parents should check for the source of leakage. Sometimes changing the catheter tube can solve this issue. Check if the tap is closed properly and if there is nothing that parents can identify for which they should call the doctor.

• Catheter Removal: It is very difficult to keep catheters in place in children due to continuous movement. If in such a case the catheter falls out and parents cannot fix it, they should contact a doctor.

• Injury: Due to improper catheterization, there are chances of injury to the urethra.

• Catheter Removal: It is very difficult to keep catheters in place in children due to continuous movement. If in such a case, the catheter falls out and parents cannot fix it, they should contact a doctor.

• Urinary Tract Infection: It is an infection caused by prolonged catheterization. This can lead to urosepsis, which is an infection spreading to the kidneys.

• Bladder Stones: It is a mass or a solid mineral inside the bladder.

• Haematuria: When due to several complications, the blood is passed through urine, it is called haematuria.

• Bladder Spasms: It is a sudden squeeze or contraction of muscles of the bladder. Due to this, the involuntary release of urine occurs.

• Pressure Necrosis: It is an injury to a certain location due to intense and long-term pressure, which causes ulceration. This can be very painful in children and requires immediate medical care.

• Pain and Discomfort: Due to prolonged catheterization, there are chances of discomfort in children.

• Epididymitis: Epididymis is a small coiled tube at the back of the testicle (male organ). Epididymitis is an inflammation of that tube due to bacterial infection.

• Creation of False Passage: It is more commonly seen in male patients who are catheterized for a longer period of time. Due to this, a false passage might be created near the external sphincter, distal to the prostate.

Conclusion:

Urinary catheterization is an important but very delicate procedure, especially in children. With all the benefits and uses of this procedure, there are many complications related to it. If a child is recommended for this procedure, parents should keep an eye on them, and in case of discomfort or complications, they should immediately call a doctor.