Definitions

catheterize

Urinary catheterization

In urinary catheterization, a plastic tube known as a urinary catheter (such as a Foley catheter) is inserted into a patient's bladder via their urethra. A balloon located at the end of the catheter is usually inflated with sterile water to prevent the catheter from slipping out once it has reached the bladder. In this manner, the patient's urine is collected and contained for various medical purposes. It can also be used to inject liquid. The procedure of catheterization will usually be done by a clinician, often a nurse, although self-catheterization is possible as well.

Types of catheterization

Catheters come in a large variety of sizes; materials (latex, silicone, PVC, or Teflon); and types (Foley catheter, straight catheter, or coude tip catheter). In the case of internal catheters, those inserted into the urethra, the smallest size is usually recommended, although a larger size is sometimes needed to control leakage of urine around the catheter. A large size can also become necessary when the urine is thick, bloody or contains large amounts of sediment. Larger internal catheters, however, are more likely to cause damage to the urethra. Some people have developed allergies or sensitivities to latex after long-term latex catheter use. In such cases, silicone or Teflon types should be used. Silver alloy coated urinary catheters may reduce infections.

Proper catheter use can also often be determined by the length of time for which the process is necessary: long-term (often called indwelling) or short-term use:

Short-term use

In some situations, incontinent patients are catheterized to reduce their cost of care. A condom catheter, which fits on the outside of the penis using adhesive, can be used for short-term catheterization in males. However, long-term catheterization is not recommended because chronic use carries a significant risk of urinary tract infection. Because of this risk catheterisation should only be considered as a last resort for the management of incontinence where other measures have proved unsuccessful and where there is significant risk to the skin.

Long-term use

A catheter that is left in place for a period of time may be attached to a drainage bag to collect the urine. There are two types of drainage bags: The first is a leg bag, a smaller drainage device that attaches by elastic bands to the leg. A leg bag is usually worn during the day, as it fits discreetly under pants or skirts, and is easily emptied into a toilet. The second type of drainage bag is a larger device called a down drain that may be used during the night. This device is usually hung on the patient's bed or placed on the floor nearby.

During long-term use, the catheter may be left in place during the entire time, or a patient may be instructed on a procedure for placing a catheter just long enough to empty the bladder and then removing it (known as intermittent self-catheterization). Patients undergoing major surgery are often catheterized and may remain so for some time.

Long-term catheterization can expose patients to an increased risk of infection. Long-term catheterization as a remedy for incontinence is not appropriate, as the risks outweigh the benefits.

Sex differences

In males, the catheter tube is inserted into the urinary tract through the penis. A condom catheter can also be used. In females, the catheter is inserted into the urethral meatus, after a cleansing using povidone-iodine. The procedure can be complicated in females due to varying layouts of the genitalia (due to age, obesity, Female genital cutting, childbirth, or other factors), but a good clinician should rely on anatomical landmarks and patience when dealing with such a patient. In the UK it is generally accepted that cleaning the area surrounding the urethral meatus with 0.9% sodium chloride solution is sufficient for both male and female patients.

Possible causes and effects

Common indications to catheterize a patient include acute or chronic urinary retention, orthopedic procedures that may limit a patient's movement, the need for accurate monitoring of input and output (such as in an ICU), benign prostatic hyperplasia, incontinence, and the effects of various surgical interventions involving the bladder and prostate.

For many patients the insertion and removal of a catheter can cause excruciating pain, so a topical anesthetic should be used for patients of both sexes. Catheterization should be performed as a sterile medical procedure and should only be done by trained, qualified personnel, using equipment designed for this purpose. If correct technique is not used then trauma may be caused to the urethra or prostate (male), urinary tract infection may be caused or a paraphimosis may occur (male uncircumcised patient). Because of this it is important that any practitioner undertaking this procedure first is both trained and adequately supervised until they are able to demonstrate an approved level of competence.

Complications of catheter use may include: urinary tract or kidney infections, blood infections (sepsis), urethral injury, skin breakdown, bladder stones, and blood in the urine (hematuria). After many years of catheter use, bladder cancer may also develop.

Combating infection

By indwelling (long-term) catheters it is very important to take everyday care of catheter and drainage bag. To reduce risk of infection:

  • Daily wash urethral area (area where catheter exits body) and catheter itself with intimate soap and water.
  • Disconnect drainage bag from catheter only with soap-washed hands.
  • Disconnect drainage bag as seldom as possible, only in necessary cases.
  • Keep drainage bag connector as sterile as possible = do not touch connector by hands or by any other possible infectious surfaces (bed, cloths, floor...). If you are not sure that connector and end of catheter inside are sterile, wash them by soap and water, or use some antiseptic disinfection.
  • If possible avoid disconnecting of drainage bag in hospitals - there is increased risk of antibiotic-resistant bacteria infection. For such cases carry small bottle with some kind of antiseptic to always be able to keep connector sterile.
  • Cleanse your drainage bag periodically
  • If possible use thin catheter to reduce risk to harm urethra during insertion of catheter
  • Drink enough liquids to produce at least 2 liters of urine daily
  • Before and after sexual activity clean carefully sexual organs of you and your partner, avoid contact of sexual organs to other not cleaned parts of body (e.g. anus). Sexual contact is especially for catheterized women very high risk to get urinary infection.

Recent developments in the field of the temporary prostatic stent have been viewed as a possible alternative to indwelling catheterization and the infections associated with their use.

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