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In urinary catheterization a
latex Latex is an emulsion (stable dispersion) of polymer microparticles in water. Latexes are found in nature, but synthetic latexes are common as well. In nature, latex is found as a milky fluid found in 10% of all flowering plants (angiosperms ...
,
polyurethane Polyurethane (; often abbreviated PUR and PU) refers to a class of polymers composed of organic units joined by carbamate (urethane) links. In contrast to other common polymers such as polyethylene and polystyrene, polyurethane is produced from ...
, or
silicone A silicone or polysiloxane is a polymer made up of siloxane (−R2Si−O−SiR2−, where R = organic group). They are typically colorless oils or rubber-like substances. Silicones are used in sealants, adhesives, lubricants, medicine, cookin ...
tube known as a urinary
catheter In medicine, a catheter (/ˈkæθətər/) is a thin tubing (material), tube made from medical grade materials serving a broad range of functions. Catheters are medical devices that can be inserted in the body to treat diseases or perform a surgi ...
is inserted into the
bladder The urinary bladder, or simply bladder, is a hollow organ in humans and other vertebrates that stores urine from the kidneys before disposal by urination. In humans the bladder is a distensible organ that sits on the pelvic floor. Urine en ...
through the
urethra The urethra (from Greek οὐρήθρα – ''ourḗthrā'') is a tube that connects the urinary bladder to the urinary meatus for the removal of urine from the body of both females and males. In human females and other primates, the urethra ...
to allow
urine Urine is a liquid by-product of metabolism in humans and in many other animals. Urine flows from the kidneys through the ureters to the urinary bladder. Urination results in urine being excreted from the body through the urethra. Cellul ...
to drain from the bladder for collection. It may also be used to inject liquids used for treatment or diagnosis of bladder conditions. A
clinician A clinician is a health care professional typically employed at a skilled nursing facility or clinic. Clinicians work directly with patients rather than in a laboratory or as a researcher. A clinician may diagnose, treat, and otherwise care for pat ...
, often a
nurse Nursing is a profession within the health care sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses may be differentiated from other health ...
, usually performs the procedure, but self-catheterization is also possible. A catheter may be in place for long periods of time (indwelling catheter) or removed after each use (
intermittent catheterization Intermittent catheterization is a medical technique used in conditions where patients need either short-term catheter-based management of the urinary bladder or as a daily habit for life. Intermittent catheterization is considered the "gold standar ...
).


Catheter types

Catheters come in several basic designs: *A Foley catheter ( indwelling urinary catheter) is retained by means of a balloon at the tip that is inflated with sterile water. The balloons typically come in two different sizes: 5 cm3 and 30 cm3. They are commonly made in silicone rubber or natural rubber. *An intermittent catheter/Robinson catheter is a flexible catheter that is removed after each use. Unlike the Foley catheter, it has no balloon on its tip and therefore cannot stay in place unaided. These can be non-coated or coated (e.g.,
hydrophilic A hydrophile is a molecule or other molecular entity that is attracted to water molecules and tends to be dissolved by water.Liddell, H.G. & Scott, R. (1940). ''A Greek-English Lexicon'' Oxford: Clarendon Press. In contrast, hydrophobes are n ...
coated and ready to use). *A coudé catheter, including Tiemann's catheter, is designed with a curved tip that makes it easier to pass through the curvature of the prostatic urethra. *A
hematuria Hematuria or haematuria is defined as the presence of blood or red blood cells in the urine. “Gross hematuria” occurs when urine appears red, brown, or tea-colored due to the presence of blood. Hematuria may also be subtle and only detectable w ...
catheter is a type of Foley catheter used for Post-TURP
hemostasis In biology, hemostasis or haemostasis is a process to prevent and stop bleeding, meaning to keep blood within a damaged blood vessel (the opposite of hemostasis is hemorrhage). It is the first stage of wound healing. This involves coagulatio ...
. This is useful following endoscopic surgical procedures, or in the case of gross hematuria. There are both two-way and three-way hematuria catheters (double and triple lumen). *A condom catheter can be used by males and carries a lower risk of infection than an indwelling catheter. Catheter diameters are sized by the
French catheter scale The French scale, French gauge or Charrière system is commonly used to measure the size of a catheter. It is most often abbreviated as Fr, but can often be seen abbreviated as Fg, FR or F. It may also be abbreviated as CH or Ch (for Charrière, ...
(F). The most common sizes are 10 F (3.3mm) to 28 F (9.3mm). The clinician selects a size large enough to allow free flow of urine, and large enough to control leakage of urine around the catheter. A larger size is necessary when the urine is thick, bloody, or contains large amounts of
sediment Sediment is a naturally occurring material that is broken down by processes of weathering and erosion, and is subsequently transported by the action of wind, water, or ice or by the force of gravity acting on the particles. For example, sand ...
. Larger catheters, however, are more likely to damage the urethra. Some people develop allergies or sensitivities to latex after long-term latex catheter use making it necessary to use silicone or Teflon types. Evidence does not support an important decrease in the risk of
urinary tract infections A urinary tract infection (UTI) is an infection that affects part of the urinary tract. When it affects the lower urinary tract it is known as a bladder infection (cystitis) and when it affects the upper urinary tract it is known as a kidne ...
when silver-alloy catheters are used.


Indications

Common indications for urinary catheterization include acute or chronic
urinary retention Urinary retention is an inability to completely empty the bladder. Onset can be sudden or gradual. When of sudden onset, symptoms include an inability to urinate and lower abdominal pain. When of gradual onset, symptoms may include loss of bladd ...
(which can damage the kidneys) from conditions such as
benign prostatic hyperplasia Benign prostatic hyperplasia (BPH), also called prostate enlargement, is a noncancerous increase in size of the prostate gland. Symptoms may include frequent urination, trouble starting to urinate, weak stream, inability to urinate, or loss o ...
, orthopedic procedures that may limit a patient's movement, the need for accurate monitoring of input and output (such as in an ICU), urinary incontinence that may compromise the ability to heal wounds, and the effects of various surgical interventions involving the bladder, prostate, or bowel. Intermittent self-catheterization may be indicated in cases of neurogenic bladder due to damage to the spinal cord or brain. This can be performed by the patient four to six times a day, using a clean technique. Nurses use a sterile technique to perform intermittent catheterization in hospital settings. For patients with neurogenic bladder due to spinal cord injury, intermittent catheterization (IC) is a standard method for bladder emptying. The technique is safe and effective and results in improved kidney and upper urinary tract status, lessening of vesicoureteral reflux and amelioration of continence. In addition to the clinical benefits, patient quality of life is enhanced by the increased independence and security offered by self-catheterization.


Catheter maintenance

A catheter that is left in place for more than a short period of time is generally attached to a drainage bag to collect the urine. This also allows for measurement of urine volume. There are three types of drainage bags: The first is a leg bag, a smaller drainage device that attaches by
elastic Elastic is a word often used to describe or identify certain types of elastomer, elastic used in garments or stretchable fabrics. Elastic may also refer to: Alternative name * Rubber band, ring-shaped band of rubber used to hold objects togethe ...
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 overnight. This device is hung on a hook under the patient's bed—never placed on the floor, due to the risk of bacterial infection. The third is called a belly bag and is secured around the waist. This bag can be worn at all times. It can be worn under the patient's underwear to provide a totally undetectable look. During long-term use, the catheter may be left in place all the 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 Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pa ...
are often catheterized and may remain so for some time. The patient may require irrigation of the bladder with sterile saline injected through the catheter to flush out clots or other matter that does not drain.


Complications

Catheterization can have short and long term complications. Generally long-term catheterization carries higher risk of complications. Long-term catheterization carries a significant risk of
urinary tract infection A urinary tract infection (UTI) is an infection that affects part of the urinary tract. When it affects the lower urinary tract it is known as a bladder infection (cystitis) and when it affects the upper urinary tract it is known as a kidne ...
. Because of this risk catheterization is a last resort for the management of incontinence where other measures have proved unsuccessful. Other long term complications may include blood infections (
sepsis Sepsis, formerly known as septicemia (septicaemia in British English) or blood poisoning, is a life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. This initial stage is follo ...
),
urethral injury The urethra (from Greek οὐρήθρα – ''ourḗthrā'') is a tube that connects the urinary bladder to the urinary meatus for the removal of urine from the body of both females and males. In human females and other primates, the urethra ...
, skin breakdown,
bladder stones A bladder stone is a stone found in the urinary bladder. Signs and symptoms Bladder stones are small mineral deposits that can form in the bladder. In most cases bladder stones develop when the urine becomes very concentrated or when one is d ...
, and blood in the urine (
hematuria Hematuria or haematuria is defined as the presence of blood or red blood cells in the urine. “Gross hematuria” occurs when urine appears red, brown, or tea-colored due to the presence of blood. Hematuria may also be subtle and only detectable w ...
). After many years of catheter use,
bladder cancer Bladder cancer is any of several types of cancer arising from the tissues of the urinary bladder. Symptoms include blood in the urine, pain with urination, and low back pain. It is caused when epithelial cells that line the bladder become ma ...
may also develop. Some people experience bladder spasms with catheterization and may be more common in males. If bladder spasms occur, or there is no urine in the drainage bag, the catheter may be blocked by blood, thick sediment, or a kink in the catheter or drainage tubing. Sometimes spasms are caused by the catheter irritating the bladder,
prostate The prostate is both an accessory gland of the male reproductive system and a muscle-driven mechanical switch between urination and ejaculation. It is found only in some mammals. It differs between species anatomically, chemically, and phys ...
/
skene's glands In female human anatomy, Skene's glands or the Skene glands ( , also known as the lesser vestibular glands, paraurethral glands) are glands located around the lower end of the urethra. The glands are surrounded by tissue that swells with blood ...
, or
penis A penis (plural ''penises'' or ''penes'' () is the primary sexual organ that male animals use to inseminate females (or hermaphrodites) during copulation. Such organs occur in many animals, both vertebrate and invertebrate, but males d ...
/
vulva The vulva (plural: vulvas or vulvae; derived from Latin for wrapper or covering) consists of the external female sex organs. The vulva includes the mons pubis (or mons veneris), labia majora, labia minora, clitoris, vestibular bulbs, vulv ...
. Such spasms can be controlled with medication such as butylscopolamine, although most patients eventually adjust to the irritation and the spasms go away.


Preventing infection

Everyday care of the catheter and drainage bag is important to reduce the risk of infection. Such precautions include: * Urinary catheterization should be done in a sterile aseptic manner. * Cleansing the urethral area (the area where the catheter exits body) and the catheter itself. * Disconnecting the drainage bag from catheter only with clean hands * Disconnecting the drainage bag as seldom as possible. * Keeping the drainage bag connector as clean as possible and cleaning the drainage bag periodically. * Use of a thin catheter where possible to reduce the risk of harming the
urethra The urethra (from Greek οὐρήθρα – ''ourḗthrā'') is a tube that connects the urinary bladder to the urinary meatus for the removal of urine from the body of both females and males. In human females and other primates, the urethra ...
during insertion. * Drinking sufficient liquid to produce at least two litres of urine daily * Sexual activity is very high risk for urinary infections, especially for catheterized women. There is no clear evidence that any one catheter type or insertion technique is superior compared to another in preventing infections or complications. 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 as there is no reliable evidence to suggest that the use of antiseptic agents reduces the risk of
urinary tract infection A urinary tract infection (UTI) is an infection that affects part of the urinary tract. When it affects the lower urinary tract it is known as a bladder infection (cystitis) and when it affects the upper urinary tract it is known as a kidne ...
. 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.


History

Ancient Egyptian and
Roman Roman or Romans most often refers to: * Rome, the capital city of Italy * Ancient Rome, Roman civilization from 8th century BC to 5th century AD *Roman people, the people of ancient Rome *''Epistle to the Romans'', shortened to ''Romans'', a lett ...
physicians have been described using
reed Reed or Reeds may refer to: Science, technology, biology, and medicine * Reed bird (disambiguation) * Reed pen, writing implement in use since ancient times * Reed (plant), one of several tall, grass-like wetland plants of the order Poales * ...
s as urinary catheters to overcome blockages, and catheterization to relieve urinary retention has also been described in ancient Indian and Chinese texts.


References


External links


Female urinary catherization
Merck Manual Professional Edition

Merck Manual Professional Edition {{Urologic procedures Catheters Medical treatments Urology