Bladder Catheterization
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Female calmBladder Catheterization
Uploaded by
Female calmBladder
catheterization
By :
Ibrahim Al-Sidran , Nemer al-Mrdef
Foley’s catheters indications
1-urine output monitoring ( unstable patient )
2- oliguria ( less than 400 ml / 24 hours )
3- unconscious patient
4- intra-op & post-op
5- urine retention
What are the causes of urine retention ?
- BPH ( treated by selective alpha-1 blocker “ tamsulosin “ )
- Urethral injury
- Clot retention “post-op” & “bladder mass”
- Post spinal anesthesia & general anesthesia ( areflexic bladder )
- Painless urine retention “ diabetic cystopathy”
- Medications “ alpha adrenergic agonist “ drugs that are used to treat
allergic rhinitis
- Neurological disease “LMNL” & “UMNL”
Causes of urine retention In females :
1- pelvic prolapse ( uterine prolapse or cystocele )
2- uretheral stones
3- severe UTI
Note : Normal urine output ( 0.5 – 1 ml/kg/h )
Foley’s catheter is foreign body “ risk of infection “ so you have to
remove it as soon as possible except in bladder surgery keep it for
2 weeks why ? for healing
Classification of bladder injury :
1- intra peritoneal bladder injury
2- extra peritoneal bladder injury ( foley’s catheter + antibiotics )
Contraindications :
Absolute contraindications:
1- patient refuse
2- urethral injury
What are the signs of urethral injury ?
blood at meatus , high riding prostate “know it by DRE”, butter fly
hematoma and pelvic fracture .
Relative contraindications :
1- acute prostatitis “discomfort”
Foley’s catheters
● 2 types ( silicone , rubber )
● Short, usually with 2 ports only ( 1 for drainage, and 1 for
ballon inflation ).
● 2 ports foley’s catheter ( silicone )
● This type is used for long period catheterization 4 – 6
weeks ,because it is less associated to infections due to
silicone ( have better quality ).
● 2 ports foley’s catheter ( Rubber ) .
● Change after 4 weeks .
● Other types ( larges sizes) include :
- 3ports ( 3 ways) used in cases of clot retention in hematuria as follows :
1 _way for ballon inflation .
1 _way for drainage .
1 _way for irrigation by saline to remove the clots ( continuous bladder irrigation ) .
● Indications of continuous bladder irrigation :
1- hematuria ( in catheter it’s classified in color either red , pink , light pink , clear or
crystal clear ) .
2- to prevent clots
Procedure
● Make sure that all equipments you need on the table before start
● Antiseptic , Lubricant , 2 syringe “lubricant”&”inflating ballon” , and cotton
wool .
● Always bring smaller size foley’s catheter
● Adult male any size 12-24
● In case of hematuria use the biggest size
● Urine retention 16-18
● Pediatric 4-12
● Drapes
● Urine bag
Procedure
● Introduce your self
● Ask of permission
● Explain what are you going to do
● Privacy
● Position : male (supine) , female (leg split position)
● Wear gloves
● Sterilisation of the field “ from suprapubic area to mid thigh ( the whole area ).” by
betadine or iodine .
● Put drapes and cover testicles
● Hold the penis by left hand “thumb & index c-shape “and keep the penis straight ,
stretch and erect
● Gently, inject lubricant “lidocaine “ and wait 5mins before start
● Take foley’s and insert it till (end of length and see urine came out “both”
● Inflate the ballon with 20 ml normal saline ( usually balloon capacity = 50 cc ) .
● Connect foley’s to bag “ from the beginning or at end “
● Fix it on the patient’s thigh
Cont.
In female :
Split leg position ( diamond shape), then hold labia majora then
separate between the two labia majora and insert catheter into
urethra “ opening above vagina “ after that do as we did in the
same steps in previous slide .
Complications
● infection ( most common ) “ remove catheter as soon as possible “ .
Except :
bladder surgeries 2 weeks
Extra-peritoneal bladder injury = foley’s catheter + antibiotics
● Urethral injury
● Bleeding secondary to urethral injury
● Clot retention “ need irrigation “
● Incarcerated stones more than 2 months
Nelaton catheter
● 1 port ( urine drainage) .
● Non- traumatic catheter ( rounded tip to prevent urethral injury) .
● It does not contain ballon ( if the patient walks it will dislodge) .
● Used for conditions like ( Benign Prostatic Hypertrophy, since foley’s
is flexible and can not pass through narrowing) .
Urinary bag