Bladder catheterization - indications and contraindications

Main purpose

Why is a urinary catheter required for women and men? In urology, catheters of various shapes and sizes are used to perform certain activities. The device is selected individually for each patient. At the outlet, such a probe is usually connected to a drainage bag, that is, directly to a collector designed to collect urine.

The bag is fixed on the patient's leg so that he can move freely and the collector can be used throughout the day. At night, larger containers are used that are hung from the bed.

Indications for the procedure are:

The need to obtain bladder urine for analysis.
The presence of inflammatory diseases of the bladder in women.
The appearance of acute or chronic urinary retention.

Description

A catheter is a tube designed to create a kind of passage between the internal cavities of the body and the external environment. An instrument is used to inject medicinal solutions, and, in addition, to rinse the organ and perform surgical procedures.

A urinary catheter is required for women and men to achieve forced emptying of the organ. For example, catheterization may be required immediately after childbirth, when the woman in labor is unable to urinate on her own for the first time. Sometimes the procedure is performed due to damage to the bladder. For example, due to injury, the lumen often closes, and urine is not naturally excreted from the human body. In a number of situations, the use of female urological catheters is required during the examination to make a diagnosis. It is often necessary:

Determination of the volume of urine present in the bladder.
Obtaining a sterile portion of urine for analysis.
Performing X-rays of the urethra and bladder by injecting a contrast component into the organs.

What it is

These devices are straight or curved tubes with two holes at the ends. One end is inserted into the urethra and reaches the bladder, the second remains outside. In this way, you can artificially drain the bladder and, thereby, get rid of urine that the body, for some reason, cannot remove on its own.

Two-way foley catheter

In addition, the catheter can be used to administer some kind of medication. In this case, the liquid is not removed, but introduced.

Correct operation of this medical device completely eliminates discomfort and, especially, pain for the patient. Therefore, the catheter must be inserted by a specialized specialist. Modern devices are distinguished by their simplicity, efficiency and maximum level of safety.

Types of catheters

There are many types of urinary catheters today. The type of medical instrument chosen directly depends on the specific case, for example:

A device called a Foley catheter is used for long-term catheterization (when patients are in a coma). It is also suitable for short-term manipulation. It is used for washing, eliminating blood clots, draining urine, and so on.
The Nelaton Catheter is designed for periodic catheterization in situations where the patient cannot independently urinate. Until the invention of the Foley catheter, this device was intended for continuous use.
A device called a Pezzer Catheter is well suited for maintaining continuous catheterization and drainage of urine through a cystostomy. This tool, unfortunately, has quite a lot of shortcomings; therefore, they work with it only in the absence of other possibilities.

Which ones are used more often?

Urinary catheters are currently predominantly flexible. Metal models are used extremely rarely. The fact is that they are less comfortable for the patient and are not very convenient to use. Catheters must be fixed after insertion; the doctor chooses the method for this and is guided by the characteristics of a particular situation.

Difference between female and male models

The difference between a female and a male urological catheter is determined by the anatomical features of the body. Although the purpose of the devices can be said to be the same, they still differ in structure:

Male models are intended for insertion into narrow and curved urethra, which is why the tube is made thin and long.
Urinary catheters for women are made with a short, wide and straight urethra in mind, so such an instrument is endowed with the appropriate characteristics, that is, a relatively large diameter, short length and the complete absence of any bends.

Today, urological catheters are available in most medical stores. Usually in the description of each such product it is indicated for which gender of the patient this or that instrument is designed. The approximate cost of the product ranges from nine to two and a half thousand rubles. The price largely depends on the type of catheter, and at the same time on the place of purchase and the material of manufacture.

How is a urinary catheter placed in a woman?

Installation Features

This procedure itself is not at all difficult, since the female body is very convenient for inserting a tube. For example, in a man, in order to be able to get to the bladder, you will need to overcome the genital organ. But in women, the urethra is located directly behind the labia.

Let’s take a closer look at how a catheter is placed in a woman’s bladder.

Before the catheterization procedure, the patient must take a shower, wash thoroughly and come to the room for manipulation. If the procedure is carried out to collect urine, then at first the doctor or nurse may try to do without inserting an instrument into the urethra. For this:

The patient needs to lie down on a couch on which a diaper or oilcloth has been previously spread.
Next, the bent legs must be spread apart so that a bedpan can be placed between them in order to accumulate urine.
A warm heating pad is placed on the patient's lower abdomen. This helps stimulate reflex urination. For similar purposes, the genitals can be watered with slightly heated water.

How to correctly insert a catheter into a woman

Due to the short length of the urethra, it is not difficult to insert a catheter into a woman. The process consists of the following manipulations:

The nurse comes in to the patient's right.
Spreads the woman's labia with his hand.
Apply water to the vulva and then add antiseptic.
Next, an instrument pre-treated at the inner end with petroleum jelly is inserted into the opening of the urethra, located externally.
Liquid should flow out of the tube; if the discharge does not drain, the procedure must be repeated. If the patient experiences pain, the nurse should take this into account.

What are the inconveniences?

Despite the fact that catheterization is much less unpleasant for women than for men, this kind of manipulation is still quite stressful. Many patients do not experience any particular pain or any other physical discomfort, but they absolutely always have to experience obvious psychological inconvenience. A good doctor manages to create a trusting and at the same time calm atmosphere in which women feel relaxed. It is very important that the patient is not afraid or embarrassed, then the procedure will be very easy, painless and fairly quick.

In simple situations, catheterization can be performed by a nurse, for example when a diagnosis needs to be confirmed. In the event that the manipulation is performed for medicinal purposes, then only a qualified doctor should work. It is important to do catheterization very carefully, since a sharp or too fast movement can damage the urethra, causing an inflammatory process (such as cystitis or urethritis).

The female urinary catheter is one of the medical achievements whose importance is very great and cannot be overestimated. Thanks to this simple device, diseases of the urinary system simply cease to be difficult for people: they are easier to recognize and treat. It would be superfluous to recall patients suffering from severe brain or back injuries, when the use of a catheter is one of the main conditions for providing comprehensive care for the patient. How to insert a catheter into a woman’s bladder is now clear.

For what pathologies is catheterization necessary?

So, catheterization of an organ such as the bladder in women is a procedure necessary in a number of cases with the development of pathologies of this organ. The procedure itself involves inserting a catheter in the form of a flexible latex tube, which can also be made of silicone or Teflon. Such a tube can pass through the urethra directly to the bladder.

Often, the need for the described event in women arises in the postoperative periods against the background of gynecological or diseases. Catheterization is done to control the volume of urine produced. In addition, it can promote the healing of postoperative wounds.

In some situations, the procedure is required for patients to rinse in case of bleeding, administration of medications, detection of general obstruction, urine output due to neurological pathologies (paralysis), incontinence or retention in a number of certain diseases.

For cancer

Bladder cancer, which is often diagnosed in women, often requires the insertion of a catheter. Typically, this disease can develop against the background of papillomas. In this case, as a rule, patients have an excessive amount of blood in their urine, which is very easily detected even with the naked eye.

Cancer is often diagnosed in smokers and those who work with aniline dyes. Often, such a pathology develops against the background of chronic inflammation of this organ, after irradiation, and in those who often do not urinate on demand. Various sweeteners and a number of medications also have an effect.

We looked at how to place a urinary catheter in a woman. This procedure is very useful, necessary for carrying out in the presence of pathologies of the bladder.

Urologists and gynecologists very often send their patients to undergo a procedure such as catheterization.

During this manipulation, a catheter is installed in the woman’s urethra, through which urine flows out or special medications are administered.

Bladder catheterization in women is prescribed for a variety of indications. At the same time, such a procedure should always be carried out only by an experienced specialist, because If the catheter is placed incorrectly, the urethra and urinary tract can easily be injured.

Indications for the procedure

Most often, women are referred for catheterization in the following cases:

for collecting urine for analysis (unlike the usual collection of morning urine in a container, this method of collecting urine allows you to obtain for research a “cleaner” biological material without foreign impurities);
for filling the bladder with medications for the treatment of various diseases of the urinary system;
for washing and disinfecting the urinary tract (catheterization will help remove pus, sand, crushed small stones, etc. from the organ);
to study the volume of residual urine filling the urinary bladder;
to empty or fill the pelvic organ before an x-ray examination (during diagnostics, the urinary bladder must be empty or filled with a special contrast agent, which, when x-rayed, will color the internal organs and tissues, thanks to which the doctor will be able to get a more accurate idea of the condition of the urinary tract);
to remove urine when it is impossible to void on your own (urine retention, acute or chronic disturbance of normal urination, etc.)

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Catheterization of the bladder with a soft catheter in women is done during surgical operations on internal organs, performed under local or general anesthesia. Catheters are also installed into the urine bladder for paralyzed people, patients who cannot move, are in a coma, etc.

Indications and contraindications

Catheterization of the urine bladder is often performed for diagnostic purposes:

urinary tract patency studies;
study of the organoleptic properties of urine;
determination of the amount and composition of urine;
for microflora analysis.

For men, a catheter is also inserted for medicinal purposes:

when it is impossible to urinate independently (in a comatose state);
with acute retention of urine outflow associated with prostate adenoma, narrowing of the lumen of the urethra, blockage of the urethra due to a tumor, hydronephrosis;
when squeezing the bladder;
for administering medications: antibiotics or disinfectant solutions directly into the urine bladder.

The catheterization procedure has a number of contraindications:

acute inflammation or injury of the urethra and bladder;
presence of blood in the scrotum, urethra;
urine does not pass into the urinary bladder (anuria);
presence of sexually transmitted diseases.

Algorithm for bladder catheterization in women

The technique for catheterizing the bladder of men and women is, of course, very different. Installing a catheter into the female urethra will not cause any significant difficulties for an experienced doctor or nurse. Due to the fact that women have a short urethra, insertion of the catheter and its passage through the urinary tract is very quick and, in most cases, painless.

The correct technique for bladder catheterization in women is as follows:

How to insert a catheter into a man's bladder video

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Initial data

The catheterization algorithm is a medical instrument in the form of a tube, designed to connect natural channels, body cavities, vessels with the external environment for the purpose of emptying them, introducing liquids into them, rinsing, or the bladder is built on general principles and is further based on the anatomical differences of the male urinary system and women.
The manipulation is carried out observing the conditions of sterility of equipment and personnel’s hands.

Metal catheters are sterilized in an autoclave; rubber catheters can also be autoclaved or kept in antiseptic solutions. But if the procedure is one-step and does not require constant presence of drainage in the patient’s body, then it is advisable to use a disposable sterile kit for bladder catheterization in the original packaging.

What types of urinary catheters are there?

This medical equipment can be classified from different points of view.

Depending on the duration of stay in the patient’s body, these can be permanent or short-term catheters, a medical instrument in the form of a tube, designed to connect natural channels, body cavities, vessels with the external environment for the purpose of emptying them, introducing liquids into them, washing them, etc. And, if the nurse who performs the procedure is responsible for short-term ones, then a permanent catheter requires some knowledge from the patient.

Indwelling catheter

The drainage tube itself is connected to a urinal and can serve a person for a long time. Caring for this system involves daily washing of the external opening of the urethra. The canal (synonym: urethra, Latin urethra) is an unpaired tubular organ of the urinary (genitourinary) system of humans and other vertebrates, connecting the bladder with the external environment with soap and water. After each bowel movement, the external organs should be toileted so that the intestinal flora does not get on the catheter and into the urethra.

If discomfort or signs of inflammation appear or the catheter is clogged, it should be replaced with sludge and an attempt to flush it out. You can also flush the catheter at home using a sterile syringe and NaCl solution (for injection). Each patient requiring continuous bladder drainage is taught how to flush the catheter themselves. For hygienic purposes, you should empty the urine bag on time, at least every 8 hours, keep the outlet valve clean and wash it with soap.

Suprapubic catheter

This type of catheter is placed into the bladder not through the urethra, but directly through the abdominal wall. This is necessary for urinary incontinence, urethral blockage or after surgery, allows you to empty your bladder and minimize the risk of infection. For safe use, it is recommended to change catheters every 4 weeks.

Short-term catheters are a medical instrument in the form of a tube, designed to connect natural channels, body cavities, vessels with the external environment for the purpose of emptying them, introducing liquids into them, a substance in a liquid state of aggregation, occupying an intermediate position between solid and gaseous states, washing, or

In principle, they can be divided into soft and metal. Metal catheters are only allowed to be inserted by a doctor, and a nurse can catheterize the bladder with a soft catheter, a medical instrument in the form of a tube designed to connect natural channels. An elongated, artificially limited space intended for organizing communication, transferring or moving something, body cavities, vessels with external environment for the purpose of emptying them, introducing liquids into them, washing them, or.

Soft catheters are represented by rubber, latex, silicone, and polyvinyl chloride products and differ in numbers (sizes). The size range ranges from 1 to 30, most often in adults sizes from 14 to 18 are used.

Metal ones are made of stainless steel or brass and have different configurations - “for women” and “for men”. For catheterization of the bladder, an area filled with some gas (usually round in shape), limited by walls of some liquid; filled with some gas, an area (usually round in shape), limited by walls of some liquid; in women, shorter catheters with a bend are required special form.

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Below are the different types of catheters.

Name	Description	Purpose
Foley 2-way	Equipped with an inflatable balloon for fixation, a first channel for inflating this balloon and a second channel for urine outflow	Long-term catheterization and manipulation
Foley 3-way	The third channel is used for introduction in the proper sense - preliminary messages of a general nature that precede a work, usually of a scientific nature, in order to introduce the reader to the subject of drugs	Removing blood clots, flushing the bladder, an area (usually round in shape) filled with some kind of gas, bounded by walls of some kind of liquid
with Timman tip	Has a curved tip	Catheterization of men with prostatic hyperplasia
Nelaton	A straight catheter with a rounded end and two side holes for drainage. Small diameter lumen	Previously, for long-term catheterization, it was sutured to the genitals. Little used today Actively used for one-time catheterization
Pezzera	Rubber tube with a clamp in the form of a plate-shaped thickening	For permanent suprapubic catheterization, a medical instrument in the form of a tube designed to connect natural channels, body cavities, vessels with the external environment for the purpose of emptying them, introducing liquids into them, washing, or

Procedure

In addition to the catheter, the standard kit for this manipulation should include:

sterile consumables - gauze wipes, diapers, cotton balls;
a sterile substance to facilitate catheter insertion (glycerin) or with an additional analgesic effect (Lidocaine gel 2%);
sterile tweezers, syringe with a blunt tip;
a tray or container where urine will be collected;
antiseptic solution (most often Furacilin or Povidone-iodine);
necessary care items for the toilet of the external genitalia.

Before the procedure, the patient is washed with a weak antiseptic solution so that the direction of the stream is from front to back. This is especially true for women, since it is easy for them to carry intestinal flora into the urethra.

The most comfortable position, the so-called “toad legs,” is on your back, with your knees and pelvic joints slightly bent and your legs apart. Thus, medical personnel have good access to the injection site.

Before the catheter is inserted, the external opening of the urethra canal (synonym: urethra, lat. urethra) is an unpaired tubular organ of the urinary (genitourinary) system of humans and other vertebrates, connecting the bladder with the external environment canal An elongated, artificially limited space intended for organization connection, transmission or movement of something (synonym: urethra, lat. urethra) - an unpaired tubular organ of the urinary (genitourinary) system of humans and other vertebrates, connecting the bladder with the external environment is treated with a solution of furatsilin, and a couple of drops are additionally injected into it for the man lubricant. If it is Lidocaine gel 2%, then wait two or three minutes for the anesthetic to take effect.

Weak stronger sex

Catheterization is a medical instrument in the form of a tube, designed to connect natural channels, body cavities, vessels with the external environment for the purpose of emptying them, introducing liquids into them, rinsing, or the bladder in men - a more subtle process. The urethra is a narrow fibromuscular tube through which not only urine or urine (Latin urina) is excreted from the body - a type of excrement, a waste product of animals and humans, secreted by the kidneys, but also sperm. The male urethra is sensitive to various pathological conditions, ranging from traumatic to infectious and neoplastic (tumor). Therefore, the procedure is contraindicated if there is any damage to the canal, in order to avoid ruptures when installing a drainage tube into the urethra.

A special technique for catheterizing the bladder is that the head is first exposed by sliding the foreskin with a sterile napkin. Then, holding the catheter with a clamp, insert it with its rounded end into the opening of the canal to a depth of 6 cm. Next, advance the tube another 4-5 cm, as if pushing the genital organ onto it. We can say that the catheter is located in the bladder, an area filled with some gas (usually round in shape), limited by walls of some liquid, if urine or urine (lat. urina) is released from the free end - a type of excrement, a waste product of animals and human, excreted by the kidneys.

In connection with male anatomy, namely the possible hypertrophy of the prostate gland, a special type of catheter was developed. It has a stiffer, curved tip specifically designed to overcome severe urethral obstruction in patients with benign prostatic hypertrophy. When inserting, the curved tip should be directed forward and upward in order to be able to push the tissues apart and install the catheter, a medical instrument in the form of a tube designed to connect natural channels, body cavities, vessels with the external environment for the purpose of emptying them, introducing liquids into them, washing, or into the bladder.

Feminine

Catheterization is a medical instrument in the form of a tube, designed to connect natural canals, body cavities, vessels with the external environment for the purpose of emptying them, introducing liquids into them, washing, or the bladder in women is easier, since the urethra canal itself (synonym: urethra, lat. . urethra) - an unpaired tubular organ of the urinary (genitourinary) system of humans and other vertebrates, connecting the bladder - an area filled with some gas (usually round in shape), bounded by walls of some liquid with the external environment - short and wide. Her hole is clearly visible when the nurse spreads her labia. A woman's drainage tube is inserted to a depth of 5-6 cm, this is enough for urine to begin to flow through the catheter.

After the complete release of urine, the bladder is washed with furatsilin. Using a syringe that is attached to the catheter, the solution is supplied until the rinsing waters become clear.

Afterwards, the catheter is removed, turning it slightly around its axis to facilitate the process. The external opening of the urethra is again wiped with an antiseptic solution to prevent infections.

Childhood

Catheterization of the bladder in children is carried out with double caution so as not to damage the delicate tissues of the urethra canal (synonym: urethra, Latin urethra) - an unpaired tubular organ of the urinary (genitourinary) system of humans and other vertebrates, connecting the bladder with the external environment canal (synonym : urethra, Latin urethra) is an unpaired tubular organ of the urinary (genitourinary) system of humans and other vertebrates, connecting the bladder with the external environment. Children can break free and cry convulsively, thereby creating difficult working conditions for medical personnel. The procedure is performed only with soft, small-diameter catheters. To determine the size of the catheter for a child, divide his age by 2 and add 8.

The principle of implementation is according to gender characteristics, as in adults. They carefully monitor the sterility of staff’s hands and instruments, since the child’s immunity is not yet sufficiently developed, there is a risk of infectious inflammation.

Videos about catheterization in children can be viewed on the Internet.

Complications

If the technique is not followed, various consequences are possible:

infections, including urethritis, cystitis, pyelonephritis, carbuncle, etc.;
paraphimosis caused by inflammation and swelling of the foreskin after catheterization;
perforation of the urethral canal (synonym: urethra, Latin urethra) - an unpaired tubular organ of the urinary (genitourinary) system of humans and other vertebrates, connecting the bladder with the external environment, the creation of fistulas;
bleeding;
non-infectious complications of short-term and long-term catheterization are a medical instrument in the form of a tube designed to connect natural channels, body cavities, vessels with the external environment for the purpose of emptying them, introducing liquids into them, washing them, or include accidental pulling out of the catheter, clogging it with blood clots. But this is observed much less frequently than infection of the urinary tract.

With high-quality manipulation and thanks to the wide variety of this type of medical device, bladder catheterization is now actively used for various diseases, significantly facilitating diagnosis and treatment, as well as improving the patient’s quality of life.

Inserting a catheter into a man's bladder through the urinary (urethral) canal is a fairly commonly used medical procedure. This method is widely used for diagnostic and therapeutic purposes. A bladder catheter in men can be installed for a short period of time, as a rule, it is necessary during long complex surgical operations or for the long term. Long-term catheterization is often carried out in diseases, in cases where the physiological act of urination is difficult or impossible, for example, with prostate carcinoma.

Knowledge of the anatomy of the male urethra is important for all specialists performing this procedure - catheterization of the bladder, an area filled with some kind of gas (usually round in shape), bounded by walls of some kind of liquid, is one of the most commonly performed in the healthcare field. The male urethra is very susceptible to various pathological conditions: from traumatic infectious to neoplastic. Pathophysiological processes in the urethra can have catastrophic consequences, such as renal failure or infertility. Therefore, catheterization is a medical instrument in the form of a tube, designed to connect natural channels, body cavities, vessels with the external environment for the purpose of emptying them, introducing liquids into them, washing them, or a medical instrument in the form of a tube, intended to connect natural channels, body cavities, vessels with the external environment for the purpose of emptying them, introducing liquids into them, washing them, or should only be carried out by an experienced specialist.

Indications and contraindications

A catheter is a medical instrument in the form of a tube, designed to connect natural channels, body cavities, vessels with the external environment for the purpose of emptying them, introducing liquids into them, rinsing, or the bladder in men is installed for the following diagnostic indications:

Obtaining a urine sample for subsequent studies directly from the bladder cavity. This is often necessary to determine the species composition of the microflora found in it.
Constant monitoring of the amount of excreted urine or urine (lat. urina) - a type of excrement, a waste product of animals and humans, excreted by the kidneys and its organoleptic characteristics in the process.
Study of urinary tract patency.

Therapeutic catheter placement includes the following reasons:

Acute retention of urine, for example due to benign prostatic hypertrophy, blockages in the bladder neck or urethra.
Chronic obstruction caused by hydronephrosis.
Irrigation of the inner walls of the bladder with drugs.
Intermittent decompression of the neurogenic bladder. Catheterization in this case is an integral part of therapy.
Ensuring urine excretion in patients for whom organizing the physiological act of urination presents certain difficulties. Often required in bedridden patients.

In some cases, a bladder catheter in men may not be recommended or completely contraindicated. This is relevant when:

Fractures of the penis.
Injuries of the lower urinary tract - urethra, cervix or bladder sphincter.
Other injuries in the pelvic area, in which the insertion of a catheter is a medical instrument in the form of a tube designed to connect natural channels, body cavities, vessels with the external environment for the purpose of an ideal or real object of the subject’s conscious or unconscious desire; the end result that the process is intentionally aimed at; “bringing it to the point of completely emptying them, introducing liquids into them, washing them, or may be difficult or provoke additional disorders: extensive deep hematomas in the perineal area, bone fractures, and so on. In this case, the introduction in the proper sense - preliminary messages of a general nature, preceded by a work, usually of a scientific nature, in order to introduce the reader to the subject of the catheter, is necessarily preceded by a retrograde urethrogram.

Methodology

Urethral catheterization in men is associated with certain difficulties in the procedure, which is due to the anatomical structure of the urinary tract. The male urethra is longer and narrower in diameter, which, among other things, requires additional anesthesia.

In addition, due to the tenderness of the mucous membrane of the urethra, catheterization must be carried out carefully to avoid unnecessary pain and injury. Internal damage to the urethra is fraught with the development of purulent-necrotic inflammatory processes, which can lead not only to problems with urination in the future, but also to disorders of reproductive functions.

The urinary catheter is placed with the patient lying on his back, with his lower limbs slightly apart. The man's pelvic area is covered with a sterile napkin, in which a hole is cut to allow the penis to emerge. The entire procedure is carried out under antiseptic conditions.

Local anesthesia of the urethral canal is carried out with 2% lidocaine gel, which is injected immediately before catheterization into the external opening of the male urethra. Many modern bladder catheterization kits include a gas-filled area (usually round in shape) bounded by walls of some liquid that includes a syringe with an appropriate plastic needle filled with anesthetic. After lidocaine is administered, the opening of the urethra is pinched with your fingers for a couple of minutes to prevent the medication from leaking out.

Catheterization is carried out using urinary catheters, a medical instrument in the form of a tube designed to connect natural channels. An elongated, artificially limited space intended for organizing communication, transferring or moving something, body cavities, vessels with the external environment for the purpose of emptying them, introducing them into one’s own body. sense - preliminary messages of a general nature, preceded by a work, usually of a scientific nature, with the goal of an ideal or real object of the conscious or unconscious aspiration of the subject; the end result that the process is intentionally aimed at; “bringing the opportunity to fully introduce the reader to the subject of liquids in them, washing, or, which are ordinary tubes of narrow diameter, made of various materials. The most commonly used catheters are latex or pure silicone, coated with a silver alloy and impregnated with antibiotics. The inner end of the tube is sealed, and there are several holes on the sides. On the outside of the catheter, as a rule, there are two branches: a sleeve for connecting a urine bag and a plugged outlet for collecting urine for analysis.

Immediately before insertion, the man’s penis is retracted slightly, the foreskin is placed over the head and squeezed to open the opening of the urethral canal. Then the inner end of the catheter is slowly inserted into the urethra with twisting movements. During insertion of the catheter, the outer edges of the urethra are covered with sterile cotton swabs soaked in a disinfectant solution.

After visual confirmation of the receipt of urine or urine (lat. urina) - a type of excrement, a waste product of animals and humans, secreted by the kidneys into the catheter tube, its administration is stopped. It is worth noting that the anesthetic gel can clog the catheter inlets at its inner end during insertion. Therefore, if urine does not come out, aspiration with a syringe is possible. If this does not bring results, the catheter is removed and catheterization is repeated under ultrasound control.

After a successful introduction in the proper sense - preliminary messages of a general nature, preceded by a work, usually of a scientific nature, in order to introduce the reader to the subject of the catheter, the penis is lowered, the outer end of the tube is secured to the patient’s skin on the inside of the thigh.

Possible complications

In general, catheterization of the bladder in men is not particularly difficult for professionals, but in some cases the following complications caused by medical error are possible:

Infectious inflammatory processes in the urinary system: urethritis, cystitis, pyelonephritis, carbunculosis, transient infections.
Paraphimosis due to the foreskin pinching the penis below its head. Catheterization is performed only with the foreskin raised.
The creation of false canals is physical damage to the urethra by a catheter.
Strictures, urethral perforation.
Bleeding.

Additional complications of the non-infectious type include catheter loss, blockage and urine leakage past the artificial channel. An elongated, artificially limited space intended for organizing communication, transferring or moving something catheter.
The most important thing when determining the need for bladder catheterization is to take into account the reasons, clinical indications and contraindications. If such a medical procedure is still necessary, it must be carried out extremely carefully and contact an experienced specialist to avoid complications. Act thoughtfully and carefully, because health is the most valuable thing a person has.

Tools used

According to medical standards, when performing catheterization in women, a physician must use the following instruments and consumables:

sterile soft catheters of different sizes;
tweezers;
urine collector;
tray for used tools;
sterile wipes and cotton balls;
disposable syringes (for administering medicinal solutions);
medical gloves;
oilcloth;
furatsilin in the form of a solution;
glycerin or petroleum jelly.

How does catheter placement occur in men?

The procedure is carried out with the consent of the patient (if he is conscious), and the medical staff is obliged to inform about how the manipulation will be carried out and why it is needed. Most often, a flexible catheter is inserted.

Due to the pain and risk of injury, transurethral drainage with a metal catheter is rarely performed and only by an experienced urologist. Such manipulation is required for strictures (pathological narrowings) of the urethra.

To carry out the procedure with a flexible catheter, the nurse prepares sterile instruments and consumables:

gloves;
disposable catheter;
medical oilcloth;
forceps for working with consumables;
tweezers for inserting a catheter;
sterile dressing material;
trays;
Janet syringe for rinsing the bladder.

Before the procedure, the health care provider must inform the patient about the upcoming catheterization

Pre-sterilized petroleum jelly, a disinfectant solution for treating the hands of medical staff, for example, Sterillium, a solution of furatsilin or chlorhexidine for disinfecting the penis are also prepared. Povidone-iodine can be used to treat the urethral outlet, and Kategel (gel with lidocaine and chlorhexidine) can be used for local anesthesia.

If there is a strong spasm of the sphincter (closing muscle) of the bladder, preparation is carried out before the procedure: apply a warm heating pad to the suprapubic area and inject an antispasmodic - a solution of No-shpa or Papaverine.

Gel Cathegel with lidocaine is intended for pain relief and prevention of complications during bladder catheterization

Sequence:

The patient is placed on his back with his legs slightly apart, having previously laid down an oilcloth.
Hygiene treatment of the genitals is carried out by wetting a napkin in an antiseptic solution, while the head of the penis is washed with a disinfectant solution from the opening of the urethra downwards.
After changing gloves, the penis is taken with the left hand, wrapped in a gauze cloth and straightened perpendicular to the patient’s body.
The foreskin is pushed down, exposing the urethral outlet, the area is treated with an antiseptic - Povidone-iodine or chlorhexidine, and Katedzhel (if available) is injected into the urethra.
Treat the end of the tube that will be inserted with Cathegel or Vaseline oil.
Using sterile tweezers, held in the right hand, the catheter is clamped at a distance of 50–60 mm from the beginning, the end is pinched between two fingers.
Carefully insert the end of the tube into the urethral opening.
Slowly move the tube along the canal, intercepting it with tweezers, while carefully pulling the penis up with your left hand, as if “stringing” it onto a catheter. In areas of physiological narrowing, short stops are made and the tube continues to be advanced with slow rotational movements.
There may be resistance when entering the bladder. In this case, they pause and ask the patient to take slow, deep breaths several times.
After inserting the tube into the cavity of the bladder, urine appears from the distal end of the catheter. It is poured into a tray provided.
If a permanent catheter is inserted with a urine bag, then after urine flows out, the fixing balloon is filled with saline solution (5 ml). The balloon will hold the drainage in the bladder cavity. After this, the catheter is connected to a urinal.
If you need to rinse the bladder cavity, this is done using a Janet syringe after the outflow of urine. Usually a warm solution of Furacilin is used.

Video: bladder catheterization technique

When determining significant resistance to the advancement of the catheter along the urethra, you should not try to overcome the obstacle by force - this can lead to serious complications, including rupture of the urethra. After 2 unsuccessful attempts to perform transurethral catheterization of the bladder, it is necessary to abandon it in favor of other techniques.

Catheterization with a rigid instrument requires even greater caution. The insertion technique is similar to catheterization with a soft tube. After standard hygienic treatment of the genitals, a sterile metal catheter is inserted into the urethra with the curved end downwards. Carefully move along the canal, pulling up the penis. To overcome the obstacle in the form of a muscle sphincter created by the bladder sphincter, the penis is positioned along the midline of the abdomen. The successful completion of the administration is indicated by the flow of urine from the tube and the absence of blood and pain in the patient.

Catheterization of the bladder with a metal catheter is a complex procedure that can lead to injury to the urethra or bladder

Traditionally, a catheter is inserted into the urethra of men without anesthesia, and to facilitate the sliding of the tube, it is simply treated with sterile glycerin or petroleum jelly. When my husband was in the urology department, the procedure was performed this way for the first time. Moreover, everything was done very quickly and rather roughly. The husband complained that there was very little pleasant about it. Severe discomfort during and after the procedure: burning, false urge to urinate, nagging pain in the lower abdomen. Going to the toilet for another two days was accompanied by noticeable pain. The next time we had to insert a catheter, we asked to use Katedzhel and a catheter of a smaller diameter. The manipulation was carried out by another nurse, and she acted very carefully: she advanced the catheter slowly, paused, giving the husband the opportunity to relax and breathe calmly. Anesthesia and the correct technique did their job - there was practically no pain and after removing the catheter, the discomfort went away much faster.

Consequences and complications of the procedure

There are two most common consequences that appear after catheterization:

damage to the walls of the urethra and the bladder itself (ranging from minor injuries to ruptures);
infection in the urinary tract and, as a consequence, the development of cystitis, urethritis and other similar diseases.

If there is a sharp rise in temperature, symptoms of intoxication and pain in the lower abdomen that occurs after catheterization, the woman should urgently seek medical help.

Possible complications

Catheterization of the bladder with a soft catheter in men is associated with a high risk of complications, and therefore should be performed only in cases where there are indications that require catheterization beyond doubt.

insufficient preliminary examination of the patient, missed inflammatory processes that provoked secondary infection of the urinary tract;
unscrupulous sanitary and hygienic measures for antiseptic and aseptic devices can cause inflammatory processes in the urethra and bladder;
technically incorrect execution leading to injuries and ruptures of the urethra

Video on the topic

And a visual reinforcement of information: about how catheterization of the bladder in women is carried out in the video in front of you:

Catheterization is an important and useful procedure that allows you to diagnose a disease or cure a particular ailment. In order for the manipulation to be successful and not cause complications, women need to trust their health only to qualified medical specialists.

In order to recognize and treat various diseases and dysfunctions of the female genitourinary organs, endoscopic manipulations are often performed, one of which is catheterization of the bladder of patients. This concept means the introduction of a special instrument into the specified organ through the urethra.

Design and types of catheters

A catheter is an empty thin tube made of soft or hard material. It consists of anterior, middle and posterior parts, which are respectively called beak, body and pavilion. The beak is made in the shape of a cylinder or cone; it can be either curved at an angle of 20–35° or straight. There are one or two holes on the front of the catheter.

The instrument pavilion has been slightly expanded. This is provided so that the catheter does not accidentally slip into the bladder entirely and can be attached to a flexible system. With the help of the latter, the organ is washed or irrigated with medicinal solutions.

Number 1 indicates the beak of the catheter, number 2 indicates the body, and number 3 indicates the pavilion.

The length of flexible catheters ranges from 22–38 cm, rigid ones - 11–16 cm. Short instruments are usually used for women.

Depending on the internal diameter, 30 calibers of catheters are produced. This size for each subsequent tool number is 1/3 mm larger than the previous one. The most commonly used catheters for adult women are 16- to 20-gauge catheters.

Depending on the type of material used, instruments can be hard, or rigid, or soft. The first ones are made of steel and have a smooth nickel-plated surface. Metal catheters do not change the angle of the beak.

Soft (elastic) catheters are less traumatic for patients; their administration is better tolerated. The material for them can be polyethylene or rubber. Elastic instruments made of polymers can change the angle of curvature of the beak when heated, taking the shape of the urinary tract.

Catheters are available for single use and reusable use. The former are stored in sealed sterile bags. The latter require special treatment and sterilization before each reuse.

Disposable urological catheters must be removed from the packaging before use.

Equipment required for the catheterization procedure

Let's look at what equipment should be used to carry out the catheterization procedure, so that not only a medical professional, but also a patient who does not have special knowledge can evaluate at this stage the quality of preparation for the procedure.

For catheterization the following will be used:

catheter directly;
tray;
2 tweezers;
gauze napkins and cotton wool (usually in balls);
syringes (10-20 ml);
forceps (a surgical instrument used to insert tampons into deep wounds, remove foreign objects, and conduct drainage);
latex gloves;
glycerin (usually in a bottle) or petroleum jelly;
solutions of furatsilin (1:5000) and potassium permanganate (1:10000);
ethyl alcohol (70%).

In addition, the procedure uses non-sterile parts such as

oilcloth,
diaper,
vessel.

As already mentioned, catheters can be either flexible or rigid.
Flexible (or soft) catheters are an elastic tube made of rubber, polyvinyl chloride, or other flexible material. The diameter of the catheter for the bladder is, as a rule, from 0.4 to 10 mm, the length of the catheter (for women) is 25-30 cm. The urethral end of the catheter is rounded, has oval slits on the sides, the outer end is widened or obliquely cut, for ease of administration of solutions and drugs.

Rigid catheters are made of metal and are intended for reusable use. Their design is similar to soft catheters, but the length is much shorter (female catheter - 12-15 cm).

Catheterization of the bladder in men is more difficult and painful than in women.

Polyuria is a disease that occurs in both adults and children. What kind of disease is this and how to treat it - you will find the answer to this question here.

Goals and objectives of the procedure

The purposes of performing bladder catheterization may be diagnostic, for example:

detection of residual urine;
calculation of organ capacity;
infusion of a contrast agent into the bladder for subsequent X-ray photographs (cystograms);
monitoring urine output after any injury or surgery;
obtaining a portion of urine directly from the bladder for laboratory analysis.

The first two indications for diagnostic catheterization are appropriate when a safer method of examining the bladder - ultrasonography - was for some reason unavailable or did not provide comprehensive information.

This procedure can also be prescribed to perform therapeutic measures, such as:

releasing the bladder from urine during acute or chronic retention;
washing the mucous membrane of the organ from tumor decay products, pus, remains of stones and sand;
injection of medicinal solutions into the bladder for their local effect on the affected mucous membrane;
excretion of urine in paralyzed bedridden patients with dysfunction of the organs of the lower half of the body.

What is the procedure

Catheterization involves inserting a thin tube (catheter) through the urethra into the inside of the bladder. Manipulation can only be carried out by an experienced specialist - a urologist or a nurse with certain skills.

The procedure itself can be short-term or long-term:

For a short period of time, a catheter is installed during surgical interventions on the urinary organs or after surgery, as well as for diagnostic purposes or as an emergency aid for acute urinary retention.
A transurethral catheter is placed for a long time for certain diseases when urination is seriously difficult or impossible.

The advantage of the procedure is that thanks to it you can quite easily carry out certain diagnostic measures, for example, taking a portion of sterile urine for analysis or filling the bladder space with a special contrast agent for subsequent retrograde urography. Urgent drainage in some situations may be the only way to empty a full bladder and avoid hydronephrosis (a pathology characterized by dilation of the renal pelvis followed by atrophy of the parenchyma). For bladder diseases, transurethral catheterization is an effective way to deliver medications directly to the site of the inflammatory process. Urinary drainage through a catheter can also be part of the care program for seriously ill bedridden patients, especially the elderly.

Bladder catheterization is performed for diagnostic and therapeutic purposes.

The disadvantages of the procedure include a high risk of complications, especially if the catheter is inserted by an inexperienced healthcare worker.

Excretion of urine can be carried out using different devices. Catheters that are placed for a short time can be soft (flexible) or hard:

Flexible ones are made of rubber, silicone, latex, they come in different sizes. The Tieman or Nelaton models are most often used. They can be placed by a mid-level health worker with experience in performing such manipulations.
Rigid catheters are made of metal - stainless steel or brass. Only a urologist can introduce such a design. Rigid catheters are used only at one time.

A metal catheter can only be inserted by a urologist.

Indwelling catheters, intended for long-term use, can be of different shapes and configurations - have 1,2 or 3 strokes. Most often, a latex Foley catheter is installed, which is fixed in the lumen of the bladder by a small balloon filled with sterile saline solution. Due to the risk of complications (urethritis, prostatitis, pyelonephritis, orchitis), it is recommended to leave the catheter in the urethra for no longer than 5 days, even if accompanied by antibiotics or uroantiseptics. If longer-term use is required, designs with nitrofuran coating or silver plating are used. Such devices can be changed once a month.

Soft catheters come in different models and sizes

There is another method of draining the bladder - through a puncture in the abdominal wall. For this purpose, special suprapubic devices are used, for example, a Pezzer catheter.

Catheterization of the bladder can be not only transurethral, but also percutaneous suprapubic

How is female catheterization performed?

A woman's urethra is several times shorter than a man's and much wider; it has a constant curvature. The urethra is directed from top to bottom along the anterior wall of the vagina to the pubic symphysis, ending with its external opening in the vestibule of the vagina. Due to these anatomical features, it is much easier for a woman to insert an instrument into the bladder than for a man.

Women have a short and wide urethra, so it is easy for them to insert a catheter

Preparation for manipulation

Catheterization should be preceded by a detailed interview and examination of the patient's medical history. The doctor finds out if she has cardiovascular diseases or allergies to the medications used; The results of laboratory tests of blood and urine are studied.

A gynecological examination of the genital organs is mandatory. This helps determine the tactics of catheterization in the presence of tumor formations in the female reproductive system or in case of congenital malformations of the latter.

Execution technique

The catheter is inserted into the bladder under antiseptic conditions. Before starting the procedure, the nurse performing the procedure treats her hands with an antiseptic and puts on sterile gloves and a mask.

Catheterization of the urinary organ in women can be carried out with either a rigid or a polyethylene device. To facilitate sliding along the urethra, the beak of the prepared instrument is lubricated with sterile petroleum jelly or glycerin.

The procedure is carried out in the following order:

The patient lies down on a couch or gynecological chair with her knees bent and her legs spread apart.
The woman's body is covered with a clean sheet, leaving the external genitalia visible.
A urine container is placed between her thighs.
The health worker stands on the right side of the lying woman.
Spreading the woman’s labia majora with the fingers of his left hand, with his right hand he toilets the external genitalia and the entrance to the urethra with a cotton swab dipped in a disinfectant solution.
If a soft catheter is used, the physician grabs it with sterile tweezers at a distance of 4–6 cm from the beak and inserts it into the urethra with smooth rotational movements. The outer part of the flexible instrument should be clamped between the outer fingers (little and ring fingers) of the right hand, or better yet, if an assistant holds it.
If the procedure is carried out with a female steel catheter, then it is taken in the right hand and carefully, without using force, inserted into the urethra.
Urine leakage from the outer end of the instrument serves as evidence that the catheter is located in the bladder. The biological fluid is discharged into a special tray.
If it is necessary to sanitize or irrigate the bladder after it has been emptied, a special large syringe filled with medication is attached to the catheter.
After completing the procedure, the device is carefully removed. If the patient’s condition allows, she is recommended to wash the external genitalia with a weak solution of potassium permanganate or chamomile decoction for 2–3 days after catheterization.

Sometimes there are cases when this manipulation must be done systematically or the device must be left in the urinary organ for a certain time. Women, unlike men, usually easily tolerate the long stay of a urological tube in the urethra; they are less likely to experience complications from the procedure.

Long-term urine diversion is carried out using a Foley balloon catheter. After the device is in the bladder, liquid is pumped into the balloon and, if indicated, the organ is washed with an antiseptic solution (potassium permanganate 0.3:1000 or Rivanol 1:1000). The flexible catheter is fixed with an adhesive tape on the patient's thigh and left in the bladder. After 5–6 days, it is removed and a new one is introduced, if necessary.

Video: placing a flexible catheter in a woman

Possible consequences

Due to the ease of performing the manipulation, women have practically no negative consequences. Sometimes, during insertion of the catheter, spasms or damage to the urethra may occur, accompanied by bleeding. In this case, the procedure must be stopped immediately. As a rule, this happens with strictures (scar narrowings) of the lower urinary tract, which are much less common in the fairer sex than in men.

If the nurse's instruments and hands are not properly sterilized, pathogenic microorganisms may be introduced into the urinary tract. The consequence of this is acute cystitis.

Another rare complication in female patients is the so-called urethral fever, which is expressed by chills and temperature fluctuations. This condition is treated with antibiotics and antipyretic drugs.

I am familiar with this procedure firsthand - I know from my own experience what bladder catheterization is. It was done to me after a complicated birth right on the maternity table. This was necessary to assess kidney function. I can only say one thing: after 14 hours of contractions and long-term stitching of ruptures, it cost me nothing to survive the insertion of a metal catheter into the bladder. I didn’t even feel it and didn’t immediately notice that there was some kind of cold instrument in my urethra. I lay with the catheter in the bladder for about an hour, after which the doctors took it out safely and said that urine was being released, which meant everything would be fine. If this procedure had happened at another time, maybe I wouldn’t have liked it, but immediately after giving birth I almost didn’t feel it.

Installing a catheter into the bladder is not the most pleasant manipulation for women, but you should not be afraid of it. With skillful and coordinated actions of the hands of a medical professional, it will not cause you the slightest discomfort. The procedure is needed for timely recognition and treatment of various diseases of the urinary system. For women, it is painless, and inserting the instrument into their bladder in the vast majority of cases does not cause any particular difficulties for medical personnel.

Execution algorithm

When performing a procedure such as bladder catheterization in men, the algorithm of actions is as follows:

the medical worker washes their hands and treats them with a disinfectant solution (0.5% chlorhexidine solution);
prepare the place for the procedure: all the instruments necessary for the procedure are placed in a sterile tray: catheters, the ends of which are pre-lubricated with sterile glycerin or vaseline oil, tweezers, sterile cotton balls soaked in furatsilin, sterile napkins, a Janet syringe with a heated furatsilin solution. A medical diaper is placed on the couch where the patient will be;
prepare the patient: he is washed, then placed on his back with his legs slightly apart and bent at the knees. A container for urine is placed between the legs;
the medical worker puts on sterile rubber gloves and stands to the patient’s right to perform the procedure;
the penis is wrapped in a sterile napkin below the head. The foreskin is retracted. The head of the penis is treated with a cotton ball soaked in a furatsilin solution in the direction from the urethra to the periphery;
open the external opening of the urethra with your fingers and pour in a couple of drops of sterile glycerin;
Using sterile tweezers, take the required catheter at a distance of 5-6 cm from the rounded end;
the catheter is inserted into the urethra 5 cm, then the catheter is intercepted with tweezers and inserted another 5 cm, while carefully pulling the penis onto the catheter;
the appearance of urine means that the catheter has reached the bladder. The tip of the catheter is lowered into a urine container;
at the end of urine output, a Janet syringe filled with 150 ml of furatsilin is attached to the catheter. Rinse the bladder until the fluid released from the catheter becomes clear;
the catheter is removed slowly with rotational movements;
the external opening of the urethra is again treated with a sterile cotton ball moistened with furatsilin.