How is catheterization performed? catheter into the bladder

Catheterization is the procedure of inserting a catheter (for men and women) into the bladder through the urethral canal. Catheterization is used quite often and is used for the purpose of diagnosis and therapy.

Rules for installing a catheter

The catheter can be installed for a short period of time, for example, a short-term installation of a catheter is necessary for surgical intervention, and for a long time, if the patient has difficulty urinating. The latter can be caused by certain diseases.

The male can be affected by various pathological processes resulting from infection, trauma, and neoplastic syndrome. Violation of urination can provoke the development of such unpleasant consequences as kidney failure and infertility. In this article, we will consider in detail the algorithm for bladder catheterization in men.

Indications for the procedure

The catheter may be inserted for diagnostic purposes:

To obtain samples of urine in the cavity of the bladder. Samples are further used in laboratory research, for example, to determine the microflora of the bladder.
In order to determine the volume of urine that is excreted, to observe its organoleptic characteristics.
To determine the level of patency of the urinary tract.

During treatment

In addition, catheterization can be performed in the treatment of:

When restoring the urethra after surgery.
In the presence of decompression of the bladder.
In the presence of an acute urinary retention, which may occur against the background of urethritis, a pathological change that affects the prostate gland.
In order to treat the walls of the bladder with medicinal solutions.
With chronic obstruction, which can be caused by hydronephrosis.
For the purpose of excreting urine, if the patient is not able to perform the act of urination. For example, if the patient is in a coma.

The algorithm for catheterization of the bladder in men is quite complicated, but patients should not cause fear for their health, since experienced specialists are trusted to carry out this procedure.

Contraindications for catheterization

Despite the fact that there are many indications, catheterization can not always be performed. There are some contraindications:

The presence of blood in the scrotum.
The presence of bruising in the perineum.
presence in the blood.
Injured condition of the bladder.
Injured condition of the urethra.
Prostatitis in acute form.
Anuria.
Some diseases of the genitourinary system, for example, gonorrhea.
Spasm of the urethral sphincter.
Acute inflammatory processes occurring in the bladder or urethra.
Fracture of the penis.

Features of catheterization in men

Due to the anatomical features of the urethra in men, only experienced specialists should perform the catheterization procedure. Difficulties in carrying out catheterization arise due to the fact that the male urethra has a relatively large length, about 25 centimeters. In addition, there are two physiological constrictions in the urethra that prevent the free insertion of the catheter. Also, it is very narrow.

The greatest care must be taken if the procedure is performed using a metal catheter. If excessive force is applied during the manipulation, then the walls of the urinary system can be damaged, as a result of which the occurrence of false passages is not excluded.

The algorithm for catheterization of the bladder in men must be strictly observed.

Instruments used in catheterization

For the catheterization procedure, you will need the following tools:

Algorithm for bladder catheterization in men

If the procedure is performed using a soft catheter, then the specialist should perform the following steps:

The health worker must first prepare their hands, wash them thoroughly, and treat with a disinfectant solution.
The patient is laid on his back, his legs are slightly pushed apart, while the knees should be bent. A tray is required between the legs, and a diaper is placed under the pelvic area.
The medical worker should put on sterile gloves, clasp the penis below the head with a sterile napkin. This will open the external opening of the urethra.
Next, you need to treat the head with a cotton swab, previously moistened with furacilin. Processing should be carried out in the direction from the urethra to the edge of the head.
By squeezing the glans penis, it is necessary to open the external urethral opening. After the hole has opened, a few drops of sterile glycerin are poured into it.

With the help of tweezers, the catheter is captured, and its rounded hole is moistened with vaseline oil or glycerin. The catheter is then inserted into the open urethral opening. With the help of sterile forceps, the first five centimeters of the catheter are inserted, while holding the head.

Immersion of the catheter

It is necessary to immerse the catheter into the urethra slowly, intercepting it with tweezers. In this case, the penis must be pushed onto the catheter with the free hand. This technique will allow you to move the catheter through the urethra with greater ease. In the area at the junction of the membranous part and the spongy part, slight resistance may occur. If it occurs, then it is necessary to pause for two to three minutes to wait for the disappearance of muscle spasm, and then continue the introduction of the catheter.

Physiological narrowing is also present at the entrance of the urethra to the bladder. In this area, the occurrence of re-introduction of the catheter is not excluded.

After the first portion of urine appears, the opposite tip of the catheter must be lowered into the urinal.

Before the end of urination, the bladder must be washed. After that, observing safety measures, the catheter is carefully removed.

After the end of urine output, a Janet syringe filled with a furatsilin solution is attached to the catheter, which is poured into the bladder cavity very slowly. The volume of the injected solution should be about 150 milliliters. After that, the catheter is directed into the tray to remove the liquid. The washing procedure should be carried out until the contents of the bladder become clear.

After flushing is completed, the catheter is removed from the urethra by performing gentle rotational movements. After that, the external opening of the urethra is re-treated with a cotton ball, pre-moistened in a solution of furacilin. At the end of the catheterization procedure, all instruments should be placed in a disinfectant solution.

If the use of a soft catheter does not allow the procedure, then the use of a metal catheter will be required. A similar procedure for introducing a urinary catheter should be carried out exclusively by a qualified doctor, because the technique is very complex, requiring special care and attention.

The patient is placed on his back, the opening of the urethra is treated. I turn the catheter down with the “beak” and advance it along the urethra until it reaches the bladder. To overcome the sphincter area, the penis should be directed along the midline. The catheter is inserted further, slowly moving the urethra in the direction of the instrument.

If the procedure is performed correctly, then there is a discharge into the urine container, while the patient does not experience pain. Due to the fact that catheterization with a metal catheter is quite painful and traumatic, it is rarely performed.

Complications during catheterization

In some cases, some complications may occur, for example:

Infection of the urinary system. As a result, pyelonephritis, cystitis, urethritis can develop.
Damage to the urethra, sometimes significant, up to perforation.

Complications may arise due to errors made when inserting a catheter, especially a metal one, or due to insufficient preliminary examination of the patient. Most often, complications arise as a result of a violation of asepsis.

Diagnosis and treatment of certain diseases of the urinary system require bladder catheterization. The essence of this procedure is the introduction of a special hollow tube into the organ cavity. This is usually done through the urethra, although in some cases the manipulation can be done through the anterior abdominal wall.

The catheter itself in the bladder is used to remove urine, flush the organ, or directly administer drugs.

Indications and contraindications

The main indications for catheterization are:

Urinary retention, which can be observed with prostate adenoma, blockage of the urethra with a stone, strictures of the urethra, paralysis or paresis of the bladder, provoked by lesions of the spinal cord, after surgical interventions, etc.
The need for a laboratory study of bladder urine.
The condition of the patient in which self-diversion of urine is impossible, for example, comatose.
Inflammatory diseases, in particular, cystitis. In such cases, washing the bladder through the catheter is indicated.
The need to inject drugs directly into the bladder.

However, the procedure may not always be performed even if indicated. Most often, this is prevented by acute inflammation of the urethra, which usually occurs with gonorrhea, spasm or trauma to the urinary sphincter.

Attention! Before performing catheterization, the doctor must be sure to report all changes in his condition, without hiding anything.

How is the procedure carried out

Today, doctors have two types of catheters at their disposal:

soft (rubber), having the form of a flexible thick-walled tube with a length of 25-30 cm;
rigid (metal), which are a curved tube 12–15 cm long for women and 30 cm for men with a rod, a beak (curved end) and a handle.

In most cases, catheterization of the bladder is performed with a soft catheter, and only if it is impossible to implement it, a metal tube is used. The patient is laid on his back, a small pillow is placed under the buttocks, which can be replaced with a towel folded several times, and the patient is asked to spread apart and bend his knees. A container is placed at the perineum to collect urine.

As a rule, the procedure is performed by a nurse, the help of a doctor may be required only when installing a metal catheter for men. She must carefully treat the hands and genitals of the patient in order to avoid infection. The tube is inserted as carefully as possible so as not to injure the delicate walls of the urethra.

Attention! The procedure is performed exclusively with a sterile catheter, the packaging of which has not been prematurely damaged.

During instillation, the drug is injected through the catheter into the cavity of the bladder, after which the tube is immediately removed. If it is required to flush the bladder in order to remove pus, small stones, tissue decay products and other substances, an antiseptic solution is injected into its cavity through the installed catheter using a Janet syringe or Esmarch's mug. After filling the bladder, its contents are aspirated and a new portion of the solution is injected. Washing is carried out until the sucked liquid is completely clean.

Important: after washing the bladder, the patient should remain in a supine position for half an hour to an hour.

Indwelling urinary catheter

In cases where a permanent catheter is installed in a patient, a urinal is attached to his thigh or by the bed, which is usually required at night or to collect urine from bedridden patients. In this case, you must carefully follow all the rules of hygiene in order to avoid infection of the urinary organs, and be as careful as possible with the probe, as sudden movements can cause it to be pulled out and cause injury. If the patient has any difficulties in caring for an indwelling catheter, he began to leak, his body temperature rose, or signs of inflammation appeared, you should immediately consult a doctor.

Features of conducting in women

Usually, bladder catheterization in women is quick and easy, because the female urethra is short. The procedure is carried out as follows:

The nurse stands at the right side of the patient.
She spreads her labia with her left hand.
Treats the vulva with water and then with an antiseptic solution.
Introduces the inner end of the catheter, previously lubricated with vaseline oil, into the external opening of the urethra.
Checks for discharge from the tube, which indicates that the procedure was performed correctly and the catheter reached its destination.

Important: the appearance of pain during the manipulation should be immediately reported to the health worker.

Bladder catheterization in women

Features of conducting in men

Bladder catheterization in men causes more difficulties than manipulation in women. After all, the length of the male urethra reaches 20-25 cm, it is characterized by narrowness and the presence of physiological constrictions that prevent the free insertion of the tube. The procedure is carried out as follows:

The nurse stands to the right of the patient.
Treats the glans penis with an antiseptic solution, paying special attention to the external opening of the urethra.
He takes the catheter with tweezers and inserts the end of the rubber tube, previously lubricated with glycerin or vaseline oil, into the urethra, holding the penis with his left hand.
Gradually, without violence, it advances it, resorting to rotational movements as necessary. Upon reaching the sites of physiological narrowing of the urethra, the patient is asked to take several deep breaths. This helps to relax the smooth muscles and make it possible to advance the tube further.
If during the manipulation a spasm of the urethra occurs, its execution is suspended until the urethra relaxes.
The end of the procedure is indicated by the leakage of urine from the outer end of the device.

Bladder catheterization in men with a soft catheter

If the patient is diagnosed with urethral strictures or prostate adenoma, insertion of a soft catheter may not be possible. In such cases, a metal device is introduced. For this:

The doctor stands to the right of the patient.
Treats the head and opening of the urethra with an antiseptic solution.
The left hand holds the penis in a vertical position.
The catheter is inserted with the right hand so that its rod maintains a strictly horizontal position, and the beak is directed clearly down.
Carefully moving the tube with his right hand, as if pulling the penis on it until the beak is completely hidden in the urethra.
Tilts the penis to the stomach, lifts the free end of the catheter and, maintaining this position, inserts the tube to the base of the penis.
Moves the catheter to a vertical position.
Slightly presses the index finger of the left hand on the tip of the tube through the lower surface of the penis.
After successfully passing the physiological constriction, the catheter is deflected towards the perineum.
As soon as the beak of the device penetrates the bladder, the resistance disappears and urine begins to flow from the outer end of the tube.

Hidden dangers

Although the purpose of bladder catheterization is to alleviate the patient's condition, in some cases the procedure can result in damage or even perforation of the urethra, as well as infection of the urinary organs, that is, the development of:

cystitis,
urethritis,
pyelonephritis, etc.

This can happen if asepsis rules were not followed during the manipulation, mistakes were made when installing a catheter, especially a metal one, or the patient was insufficiently examined.

Content

This procedure is prescribed for therapeutic and diagnostic purposes. A urinary catheter is introduced to patients with a variety of urogenital pathologies. Learn about the features of this medical manipulation in men and women.

Types of catheterization

Emptying the patient's bladder is carried out using a special tool that looks like a regular tube. In this case, depending on the condition of the patient, his age and the goals of the procedure, permanent or short-term (periodic) catheters are used. Regarding the former, we can say that they are used for continuous urine diversion. Periodic, or intermittent, devices are designed for a single collection of urine.

In addition, there are the following types of catheterization, or epicystostomy:

sterile - carried out permanently;
clean epicystostomy of the bladder - carried out at home;
using soft rubber tubes (set in most cases);
catheterization involving the use of hard metal instruments;
epicystostomy of the renal pelvis:
ureteral catheterization;
with access through the urethra or stoma (set after surgery);

Bladder catheterization technique

A nurse can insert a tube made of soft materials, while only a doctor can insert a rigid device. The technique of bladder catheterization involves strict adherence to the rules of septic and antiseptic, which is due to a multiple increase in the risk of secondary urogenital infection. Such consequences are very dangerous for a woman during childbearing.

Bladder catheterization algorithm

Epicystostomy in men and women is carried out the same way. At the same time, the bladder catheterization algorithm in patients of different genders still has its own characteristics. Differences are observed only in the technique of introducing the tube. In general, female epicystostomy is considered a simpler option for manipulation. The installation of a urinary catheter in men is carried out using a long tube and requires some patience from the patient. Nevertheless, with strict adherence to the algorithm of actions, the procedure does not cause the patient any pronounced discomfort.

Bladder catheterization in men

Some complexity of the technique of epicystostomy in the stronger sex is due to the long urethra and physiological constrictions that prevent the introduction of the tube. Bladder catheterization in men with a rigid device is performed only if there are special indications (adenoma, stenosis). It is important to say that in order to relax smooth muscles and ensure further advancement of the instrument, doctors often advise patients to take a couple of deep breaths during the procedure.

Urinary catheter for men

Representatives of the stronger sex have some structural features of the urethra. For this reason, the length of the urinary catheter for men reaches 25-40 cm. In addition, curved tubes are selected for the procedure, repeating the physiological characteristics of the patient's urethra. In addition, the male urinary catheter features a small tube lumen diameter. It is important to note that disposable type devices have recently been used for a single excretion of urine.

Insertion of a catheter into the bladder of a man

Before the procedure, the doctor conducts a short conversation with the patient, during which he explains to the patient the features of the manipulation. As a rule, the installation of a catheter in the bladder of a man, as well as its removal, does not cause pain. Nevertheless, the specialist should warn about the possibility of such sensations. In addition, the male catheterization algorithm is briefly explained to the patient, which is as follows:

The patient lies on the couch with his knees bent.
Before catheterization, an antiseptic is applied to the surface of the patient's glans penis. Sterile glycerin is instilled into the urethral canal, which also processes the end of the tube.
A vessel is placed between the patient's legs to collect urine. When performing a permanent epicystostomy, the patient is knowingly explained what care for the catheter in the bladder includes, and at the end of the procedure, a urinal is installed. It is worth saying that often after surgery, patients are offered to remove the stoma.
During catheterization, the doctor takes the tube with sterile tweezers at a distance of about 6 cm from the edge and begins to gradually insert it into the patient's urethra. To avoid uncontrolled urination, the urologist holds the head of the penis, slightly squeezing it.
When the urethral catheter reaches its intended destination, there is a release of urine.
After removing the biological fluid, the tube is connected to a special syringe with a solution of furacilin, through which the doctor flushes the organ. As needed, catheterization can be used to treat urogenital infections with antibiotics and other medications.
After the doctor has flushed the bladder through the catheter, the device is removed from the urethra. The removed tube is disinfected. To avoid complications after catheterization, removal of the flushing device is carried out only after the removal of air or water from the fixing balloon.
Residual moisture in the form of drops of urine and solution is removed from the genitals with a napkin from a sterile individual set. Within an hour after completion of the procedure, the patient should be in a horizontal position.

Bladder catheterization in women

Epicystostomy in women is considered a simpler option for manipulation, which is due to the presence of a shorter urethral canal compared to the male. In addition, the procedure takes much less time. Bladder catheterization in women in most cases passes without any complications. It is worth noting that when working with ladies it is especially important to create a trusting environment.

Urinary catheter for women

The procedure for the fairer sex is carried out using a short (up to 15 cm) direct device and a syringe, through which the doctor flushes the excretory organ. At the same time, the urinary catheter for women is wider in diameter. In fact, the type of epicystostomy, as well as the nature of the flush, are determined taking into account the age and concomitant diseases of the patient. If the doctor ignores individual characteristics, a variety of complications can occur: from kidney disease to rupture of the urethral canal with subsequent blood poisoning.

Video: Foley catheter placement algorithm

Attention! The information provided in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and give recommendations for treatment, based on the individual characteristics of a particular patient.

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The catheter is made in the form of a drainage tube, which is installed in the human urinary tract by medical personnel. Depending on the gender of the patient and the material used for the manufacture of the device, the installation procedure must be carried out by a qualified specialist and in accordance with the rules.

Catheterization is used in urology for the treatment of patients suffering from diseases associated with a violation of the outflow of urine.

What are catheters

Devices are classified according to several factors, divided into male and female, which differ in length, diameter and shape.

According to the material of manufacture, types of urological tubes are distinguished:

elastic or rubber (Timman);
soft or latex, silicone (Foleya, Pezzera);
hard - plastic (Mercier, Nelaton) and metal (brass or stainless steel). They are installed in the case of the procedure with other types of catheters.

Catheters can be made from various materials

Elastic and soft devices look like a transparent tube with a funnel at the end and are distinguished by a small diameter.

According to the installation time, the types of the device are distinguished:

permanent. When installing this type of device, it is necessary to perform daily hygienic washing of the external opening of the urethra, as well as to observe the toilet of the external genital organs after urination. All patients are taught the rules for flushing the urological system. Suprapubic catheters, which are inserted through the abdominal wall, must be changed every 4 weeks.
short-term or one-time. It is made of latex or metal (the attending physician is allowed to insert a catheter) and is used for a single need for catheterization.

Catheters differ in the installation time

Depending on the place of installation, catheters are divided into:

internal - introduced into the human body;
external - one end remains outside;
single-channel, two-channel and three-channel.

Male and female devices are made in accordance with the anatomical features of the sexes. The first devices are made narrow, long (up to 30 cm) and flexible, while the second ones differ in diameter (caliber), 12-15 cm long and the absence of bends.

Based on the diagnosis, age and gender of the patient, the doctor selects a urological catheter.

Indications for holding

The introduction of a catheter into the patient's body is carried out for therapeutic purposes in the following cases:

urinary retention;
blockage of the urethral canal to prevent hydronephrosis;
the introduction of drugs to the focus of the inflammatory process;
tumors in the urethra;
washing to remove pus and remnants of stones from the bladder;
surgery and the use of epidural anesthesia.

The catheter is inserted into the patient's body for therapeutic purposes.

This manipulation is performed when pathologies such as prostate adenoma, urolithiasis, glomerulonephritis, tuberculosis of the genitourinary system, urolithiasis, bladder paralysis are detected.

For diagnostic purposes, catheterization is performed for:

taking samples of clean urine, uncontaminated by external bacteria, which makes it possible to identify the cause and pathogenic agent of the disease;
visualization of the urinary organs by filling them with a certain contrast agent;
determination of the residual volume of urine and diuresis in the postoperative period.

As a hygiene product, this urological system is used to care for bedridden patients.

Equipment for the procedure

In order for the manipulation to install the device to be successful, you need to have medical materials and medicines:

catheter;
sterile gauze pads and cotton balls;
oilcloth and diapers;
tweezers (2 pcs.);
syringes 10 and 20 ml;
medical gloves;
vessel or pallet;
glycerin or vaseline oil;
antiseptic - furatsilina solution (1:5000);
anesthetic - 2% lidocaine in the form of a gel.

Before starting the treatment manipulation, the doctor explains the procedure to the patient. Then the genitals are disinfected with a bandage, tweezers and an antiseptic solution.

Manipulation in women

The female urethra, unlike the male one, has a shorter length and larger diameter, so the catheterization process is quick and easy.

The manipulation algorithm includes the following steps:

Hygiene of the genitals.
The woman is laid in a horizontal position on her back, her legs should be spread apart and tucked in.
The nurse is located to the right of the patient and spreads her labia with her left hand.
The vulva is treated with an antiseptic solution.
The tip of the catheter is lubricated with emollient oil and inserted into the urethra by 5-10 cm. If you feel pain, you should immediately inform the medical staff conducting the procedure.
A woman should remain in this position for at least 1 hour. To collect urine, a special container is placed between her legs.

Manipulation in women

Usually, in the fairer sex, the procedure is painless, and only when urinating can they experience slight discomfort. This is due to the fact that the tube during the introduction causes minor damage to the bladder mucosa, which causes burning during urination.

At the end of the process of outflow of urine, the bladder is washed with furatsilin through an attached syringe to the catheter. Then the device is taken out by slightly scrolling around its axis and the urethra is treated with an antiseptic to prevent infection.

Performing medical work in men

The urethra of the stronger sex is a narrow tube that has its narrowing, and is designed not only to remove urine, but also sperm. It is very sensitive to damage of a different nature, so catheterization is contraindicated in the presence of injuries to the urethra. The manipulation itself is more complex than that of the female and is performed in accordance with the following rules:

The outer part of the head and the foreskin are disinfected with a solution of furacilin, and it is important to hold the latter during the procedure in order to avoid injury.
The man lies down in the same position as the woman.
The medical staff is to the right of the patient and inserts the tube of the device to a depth of 6 cm, which is pre-lubricated with an emollient, into the urethra using tweezers. The penis must be held with the left hand.
Advance the catheter slowly by 4-5 cm, with extreme care, using rotational movements as necessary.
At the moment when the device reaches the constrictions, the man takes 2 deep breaths, which will ensure relaxation of the smooth muscles and allow the tube to be advanced. If a canal spasm occurs, the procedure is suspended until the urethra becomes relaxed.
If the device is placed correctly, urine should flow from the tube. A vessel is placed between the patient's legs to collect it.

When diagnosing a patient with prostate adenoma or urethral stricture, a metal system is used. The procedure has soy features:

During the introduction of the device, it is necessary to monitor the position of the rod, which should be horizontal, while the beak is turned down.
The movement of the tube is performed with the right hand and the penis is pulled onto it until the beak is hidden in the urethra.
Then the penis is lowered towards the abdomen, raising the free end of the device, and the device is inserted to the very base of the penis.
The catheter is placed vertically and the tube is pressed through the lower surface of the penis with the index finger.
As soon as the narrowing is passed, the device is tilted towards the perineum.
When the beak of the device is immersed in the bladder, urine outflow is observed.

At the end of the procedure, the same manipulations are performed as in women.

Possible Complications

Like many types of treatment, this manipulation can lead to the development of some complications that arise as a result of an erroneous diagnosis, choosing the wrong catheter, performing the procedure without following the rules, which entails injury to the walls of the urethra and bladder, as well as introducing various kinds of infections.

Cystitis is one of the possible complications

Main complications:

cystitis;
the formation of fistulas with perforation of the urethra;
bleeding;
pyelonephritis;
paraphimosis;
urethritis;
carbunculosis;
sepsis;
mucosal damage.

This procedure greatly facilitates the treatment and diagnosis of diseases, but not every patient agrees to it. This is due to a lack of understanding and lack of complete information in a person about how the catheterization process is carried out. The therapeutic effect of this manipulation has an invaluable effect on the human body, improving its well-being and preventing the development of dangerous complications in various diseases.

In the practice of a urological doctor, one often encounters such a device as a urinary catheter. It is a rubber tube or a system consisting of several tubes that is necessary for insertion into the lumen of the bladder if the patient does not pass urine for one reason or another or for other diagnostic purposes.

Most often, catheterization is needed by men who have diseases such as prostate adenoma or its malignant degeneration (prostate cancer). Against their background, there is a violation of the patency of the urethra, which leads to urinary retention.

What is bladder catheterization?

The main goal of catheterization is to restore the normal outflow of urine from the lumen of the bladder, which normalizes all urodynamic processes and prevents a number of the most dangerous complications for the patient's life.

The catheter is inserted into the external opening of the urethra, after which it gradually moves along the urethra and reaches the lumen of the bladder. The appearance of urine in the catheter is evidence that the procedure was performed correctly and successfully.

Catheterization should only be performed by a qualified medical professional (doctor or paramedic).

Although the catheterization technique is quite simple to perform, some skill is required to perform it correctly.

When performing bladder catheterization, it is important to observe a number of the following basic conditions:

the introduction of a catheter into the urinary canal (urethra) should be done carefully, without the use of rudeness and violence;
the procedure begins with the use of elastic devices (Tieman or Mercier type catheter);
in order to minimize possible damage to the walls of the urethra, it is necessary to use a large diameter catheter;
a metal catheter is inserted into the patient only if the doctor who performs the manipulation is fluent in this skill;
if any pain occurs during catheterization, it must be stopped, and the patient should be immediately hospitalized in a hospital;
if the patient has acute urinary retention, but the introduction of a catheter into the bladder is impossible (there are contraindications), then resort to percutaneous cystostomy.

Types of catheters and their classification

Previously, only metal (rigid) catheters were used for catheterization, which led to frequent complications (mucosal injuries, ruptures, etc.). Currently, silicone (soft) and rubber (elastic) devices of different diameters have become widespread.

There are catheters for men (their length is about 30 cm) and for women (its length is 15-17 cm).

The following types of devices are used:

Nelaton's catheter(used for catheterization for a short period of time, for the purpose of one-time drainage);
Foley catheter (introduced for a long period of time, has several passages through which drugs are simultaneously administered and urine is excreted);
Timan stent (a device used by urologists for diseases of the prostate gland, well accepts the bends of the urethra).

The catheter is chosen depending on the purpose of its use.

Procedure technique

In order to carry out the catheterization procedure, in accordance with all the rules of asepsis and antisepsis, it is necessary to carry it out in a specialized hospital, using modern antiseptics, sterile devices, medical disposable gloves, etc.

Bladder catheterization in a woman

The manipulation algorithm is as follows:

The woman is laid on her back, asked to bend her knees and spread them apart.
The female genital organs are carefully treated using antiseptic solutions, after which the vaginal inlet is lined with sterile wipes.
A well-lubricated urine catheter is inserted with the right hand until it appears (about 4-5 cm).
If urine suddenly stops flowing, this may indicate that the device has rested against the wall of the bladder, so you need to pull the catheter back a little.
After the end of the manipulation, and the complete outflow of urine, it is necessary to carefully bring the catheter out, and again treat the lumen of the urethra with an antiseptic solution.
The patient is required to be in a horizontal position for an hour.

The procedure is carried out only by qualified specialists

During pregnancy, there are situations when a woman needs catheterization, for example, when a calculus is advanced, and blockage of the lumen of the urinary tract, which leads to acute urinary retention, as well as before the upcoming caesarean section.

The condition requires immediate hospitalization and observation of the woman only in a specialized hospital.

In men, catheterization complicates the anatomical structure of the urethra, namely its small diameter, significant length, tortuosity, and the presence of physiological narrowing.

The algorithm for the procedure is as follows:

The man is laid on his back (legs do not need to be bent at the knees).
The penis and inguinal region are lined with sterile wipes around the entire perimeter.
With the left hand, the doctor pulls back the foreskin, exposing the lumen of the urethra, and at the same time pulls the penis perpendicular to the surface of the patient's torso. The head of the penis and other male genital organs are carefully treated with antiseptic solutions.
The pre-lubricated catheter is inserted with the right hand, all movements should be smooth and uniform, while the doctor should apply only a small effort in places of anatomical narrowing (the patient is asked to relax as much as possible).
Periodic palpation of the tip of the catheter is recommended, especially if there are obstacles in its path, until urine passes through it (an indication that it has reached the lumen of the bladder).
When the procedure is completed, the catheter is removed, and the lumen of the urethra is re-treated with an antiseptic solution. The patient needs to be in a horizontal position for an hour.

Abduction of the penis perpendicular to the male body allows for maximum straightening of the anterior urethra

Bladder catheterization in a child

In general, the technique of catheterization in children does not differ significantly from the procedure performed in adults. It is carried out in order to restore the normal outflow of urine, and eliminate all signs of acute urinary retention.

The introduction of a catheter to a child requires special care and accuracy, since they have a high risk of damage to the mucous membranes, up to a complete rupture of the wall of the urethra or bladder. That is why a smaller diameter device is used for catheterization of children, and if such a possibility exists, then the procedure is carried out under ultrasound or X-ray control.

Indications and contraindications for the procedure

Main indications for bladder catheterization:

development of acute urinary retention in various pathological conditions;
chronic retention of urine in the lumen of the bladder;
the state of shock of the patient, in which there is no possibility of independent discharge of urine;
the need to determine the exact volume of daily urine in patients in the intensive care unit or intensive care unit;
determination of the volume of urine that remains in the patient after the act of urination;
the introduction of substances-contrasts (required for cystourethrographic examination);
washing the lumen of the bladder with solutions of antiseptics or antibiotics;
to remove blood clots from the bladder;
carrying out a number of diagnostic procedures (for example, taking a urine test for its further sowing on nutrient media, when natural delivery is impossible or difficult).

The most common cause of urinary retention in men is prostate adenoma.

The following pathological processes can serve as a contraindication for catheterization in men and women:

inflammatory process in the tissues of the prostate gland (acute prostatitis or exacerbation of its chronic form);
inflammatory process in the testicles or their appendages;
abscesses of the prostate or other volumetric formations in it, leading to a sharp narrowing of the lumen of the urethra, when the introduction of a catheter is impossible;
infection of the urethra (acute urethritis or exacerbation of a chronic process, when the edematous component is pronounced);
traumatic damage to the urethra or its sharp deformation against the background of strictures (the introduction of a catheter may lead to a rupture of the urethral wall);
severe spasm of the external sphincter of the bladder (for example, against the background of impaired innervation in case of damage to the lumbar spine);
contracture of the cervical part of the bladder.

Complications after manipulation

As a rule, if catheterization is performed by an experienced specialist, and the patient does not have any pathological processes that make it difficult to move the catheter along the urethra, then complications are quite rare.

The most common adverse outcomes from the procedure are:

damage to the walls of the urethra or bladder, resulting in blood in the urine (hematuria);
accidental rupture of the wall of the urethra or perforation of the bladder (this occurs with a rough introduction of the catheter);
infection of the urethra or bladder (cystitis or urethritis develops);
a sharp decrease in blood pressure numbers (hypotension against the background of manipulation).

The male urethra has several anatomical curves, so rough and incorrect manipulation can cause a number of complications.

Catheter replacement or removal

If catheterization of the bladder is performed for a long period of time, then it often becomes necessary to replace the device. This happens in the following situations:

initially incorrectly selected size of the catheter, as a result of which there is a gradual "leakage" of urine;
blockage of the lumen of the device;
the appearance of severe spasms in the patient or other unpleasant sensations that require temporary removal of the catheter.

Removal of the device, as well as its insertion, should only be carried out by a specialist with a medical background in order to prevent any complications. The doctor disconnects the urine reservoir from the main tube. Using a large syringe attached to the outer opening of the tube, the residual volume of urine is withdrawn, then the catheter is removed completely. All movements should be smooth and cautious, any "jerks" should be avoided.

After removing the catheter, you need to leave the patient in a horizontal position for 20-30 minutes. At the same time, it is important to ask him for any discomfort, pain, etc.

If, after catheterization, the patient has bloating, blood from the urethra or other pathological symptoms appear, then it is necessary to find out their cause

Conclusion

Bladder catheterization is a manipulation that requires the intervention of only a specialist with a medical education.

Each patient who has a catheter requires constant monitoring. If any unpleasant symptoms appear, a diagnosis of this condition is necessary, and the question of its removal is decided only by a doctor.