Healthcare and Medicine Reference
In-Depth Information
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Do not pull the catheter back on the balloon - this can be
Suprapubic catheters
uncomfortable. Allow gravity to do the work for you!
Attach the appropriate catheter bag (Figure 18.4h). Before you
Suprapubic aspiration of urine and catheterisation was fi rst
described by Huze and Beeson in 1956 and advocated as a supe-
rior way to obtain a 'clean catch' of urine for bacterial culture. It
is a relatively safe procedure but should only be performed by a
competent healthcare professional.
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do so, do you need to send a urine sample, for example as part
of a septic screen? If so, remember to document on the lab
request form that it is a catheter sample of urine (CSU). Attach
the bag to the stand.
In uncircumcised males, make sure that you replace the
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Indications
Urinary retention.
foreskin back over the glans penis to prevent paraphimosis
(and document this in the notes).
Make sure the patient is comfortable, clean and dry before
Urine sampling in paediatrics.
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Phimosis.
leaving the bedside.
Dispose of all your waste from the procedure in yellow clinical
Chronic infection of urethra/periurethral glands.
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Urethral stricture.
waste bags.
Document the procedure in the notes including your name,
Urethral trauma.
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Post transurethral surgery.
grade, date, time, name of your chaperone, indications for
catheterisation, type of catheter inserted, volume of sterile
water inserted into the balloon, date that the catheter should be
reviewed and date when it should be removed or changed.
Resection of prostate.
Neuropathic bladder.
Contraindications
Known bladder tumour (can cause spread).
Potential complications (listed early to late)
Urethral trauma: reduced by using adequate lubricant.
Neobladder.
Empty/indefi nable bladder.
Haematuria: this should settle. If this starts after a catheter has
Lower abdominal surgery/scarring.
been in situ for some time it may require further investigation.
Urinary tract infections and pyelonephritis: treat with oral/
Pelvic irradiation.
Unfamiliarity with procedure.
IV antibiotics according to microbiology advice and consider
removing the catheter. Always send a 'catheter sample of urine'
(CSU). Note that the presence of bacteria in the urine alone does
NOT confi rm a UTI.
Debris and stone formation leading to catheter blockage - fl ush
Refusal of a competent patient.
Advantages over urethral catheterisation
Reduced urethral stricture formation.
Lower rates of infection - bacteriuria, pyelonephritis and urinary
the catheter and consider removing or changing it.
Traumatic hypospadias in long-term male catheters - always
sepsis.
Prevention of penile pressure necrosis.
examine for this, especially in the community. The patient may
then require suprapubic catheterisation.
Reduced interference with sexual function.
Possibly more acceptable to patients.
Step-by-step guide: insertion of suprapubic
catheter
Removal of catheter
A trial without catheter (TWOC) should generally be undertaken
in the morning so that if recatheterisation is required it can be done
during normal working hours.
Check in the notes how much water was inserted into the
ensure they consent to the procedure.
Set up your trolley (Box 18.2).
Give a full explanation to the patient in simple terms and
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Prepare your trolley as a sterile fi eld. Wear a plastic
balloon.
Clean around the urethral meatus and catheter itself.
disposable apron and non-sterile gloves, and take alcohol
hand rub with you.
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Use a 10-mL syringe to defl ate the balloon and ensure the same
volume comes out as was inserted.
Ask the patient to relax and take some slow breaths; this relaxes
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the pelvic fl oor muscles.
Remove the catheter as gently as possible - the defl ated balloon
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Give clear and simple explanations throughout. Lie the patient
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supine with the abdomen and pelvic area exposed. Children
should be held in a supine frog-legged position (assistance for
this will be needed). Wear sterile gloves and gown, considering
also personal protective equipment such as eye protection.
Palpate 2 cm above the symphysis pubis in the midline for a full
may cause discomfort in male patients as it passes through the
prostate so warn patients of this.
Dispose of the catheter and bag in clinical waste bins.
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Advise the patient that they are likely to experience urgency and
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urethral irritation when urinating but that this should settle in
24-48 hours.
Residual volumes should be measured by ultrasound after
bladder. This should be confi rmed by ultrasound and ideally the
procedure done under ultrasound guidance, with the transducer
covered with a sterile glove.
Clean the area using a circular motion and treat as a sterile fi eld.
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micturition and documented.
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