How to insert a catheter into the bladder of a woman. Catheterization in men - indications and algorithm for performing the procedure

19.10.2019 -

Bladder- serves to accumulate urine continuously coming from the ureters, and performs an evacuation function - urination. The size depends on the filling with urine, the capacity is from 250 to 700 ml. If for some reason the evacuation of urine is difficult, a urinary catheter- an elastic tube that is inserted into the urinary tract to drain urine.

In cases where a urinary catheter is required for a long time, it is necessary to install a cystostomy (epicystostomy) - the creation of an artificial outlet channel from Bladder surgically. The exit of the channel is in the suprapubic region. Indications for cystostomy appear, as a rule, when serious pathologies urinary tract:

inability to insert a catheter through the urethra if necessary long stay drainage in the bladder;
hyperplasia prostate benign;
unsynchronized work of the muscles of the bladder and its sphincter, which leads to stagnation of urine;
pelvic injuries with urethral ruptures;
operations performed on the urethra, penis

There is also intermittent catheterization with disposable catheters, you can read more about it in our blog

Types of catheters

There are several types of catheters, but the Foley catheter is now mainly used in medical urological practice. This is the most common and popular type of catheters.

This is a urinary catheter with an inflatable balloon for filling with a sterile liquid (water or saline solution), which fixes the catheter in the bladder. On the other hand, the tube is attached to a special container (package) in which urine accumulates.

Foley catheters can be different amount internal channels made of different material. They also differ in coverage. A silicone-coated latex dual-lumen catheter is an inexpensive option. The most expensive is a silver coated silicone catheter.

The advantage of a silver-coated silicone catheter is that the silver layer inhibits the growth of pathogenic microbes, reducing the likelihood of a urinary tract infection. Therefore, after the catheter is inserted, it can remain inside for a longer period. In this case, more high price means greater safety and reduced risk of infection during catheterization.

An uncoated silicone catheter can be used if there is an allergy to latex. Silicone itself has the ability to prevent the deposition of salts on the inner layer of the catheter.

Urine excretion is possible in two ways:
1. In the mode of constant opening of the locking device, urine outflow occurs in small portions into a bag-shaped urinal attached to the sleeve.
2. In the closed state, when the outflow of urine is carried out at once, for a certain period of time, directly into the toilet or storage bag.

Catheter replacement

On average, a month after the installation of a cystostomy, it needs to be replaced. This procedure is performed by a urologist. Depending on how much the patient's mobility is preserved, you can either come to medical Center for an appointment, or call a doctor at home. In the future, the timing of the replacement of the catheter is discussed with the doctor individually for each patient and depends on the type of catheter and how it is used, whether there are any complications. On average, at normal operation cystostomy catheter, it will need to be changed every 4-8 weeks.

Now doctors do not recommend washing catheters, it is much safer to change them, since when washing with antiseptic solutions, it is highly likely that the flora present on the walls will become resistant to these agents and if inflammation occurs, it will be very difficult to cope with it. Removal and replacement of cystostomy without fail is carried out by a doctor who additionally examines the injection site, makes appointments for the underlying disease.

Caring for a cystostomy (epicystostomy)

An indwelling catheter to remove urine from the bladder requires adequate hygiene care and compliance drinking regime.

The most important thing in care is keeping clean:

The free catheter tube must be kept clean, as should the catheter entry site in the lower abdomen. If there is no special doctor's recommendation for treatment, then the skin around the catheter should be washed. warm water with soap or wipe with a swab moistened with water 2 times a day.
You can take a shower, a bath is not recommended.
If there are no signs of inflammation around the catheter, the bandage can be omitted.

A person with a catheter needs to drink plenty of fluids in order to ensure that the volume and concentration of urine passing through the catheter is sufficient to prevent the formation of calculi, salt buildup and inflammation. The recommended volume is from 1.5 to 2.5 liters per day, or the volume that the attending physician allows, in the presence of any disease in which excess fluid is not indicated.

How to properly handle a urinal bag

The catheter and urinal should not be bent.
If the patient walks, the urinal is fixed below the bladder, on the thigh. If the patient is lying down, the urinal is fixed below the level of the body, but not on the floor. The location of the urinal should allow urine to drain into the bag and not fall back into the bladder.
Empty the urinal when it is half full. Change once a week on average, unless required sooner due to damage or clogging.

Training of the accumulative function of the bladder

When setting up and replacing the catheter, the urologist should talk about training the accumulative function of the bladder. It is carried out in order to maintain the contractility of the walls of the bladder. The mode of constant outflow of urine disrupts the functioning of this organ, it is important to periodically create conditions for its filling.

The training of the accumulative function of the bladder consists in clamping the drainage of the cystostomy, until the urge to urinate occurs. When an urge occurs, the drainage should be opened and the bladder should be emptied. This method has absolute and relative contraindications. It is impossible to start training without consulting a doctor, this can lead to serious complications.

Absolute contraindications, in these cases, training is prohibited:

Vesicorectal, urethroperineal and other fistulas
Spicy inflammatory process urinary tract
Gross hematuria and urethrorrhagia.

Relative contraindications:

Bladder atony
Bladder stones
Vesicoureteral reflux.

With relative contraindications, bladder training is practically impossible at home, as hardware diagnostics are required.

Patients with a cystostomy should immediately contact their healthcare professional if:

There is pain in the lower abdomen
Decreased amount of urine excreted
The color of urine changes, an admixture of blood or sediment appears, turbidity occurs, a sharp bad smell
If the catheter is clogged or damaged, it slips out of the bladder.

Finally, I would like to say that you can get used to the catheter. Of course, this creates certain inconveniences, but when the use of a catheter is necessary, with proper care and following the recommendations of the doctor, you can not lose the quality of life after its installation.

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 urethra, paralysis or paresis of the bladder, provoked by lesions spinal cord, after surgical interventions etc.
The need for laboratory research vesicular 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 prevents acute inflammation urethra, which usually occurs with gonorrhea, spasm or injury of 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.

Typically, the procedure is performed nurse, medical assistance may only be required when inserting 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 indwelling catheter, it began to leak, the 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 introduction of the tube. The procedure is carried out as follows:

The nurse stands to the right of the patient.
Treats the head of the penis with an antiseptic solution, giving Special attention 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 inserted. 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 push the tube right hand, as if pulling the penis on her 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.
Lightly presses index finger 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.

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 purpose 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 life of the patient.

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 they 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).

Apply the following types devices:

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.
Produce a thorough treatment of the female genital organs using antiseptic solutions, after which the inlet of the vagina is lined with sterile napkins.
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 stay in horizontal position.

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.

Catheterization is more difficult in men anatomical structure 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).
penis and groin area lined with sterile napkins around the perimeter.
With his left hand, the doctor pulls back foreskin, while exposing the lumen of the urethra, and at the same time stretches 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.

Penis abduction perpendicular male body allows you to straighten the anterior urethra as much as possible

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;
for the purpose of removing blood clots from the bubble
carrying out a number of diagnostic procedures (for example, taking a urine test for its further sowing on nutrient media, when naturally impossible or difficult).

most common cause the development of urinary retention in men is prostate adenoma

The following are contraindications for catheterization in men and women: pathological processes:

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 injury 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);
pronounced spasm of the external sphincter of the bladder (for example, against the background of impaired innervation in case of damage 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);
sharp decline in numbers blood pressure(hypotension on 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 a patient or other discomfort requiring temporary removal of the catheter.

The removal of the device, as well as its insertion, should only be carried out by a specialist with medical education 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 appears from the urethra or other pathological symptoms, 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.

Bladder catheterization is a manipulation performed using a catheter (a special rubber tube) inserted through the urethra.

The procedure is simple, but you must have special skills, carefully observe a number of requirements (including sterility).

The procedure is carried out in medical institutions, may be prescribed for diagnosis or treatment.

The need for catheterization occurs when:

holding laboratory diagnostics using bladder urine.
Administered medicines inside the bladder.
Determining the volume of residual urine.
holding surgical intervention using general anesthesia or epidural anesthesia.
Bladder lavage.
holding x-ray examination(special substances are injected into the bladder).
Inability to urinate naturally.
Retention (acute, chronic) of urine.

Tools Used

For catheterization in women, you will need:

2 soft catheters sterile;
2 cotton balls sterile;
2 sterile gauze wipes;
tray;
cortsang;
furacillin solution;
vaseline oil or glycerin;
container for urine;
oilcloth;
rubber gloves;
washing tools;
syringes (for the installation of drugs).

And here you will find out for the diagnosis of which diseases it is used CT scan kidneys. The essence of the procedure, indications and contraindications for carrying out.

Technique and procedure algorithm

The urethra of women is short, so the procedure is not difficult. Bladder catheterization is performed using a sterile catheter (rubber or metal).

The nurse can perform the catheterization procedure using only a soft catheter.

The nurse prepares for the procedure (washes her hands thoroughly, treats them disinfectant) and prepares the necessary tools (tray with sterile catheters, tweezers, sterile wipes).

The procedure consists of several stages:

An oilcloth is placed under the patient's pelvis and hips, they help to take a position (on the back with legs spread apart and bent at the knees). Place a container prepared for urine. Beforehand, a woman should be washed or douched so that vaginal discharge does not enter the urethra.
The nurse is on the right of the patient, puts a sterile napkin on the pubis, pushes the labia apart to expose the external opening of the urethra.
Performs treatment of the external genital organs of the patient, performing movements from top to bottom, using a solution of furacilin. After disinfecting the urethra, the nurse should change rubber gloves.
With his right hand, he grabs the catheter with tweezers and moistens its rounded end with glycerin or vaseline oil.
Inserts the catheter with light rotating movements into the urethra (by 4-5 cm), directing the free end of the catheter into the prepared urinal. If difficulties arise during the insertion of the instrument, it should be replaced with another (smaller) one.
The appearance of urine from the catheter indicates correct introduction and its presence in the bladder.
It is necessary to start removing the catheter from the bladder before the bladder is completely emptied (it is necessary that the stream of urine be able to flush the urethra after the catheter is removed). When the flow of urine stops, you can lightly press the bladder through the wall of the abdomen to release the remaining urine.
If it is necessary to take urine for culture, fill a sterile tube with urine and tightly close it with a sterile cotton swab. If it is required to measure the amount of residual urine, it is poured into a special container with markings. When carrying out the procedure for the purpose of installation, enter medicinal substance into the bladder and then remove the catheter. If the instrument was inserted to drain the bladder, then saline solution is injected into the balloon located at the end of the catheter.
Removal of the catheter is performed by rotating movements, then the external opening of the urethra is treated with a ball moistened in a solution of furacilin, and the remaining moisture is removed from the perineal area with a napkin.
Required strict observance asepsis and antiseptics to prevent the development of an ascending infection.

After the end of the procedure, the patient should be helped to stand up, and the used instruments should be placed in a disinfectant solution (the catheter is placed in a 3% chloramine solution for 1 hour, after which it is treated in accordance with the requirements).

Consequences and complications

The purpose of catheterization is to alleviate the patient's condition.

However, in some cases, damage to the urethra occurs, and in more severe cases, its perforation.

The procedure is performed without the use of anesthesia, so that the patient can report the occurrence of pain.

In the case of deep insertion of the catheter, its tip will rest against the wall of the bladder.

It is possible to damage the bladder during the insertion of the catheter if it is underfilled. To prevent such a situation, before the introduction, percussion (tapping) of the bladder in the area above the pubis should be performed.

Frequent catheterization in women can cause urethral fever, which develops as a result of microbes entering the circulatory system through areas of the urethra that have been damaged by medical instruments. It is characterized elevated temperature, intoxication of the body. To prevent such a complication, it is necessary to introduce a disinfectant solution into the bladder before removing the catheter from the urethra.

Complications that can occur during catheterization are due to a number of reasons:

use of force when inserting a catheter;
improperly placed metal catheter;
violation of the rules of asepsis during manipulation;
conducting an incomplete survey.

Main possible complications are considered:

trauma to the walls of the urethra (including complete break);
infection of the urethra with subsequent progression of urethritis, and later - cystitis and pyelonephritis.

Bladder catheterization with a soft catheter in women can reduce the likelihood of complications. Catheterization should not be performed on patients with infectious diseases urinary tract, with a damaged urethra.

Endoscopic methods are very effective in diagnosing diseases, since the doctor can assess the internal state of the organ with his own eyes. , indications, stages of carrying out and possible consequences, read carefully.

What is the rate of leukocytes should be according to the results of a urinalysis, you will find out in the block. As well as the reasons for the deviation from the norm.