Insert an indwelling catheter into the bladder. How and why is a catheter inserted into the bladder

Catheterization is the introduction of a special tube (catheter), which may have different shape and length, diameter and material of manufacture, into certain cavity structures or channels of the body for the purpose of treatment or diagnosis.

Kidney catheterization

Kidney catheterization is the introduction of a catheter into the ureter or pelvis. A similar procedure is performed using a special urethrocystoscope, through which the ureteral catheter is advanced. The procedure requires strict adherence to antiseptic and aseptic rules. Sometimes catheterization is prescribed for the purpose of probing or draining.

Why is a catheter placed?

In general, catheterization is indicated in the following cases:

1. To determine the ureteral patency and the degree of obstruction in it;
2. In order to obtain separate urine for the diagnosis of leukocyturia and determine its origin;
3. To eliminate urinary stasis;
4. Bougienage;
5. Bringing down stones;
6. For the procedure of retrograde pyeloureterography;
7. To restore urine output acute form pyelonephritis or ureteral stone occlusion.

Indications for the procedure may vary depending on the gender and age of the patient.

During pregnancy

Pregnant women are at risk of developing renal pathologies increases significantly, which is associated with changes in the urinary organs during the period of bearing a child. Kidney lesions adversely affect pregnancy and fetal health.

Catheterization for pregnant women may be prescribed in such cases as:

• Renal hydronephrosis;
• Chronic or gestational pyelonephritis.

Catheterization in pregnant women with pyelonephritis performs a serious therapeutic task - it saves the patient from renal blockade.

In men

The catheterization procedure in men is technologically more complex, since the length of the male urethra is longer than that of the female.

Indications for catheterization in male patients are:

1. urinary tract disorders;
2. Inflammatory processes in the urinary system (for the purpose of washing);
3. With chronic or acute urinary retention;
4. To obtain urine from the pelvis in order to study it in more detail;
5. For therapeutic purposes, the technique is used to introduce medicines.

A soft catheter is usually used, but if it is not possible to enter it, then a rigid tube is used, for example, with an adenoma prostate or strictures of the urethra.

Among women

In women, catheterization of the kidney and ureter, in addition to diagnostic purposes and some of the above diseases, can also be performed for acute nephritis and urolithiasis. When to do this, the attending physician decides.

If there are stones in the kidneys, the catheter helps to restore the urine flow, which is blocked by the stone.

Performing a procedure

Most often, in the process of catheterization, rubber catheters of different lengths and diameters are installed. The procedure is carried out using a cystoscope, at the end of which there is specialized equipment for the most accurate installation of the tube - the Albarran lift.

The microcamera on the device visualizes the progress of the catheter:

• Before a catheter is inserted, a cystoscope is inserted into the bladder, if the procedure is performed for men, then a solution is first injected local anesthesia. Before insertion, the urethral opening must be processed antiseptic.
• The cystoscope is thoroughly disinfected before insertion and treated with vaseline or glycerin oil.
• Women this procedure performed in a supine position with hips apart and knees bent.
• If necessary, the bladder cavity is pre-washed from bloody or urinary residues and filled with saline.
• Then they look for an exit to the ureter by rotating the microcamera of the cystoscope. When the ureteric orifice is located, the microcamera is brought to it so that it is enlarged and located directly in the center of the visual field.
• The catheter is then carefully inserted. Having reached the right place, it is fixed. How long the procedure takes depends on the goals.

As for how long a catheter is placed, it all depends on the purpose. For the purpose of diagnosis, the doctor receives the necessary biomaterial and removes the device back. If the procedure is carried out for therapeutic purposes, then the catheter can be left indefinitely, for example, for a gadfly from the urine pelvis. Then a special tube is used, which has loops at the end for better fixation.

If there are problems with urination, catheterization is carried out 6 r / day (every 4 hours). At prolonged wear catheter, an infectious process can occur, so the doctor periodically removes it, rinses it and sets it back. Please note that only an experienced specialist can flush the catheter.

The scheme of introducing a catheter into the kidney

Carrying out diagnostics and a therapeutic course in some cases requires the installation of a catheter in the patient's bladder. Most often, the tube is inserted through the urethra, but placement through the abdominal wall, located in front, is also possible. The catheter performs such important functions:

• removes urine;
• flushes the bladder;
• helps to administer the medicine.

See also: How is instillation done? Bladder

When a catheter can and cannot be used

Catheterization is used in such cases:

1. If urine does not pass or passes very weakly, not in full. This is observed with prostate adenoma, if the blockage of the urethra with stones is disturbing, the diagnosis is paralysis or paresis of the bladder, which appeared due to lesions in the spinal cord, after operations.
2. You need to examine the bladder urine.
3. The patient does not pass urine on his own, for example, if he is experiencing coma.
4. If the patient is concerned about cystitis, it is more effective to prescribe a bladder lavage through a catheter.

Do not rush to put a catheter, even if there is evidence for this. First, check the contraindications when it is dangerous to place a catheter:

• suffers from an acute inflammatory process affecting the urethra caused by gonorrhea;
• There is an injury to the urinary sphincter.

That is why experts advise patients to be extremely frank with their doctor. Otherwise, you can invite big trouble.

How to choose a catheter for a particular patient

Catheters are sold in pharmacies of two types:

• soft instrument - equipped with a flexible tube with thick walls, 25 to 30 cm long;
• rigid, in which metal is present. The tube is curved, for women - 12-15 cm long, and for men - 30 cm. The instrument has a rod, a beak and a handle.

The use of a rigid catheter is gradually becoming a thing of the past. The soft catheter does not injure the urethra and performs the same functions. The one who inserts the tube puts a disinfectant on his hands, otherwise you can bring an infection into the genitals of a sick man or woman. The tube is inserted as carefully as possible, the task of the nurse is not to violate the integrity of the walls of the urethra. Make sure that the catheter packaging is sealed!

How to put a catheter in a woman

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

1. The nurse enters to the right of the patient.
2. She spreads the woman's labia with her hand.
3. Apply water to the vulva and then add an antiseptic.
4. Further, an instrument pre-treated at the inner end with vaseline oil is inserted into the opening of the urethra, located outside.
5. Fluid should flow from the tube, if the discharge does not go away, the procedure must be repeated. If the patient has pain, the nurse should take this into account.

The subtleties of installing a catheter in the bladder of a man

The male urethra is longer and narrower. It may not be possible for everyone to freely insert a tube from the first eye. Follow these instructions:

1. The nurse should stand up from the patient right side.
2. The health worker treats the head of the penis with an antiseptic, you need to smear the external opening of the urethra well.
3. Glycerin or liquid paraffin is applied to the tube, after which it is grasped with tweezers and distributed in the urethra. The penis is supported with the left hand.
4. Push the tool a little, you can resort to translational rotational movements. In the supposed site of narrowing of the urethra, the man is asked to take a deep breath, he will relax the muscles of the smooth muscles, and the catheter will pass more easily.
5. If the patient complains of soreness in the urethra, stop and wait until the urethra is relaxed. Use the deep breath technique. The appearance of highlights indicates that the object has reached its final destination.

If soft tubing is ineffective

This happens if a man suffers from urethral strictures or is worried about prostate adenoma. If it is impossible to do without a tube that will bring out the discharge, they resort to the use of a metal tool.

Movements must be careful, haste can harm the patient:

1. The nurse takes a position to the left of the patient.
2. After treating the head and opening of the urethra with an antiseptic agent, the penis is positioned vertically.
3. With the free hand, the tube is inserted so that it takes a horizontal direction, the beak should look at the floor.
4. Advance the catheter right hand, as if pulling the penis on the instrument until the beak disappears into the urethra.
5. Point the penis towards the abdomen, lift the free end of the tube and, considering this position, insert to the base of the penis.
6. Next, the tube should be transferred to the vertical.
7. Lightly, with little effort, press down on the end of the tool, grabbing lower part sexual organ.
8. When the anatomical narrowing of the urethra is behind, the catheter is tilted towards the perineum.
9. When it enters the bladder, the resistance goes to "no", urine flows out of the tube.

Leave the handset in this position. It is impossible to rotate and move the instrument even further, this will lead to injury to the patient's bladder.

A visual video instruction on bladder catheterization is presented below:

pochkiguru.ru

Conducting bladder catheterization in men

Bladder catheterization is the installation of a special medical device that provides urine outflow directly into the cavity of the indicated organ. The measure is used in cases where the option of self-urinating a person is excluded - it is impossible due to various factors or is unacceptable according to the algorithm of specific manipulations. If in women the procedure can be performed by both a nurse and a doctor, then only a specialist with higher education and mastering the relevant practice to perfection.

Bladder catheterization in men to remove urine.

Indications

The catheter used in urological practice is flexible (rubber, silicone) and metal. The silicone product is installed in the organ of urination when it is necessary to ensure a long outflow of urine (during the operation and after it, when the man is unable to get out of bed to urinate on his own). A metal device is used only for one-stage manipulation - it is not installed for a long time.

The main indication for catheterization is acute urinary retention.

In each of the cases, the catheter is used in cases where the patient:

• acute urinary retention (more often with prostate adenoma);
• there is a need to pass urine for subsequent bacteriological or other research;
• complications due to the existing infectious process.

Violation of the outflow of urine, which is fraught with the development of dropsy of the kidney, occurs as a result of such reasons:

• emerging prostate adenoma;
• stenosis of the urethra pathological condition, at which there is a narrowing of the lumen of the urethra);
• the presence of stone-like deposits inside the urethra (rare);
• glomerulonephritis (inflammatory process covering the glomerular system of the kidneys);
• blockage of the urethra due to a tumor process;
• tuberculosis of the renal tissue and organs of the urinary system.

Also, the use of a catheter is necessary for the introduction of drugs directly into the cavity of the bladder: the catheter, overcoming the urethra, reaches the cavity of the bladder. In a flexible tube, previously attached to the catheter, enter drug preparation(more often - an antibiotic or a disinfectant solution) to flush the organ, gradually eliminating the inflammation of its tissue.

A long-term catheter (silicone) is installed for a period not longer than 5 days. If the patient's condition still does not allow him to urinate on his own, the catheter is replaced (to avoid the development of the inflammatory process).

Algorithm for catheterization

When performing the procedure, it is important to observe the sterility regime in the office. Therefore, the staff works in masks and disposable gloves. There is a certain algorithm for bladder catheterization. It is necessary to perform all actions only after the psychological preparation of the patient, an explanation of the features and order of the stages, as well as the sensations that he will note during the procedure.

1. The patient is invited to the dressing room, where he is placed on a table located here with a pre-layed diaper and oilcloth.
2. Having removed his underwear and remaining only in a special operating shirt (or disposable), the man is laid on his back, with his legs bent and spread apart. By this time, the nurse is already preparing all the necessary tools and supplies.
3. Before inserting the catheter, the doctor carefully treats the patient's genitals with an antiseptic solution, using wipes and tweezers for this. This step is necessary to eliminate pathogens from the surface of the mucous membrane of the penis, so that together with the catheter they do not move into the bladder, causing inflammation.
4. Then the doctor lubricates the surface of the instrument with glycerin (to ensure glide) and carefully inserts the catheter so as not to damage the internal structures. The urethra of men has a special structure, and the doctor, using the instrument, has to overcome two physiological bends. If force is applied at this stage, injury cannot be avoided. Therefore, the doctor performs the procedure very carefully. The success of the intervention is determined by the appearance of urine in the catheter.
5. If the main goal is to release urine, a pre-prepared tray is substituted and filled until the bladder is completely empty. To make sure that the organ is completely empty, the doctor presses on the suprapubic region.
6. If the purpose of the procedure is to administer a drug, then the staff uses a syringe and a rubber catheter. The drug is injected into the bladder through the tube, then the lumen of the adapter is closed with a clamp so that the injected medicine does not flow back.

Properly performed manipulation gives the patient mild discomfort, which is due only to being inside the urethra foreign object. In no case should there be pain, cramps or burning due to the installation of a catheter!

Possible Complications

Potential complications that can occur during catheterization of the bladder in men are associated with non-compliance with the rules of asepsis and antisepsis, as well as inept handling of the catheter.

1. Cystitis, pyelonephritis, urethritis - the inflammatory process may be preceded by insufficient hygiene of the penis before the catheter is inserted.
2. Damage to the internal structures of the penis, urethra, bladder.

Also, complications arise in cases where the preliminary diagnosis was made incorrectly or the rigid catheter was inserted incorrectly.

Inflammation of the urinary tract (urethra) is a contraindication to bladder catheterization.

Contraindications

Bladder catheterization should not be performed if the patient has:

• acute urethritis (including gonorrheal type);
• damage to the structures of the urethra or suspicion of such;
• if the sphincter (physiological valve) is contracted.

At the end of the procedure, the patient is transferred to the ward, and a sample of the urine taken is sent to the laboratory.

See also: Bougienage of the urethra in men - indications, procedure

menquestions.ru

catheter into the bladder

A urinary catheter is a device that is often inserted when urological diseases, problems with the urinary system and after surgery. To drain the organ, several tubes are installed in the bladder, through the urethra, through which urine will be excreted. Catheters help restore urination in ureter dysfunction and make life easier for the patient.

Types and sizes

The catheter in the bladder can differ not only in the main material, but also in the type of device and location in the body. Bladder catheterization for both men and women is carried out taking into account the channels and characteristics of the organs where the device is placed. The tube size is also selected taking into account individual features(for women the ideal length is 14 cm, for men over 25 cm)

The urinary catheter may differ in the material of manufacture:

• made of special rubber;
• latex and silicone;
• solid (the main material is plastic).

The device for urination also differs in terms of the period of stay in the ureter:

• constant. This type of urine catheter can be placed for a long time;
• disposable. The staging takes place in emergency situations(in case of trauma to the urinary organs or infection).

The delivered catheter in the bladder in men and women differs in the type of insertion and location. The internal urinary device is completely located inside the organ, and the external one is only partially. Also, catheters through which urine is excreted are divided into single-channel, two-channel and three-channel.

Whether it hurts to put a catheter in the bladder and how long you have to walk with it depends on what pathology the patient has encountered. fixtures various types they cost differently, you also need to take care of them in a certain way, it is not recommended to take ideas from the ceiling without consulting a doctor.

Most popular types

The device for catheterization of the bladder may also differ depending on what function it will perform. The price of the device also varies from this factor and from the material used. If the catheters are made of poor quality material, the patient may develop an allergy or rejection.

The most common types of catheters are:

1. Foley. Refers to permanent, includes one blind end and two holes. A Foley catheter can be used to flush out an organ and to remove urine and accumulated blood from it.
2. Nelaton. It has a smaller diameter than the previous version, is more elastic and has a rounded end. The placement of this type of catheter to remove urine is only temporary.
3. Timanna. The introduction of a catheter and after removing the catheter into the bladder is used only for pathologies of the prostate gland.
4. Pizzeria. Made of rubber, has 3 holes and a bowl-shaped tip. The bladder catheterization technique with a soft catheter is used to drain the kidneys when they are dysfunctional.
5. Poisson. Installation is carried out using a metal probe. This staging technique is rarely used for the treatment genitourinary system.

Each of these products has its strengths and weak sides. If catheterization of the bladder in women and men is carried out for a short time, best option- Nelaton's device, it is quite easy to put and remove. But if the urethral product is placed for a long time, and the patient must be removed not only urine, but also the decay products of medicines, the Foley catheter will be optimal.

If the patient is unable to independently excrete urine, it is recommended to install a Pizzera product for excretion.

How is the installation

How to place an indwelling urinary catheter?

• the physician will need to prepare everything necessary in advance. To do this, take: a syringe with a blunt tip, painkillers, napkins, gauze, cotton wool, a container for collecting urine, an antiseptic;
• all instruments must be disinfected, otherwise, not only will it not be possible to achieve a restorative effect, but it may also be harmful to health.

But in any case, whichever installation technique is used, patients report that the procedure is very painful. After the urine is taken by the device, the patient needs to use painkillers to help relieve the sensations.

Bladder catheterization with a metal or soft catheter in the stronger sex is much more difficult. If the patient does not relax during the installation of the bladder product, the procedure will take a longer time, while the patient will suffer from severe pain. The device is placed very slowly, if the installation is correct, urine will immediately begin to flow into the container, which means that it will be successfully catheterized.

It is much easier to catheterize the bladder with a soft catheter in women, the introduction is carried out lying on the back, it is impossible to lie on the stomach. If the doctor follows the algorithm of actions, the patient will not experience severe pain, and complications will not arise either.

How to care for your indwelling catheter

Care urinary catheter is not difficult, the main rule is that the patient must constantly keep it clean.

It is also necessary to comply following rules:

1. If the organ is catheterized, after each emptying it is necessary to wash the genitals.
2. Male and female catheters should be washed daily with soap. Such procedures remove germs and bacteria, which contributes to a speedy recovery.
3. Catheterized patients should also be monitored for tube changes. Replacement should be carried out once a week, and the product must also be moved periodically.
4. To prevent the occurrence of urinary diseases, the patient is required to administer antiseptic drugs (prescribed by a doctor).

If you properly care for the catheter, the patient will be able to avoid possible complications. The main thing is to make sure that the urine is stable (if it does not go crooked, but even, without delay, then the device is working correctly).

If the device is not installed correctly, it may begin to clog, in which case the doctors will remove it. If the catheter fails to completely remove the urine, there will be no positive effect, and health will also not be restored.

Possible Complications

In order for urine excretion to recover, the doctor must strictly follow the installation algorithm, but the patient must also adhere to the recommendations for care.

If you do not follow these rules, you may encounter the following complications:

1. The introduction of infections.
2. The occurrence of inflammatory processes (pulling out the catheter will be very problematic and painful).
3. Fistula formation.
4. heavy bleeding.
5. Accidental pulling (especially the risk increases if an unsuitable device was taken for installation).

The catheterization process is quite complicated and painful and should only be carried out by an experienced doctor. It is also not recommended to purchase the device yourself. If a patient bought the wrong catheter, it may simply not fit. anatomical features and doctors will not put it.

pochki2.ru

Bladder catheterization algorithm

There are many conditions that require bladder catheterization. These include stroke, heart attack, inflammatory processes urinary system. Such a therapeutic method can save a person's life, as well as eliminate discomfort. With some diseases, it hurts very much. It is important to healing method carried out by a specialist. We must not forget that this method of excreting urine has contraindications.

Bladder catheterization is a necessary procedure for organ pathology, with the need to remove urine through a tube.

Indications and contraindications

Bladder catheterization is the removal of urine through a catheter.

Due to the fact that this technique is used quite often among patients with diseases of the genitourinary system, the following indications for catheterization can be distinguished:

• the inability to remove urine on their own (with urinary retention) and pain during urination;
• the need to take fluid for analysis directly from the bladder;
• the need to inject fluid into the bladder;
• damage to the urinary tract.

All indications and goals of catheterization are individual and depend on the patient's diagnosis. They are mandatory for people in a coma or comatose who cannot urinate on their own. As for contraindications, among them: inflammation of the urethra, gonorrhea, bladder injury. Before the procedure, the patient must inform the doctor about changes in his condition. The first time should always be done by a medical professional, after careful instruction, a person can try to perform the operation himself under the supervision of a doctor. Only after several such attempts, the patient can try to make catheterization on his own. If the least pain occurs, you should immediately consult a doctor.

Bladder catheterization is carried out once, periodically or on an ongoing basis. Back to the table of contents

Types of catheterization

There are several options for the procedure. They depend on the purpose, diagnosis and the ability of a person to move independently. The technique includes several types of catheterization:

• one-time;
• intermittent (periodic);
• constant.

Catheterization in women. Catheterization is the insertion of a catheter into the bladder. For it, catheters of multiple use (made of rubber and metal) and single use (made of polymeric materials) with different lumen diameters can be used. Metal catheters are inserted only by a doctor.
Target. Emptying the bladder; introduction medicinal substances into the bladder.
Indications for bladder catheterization in women. Acute and chronic urinary retention; obtaining urine for research on the special prescription of a doctor; local treatment bladder diseases.
Contraindications. bladder injury; acute inflammation of the bladder or urethra.
Equipment. Sterile soft catheter - 2 pcs. different diameters, cotton balls - 2 pcs., gauze napkins - 2 pcs., glycerin, Janet syringe, tray, diaper; container for urine (if urine is taken for testing for sterility, then the collection utensils are received in bacteriological laboratory(sterile)); furatsilina solution 1:5 000 - 700 - I 500 ml; 0.5% alcohol solution chlorhexidine; rubber gloves (sterile); washing set; water bath for heating furatsilina; a container marked "For catheters" with a 3% solution of chloramine.

Bladder catheterization in women, implementation algorithm.

1. Treat hands with 0.5% chlorhexidine solution, prepare a sterile tray. Sterile catheters are taken out of the bix and placed on the tray.
The rounded end of the catheter is poured with sterile glycerin. Two sterile cotton balls are moistened with a solution of furacilin, placed on a tray. Also put two sterile wipes and tweezers on the tray. 100 - 150 ml of furacilin solution heated in a water bath to 37 - 38 ° C are drawn into Janet's syringe, put it on a tray.
2. The patient is washed away, the vessel is removed.
3. Between the patient's legs divorced and bent at the knees, a clean, dry vessel or other container for urine is placed.
4. Put on gloves.
5. Standing to the right of the patient, put an unfolded sterile gauze napkin on her pubis. The fingers of the left hand spread the labia and a cotton ball, taken with the right hand with tweezers and moistened with furatsilin, treat the external opening of the urethra. Then, using tweezers, taking it like a writing pen, take the catheter at a distance of 4-5 cm from its blunt end, and support the free end between the IV and V fingers. The blunt end of the catheter is slowly introduced into the urethra to a depth of 4-5 cm with rotational movements, and the free end is lowered into the urine container. Urine output indicates that the catheter is in the bladder.
6. After the cessation of urine output, the catheter is connected to a Janet syringe filled with furatsilin, heated in a water bath to +38 ° C.
7. Slowly inject the solution into the bladder, and then, pointing the catheter into the vessel, remove it from the bladder.
8. Repeat washing until the washing liquid is clear.
9. Having finished washing, carefully remove the catheter from the urethra with rotational movements.
10. Once again, the external opening of the urethra is treated with a ball moistened with a solution of furacilin, and the remaining moisture is removed from the perineum with a napkin.
11. Immediately after use, the catheter is soaked in a 3% solution of chloramine for 1 hour, then treated according to OST 42-21-2-85.

Notes. The nurse has the right to perform catheterization only with a soft catheter and only as directed by a doctor. When carrying out catheterization of the bladder, complications are possible: infection in the bladder; damage to the mucous membrane of the urethra and bladder; urethral fever.

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 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:

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

Important: about the appearance pain during the manipulation, you must immediately tell 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:

1. The nurse stands to the right of the patient.
2. Treats the glans penis with an antiseptic solution, paying special attention to the external opening of the urethra.
3. Takes the catheter with tweezers and inserts the end of the rubber tube pre-lubricated with glycerin or paraffin oil into urethra while holding the penis with the left hand.
4. 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.
5. If during the manipulation a spasm of the urethra occurs, its execution is suspended until the urethra relaxes.
6. 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:

1. The doctor stands to the right of the patient.
2. Treats the head and opening of the urethra with an antiseptic solution.
3. The left hand holds the penis in a vertical position.
4. Inserts the catheter with the right hand so that its shaft is kept strictly horizontal position, and the beak was pointing straight down.
5. Carefully moving the tube with his right hand, as if pulling the penis on it until the beak is completely hidden in the urethra.
6. 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.
7. Moves the catheter to a vertical position.
8. Lightly presses index finger left hand on the tip of the tube through the lower surface of the penis.
9. After successfully passing the physiological constriction, the catheter is deflected towards the perineum.
10. 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.

Bladder catheterization is a necessary medical intervention carried out for therapeutic or diagnostic purposes for certain diseases of the genitourinary system. It is necessary to understand specifically what are the indications for bladder catheterization, the types and methods of its implementation, the process of removing the catheter.

In some diseases of the genitourinary system (prostate adenoma, oncological processes, various pathologies kidneys) there are serious difficulties with the excretion of urine from the patient's body.

Bladder catheterization is a medical procedure in which a special hollow device is inserted into the cavity of the urethra to force urine to drain. This manipulation requires certain knowledge and skills from the doctor performing it. The procedure can be performed on a planned or emergency basis.

The goals of bladder catheterization are:

• medical;
• diagnostic;
• hygienic.

The diagnostic orientation of the use of a catheter allows you to accurately determine the root cause of any genitourinary pathology. Sterile urine, directly taken from the indicated organ, is considered the most reliable material for conducting a certain kind of analysis. This technique allows you to perform diagnostic measures with the introduction of a contrast agent into the bladder.

Hygienic catheterization allows for proper care of critically ill patients who cannot empty their bladder on their own.

AT medicinal purposes to eliminate stagnation of urine, these manipulations are carried out in the following cases:

• for emergency forced excretion of urine when the process of urination is delayed for more than 12 hours, which occurs due to various diseases genitourinary system;
• in rehabilitation period postoperative intervention on the urinary organs;
• with various pathologies of the innervation of the bladder (disturbances of the urinary functions).

Timely and competent conduct of catheterization will allow the patient to avoid deterioration in health, and sometimes death.

Classification of catheters

The use of a catheter for bladder catheterization involves the installation of a curved or straight hollow tube with holes at the ends into the urethra.

Such conductors may be intended for short-term or long-term use. When performing surgery on the organs of the urinary system, disposable short-term catheters are often used. In chronic urinary retention, the installation of this long-acting device connected to the urinal is required.

Depending on the material of manufacture medical practice probes are used:

• hard;
• elastic.

Rigid structures are made of non-ferrous alloys, are very traumatic and are used only in severe cases of drainage. Metal constructions due to physiological characteristics have different configurations for men and women. Their installation is carried out only by an experienced specialist.

Elastic catheters are more comfortable to install and use. They can be made of modern silicone, flexible plastic, special soft rubber.

Drainage devices can be:

• urethral (internal);
• suprapubic (external).

Each of these types of catheters has its pros and cons. The suprapubic conductor exits through the abdominal wall, bypassing the urethra. It is easier to install, less traumatic, more affordable quality care. A person remains sexually active, which is important for long-term use of a catheter.

The urethral type device can easily damage the walls of the bladder, neck during installation. When the device fails, the leaking urine infects the patient's genitals, causing severe inflammation.

According to the design features, they distinguish the following types catheters:

• Nelaton (Robinson) disposable device;
• Tiemann stent;
• the Foley system (which some erroneously call Faley);
• Pezzer's device.

Each of these drainages should be considered in detail.

Common types of drains

The Nelaton (Robinson) device is presented in the form of a soft tube of small diameter with a rounded end and is distinguished by a simple mechanism of action. Used for rapid catheterization of the bladder in men and women during surgery or diagnostic urine sampling.

In some diseases of the genitourinary system with a complicated course, a rigid Tiemann stent with an elastic curved tip is used, with which it is possible to reach the bladder through the damaged and inflamed walls of the urethra.

In medical practice, it is most convenient to use a Foley catheter designed for long-term installation. It is a multifunctional 2-way or 3-way device, consisting of a flexible tube with several holes, a special reservoir, with which the system is held inside the body. A catheter of this type can be used to administer drugs, flush the bladder from pus and blood, and release blood clots.

Less common Pezzera catheters are used only for cystostomy drainage, most often for kidney failure. Such systems are a flexible tube with 2-3 functional holes that extends to the outside.

All of these types of drainage have a different diameter. The specialist, depending on the appointments in each case, will select a catheter for the patient on an individual basis.

Drainage scheme in women

Indications and contraindications for the use of bladder catheters

When appointed medical procedure when installing a catheter, the doctor must take into account the indications and contraindications for its implementation. Common indications for bladder drainage are:

• any emergency conditions associated with forced diversion of urine due to a violation of the natural process of urination (bladder paresis, adenocarcinoma, prostate adenoma, etc.);
• diagnostic measures when to staging correct diagnosis and appointments effective treatment it is necessary to take a portion of bladder urine;
• specific diseases of the urethra and bladder, requiring introduction into their cavity medicines, washing from pus and blood.

Contraindications to bladder catheterization should be considered:

• infections urinary tract(acute and chronic urethritis);
• injuries of the urethral canal and bladder;
• spasm of the urethra;
• lack of urine in the bladder (anuria).

Signs of contraindications to bladder catheterization may occur suddenly, during the illiterate conduct of this procedure due to trauma to the urinary tract.

Preparing to install a drain

In order for the catheterization of the bladder to pass without complications, it is necessary to carefully prepare for it. Necessary conditions the procedure is:

• attentive attitude to the patient;
• observance of sterility;
• perfect technique of bladder catheterization;
• high-quality materials for the manufacture of the catheter.

Before manipulation, the patient should be washed from front to back, so as not to bring intestinal flora into the urethral canal. To do this, you can use a weak solution of any antiseptic (Furacilin).

All catheterization equipment must be sterile

Bladder catheterization set includes:

• soft or hard catheter;
• container for collecting urine;
• anesthetic (Lidocaine);
• glycerin or vaseline oil to facilitate the installation of a drainage device;
• a set of consumables (cotton balls, napkins, diapers);
• tools (syringe for drug installations, tweezers, etc.).

In order to provide the most convenient access to the insertion site of the probe, the patient lies on his back, bends his knees and moves them slightly to the sides. For the successful completion of the medical actions the patient should be in a relaxed and pain-free state, and the doctor and nurse should have the necessary experience.

It is worth noting that the male algorithm for carrying out this procedure is the same as the female one. But due to some physiological features of the body structure, catheterization of the bladder in men is much more difficult.

Catheter Insertion Technique

The complexity of the installation of a cystic catheter in men is that their urethral canal is much longer than in women, and has some physiological narrowing. In most cases, a soft catheter is used for this procedure. The technique for performing this procedure requires certain skills and abilities of the doctor and nurse. After the preparatory measures, the invasion of the bladder includes the following main stages:

• the surface of the patient's penis is treated with an antiseptic, the head is especially carefully smeared with a cotton swab and anesthetized;
• a sterile lubricant is instilled into the opening of the urethra to facilitate the manipulations;
• the inserted device is lubricated with glycerin or petroleum jelly;
• elastic drainage is inserted by a doctor with tweezers into the external urethral canal;
• the catheter is gradually brought to the man far deep into the urethra, slightly turning the device around its axis;
• the patient is considered fully catheterized when urine appears in the drainage tube.

Further actions are performed depending on the doctor's prescriptions, in accordance with the technique of bladder catheterization in men. After emptying the urinary organ, it is washed with an antiseptic agent, attaching a special syringe to the catheter. Often, the tube of the installed device with a urinal is permanently fixed during long-term wear and recommendations for care are given.

Carrying out catheterization of the bladder with a metal catheter is carried out similarly, apart from some tricks of the passage of physiologically difficult areas.

Nelaton female catheters

Features of bladder drainage

The female urethra has a short and wide structure, thereby greatly facilitating the installation of the catheter. The stages of bladder catheterization in women include:

• high-quality preparation for the procedure with sterile processing of instruments and surfaces of the genital organs;
• the introduction of an elastic catheter is made with tweezers into the external opening of the urethra to a depth of 5–6 cm;
• the appearance of urine in the device will indicate the achievement of the goal.

After carrying out this procedure, in order to avoid infection, all necessary hygiene rules must be observed. When the catheter is worn for a long time, its outer end is connected to the urinal, which is securely fixed on the thigh.

But it is not always effective to conduct catheterization of the bladder with a soft catheter in women. In some rare cases, metal drainage is used.

Special attention is required for the catheterization of the child. Assign such a procedure when absolutely necessary due to the difficulty of its implementation and high risk complications. Sizes of catheters for a child are selected according to age. Only soft elastic drainage devices are used.

The immune system in children is underdeveloped, so the risk is very high infectious inflammation. Compliance with sterility when performing this invasion of the bladder is one of the main conditions for its success.

Complications during catheterization

The risk of complications during catheterization of the bladder, with its inept performance, is quite high. The procedure is always performed without general anesthesia in order to timely notice the occurrence of pain in the patient. You can list common Negative consequences that appeared during the installation of the drainage device. These include:

• damage or perforation of the urethra;
• infection urinary organs in women and men (cystitis, urethritis, paraphimosis, pyelonephritis, etc.);
• infection circulatory system through damage to the urethra;
• various bleeding, fistulas, etc.

When using a catheter of a larger diameter than prescribed, the female may suffer from dilation of the urethra.

With the constant wearing of the drainage device, it is necessary to strictly follow all the recommendations of the attending physician regarding its operation. Bladder catheterization in women and men must be accompanied by careful hygiene of the perineum and catheter, otherwise serious complications may occur. If you find urine leaks, the appearance of blood in the urinal, with discomfort in the genitourinary organs, you should immediately contact a specialist.

The catheter is removed according to the doctor's instructions. Typically, this kind of manipulation is carried out in medical institution, sometimes can be performed at home. Properly performed catheterization of the human urinary system will help in the treatment of many infectious and noncommunicable diseases and significantly improve their quality of life.